Dec. 14 marks nine years since Jane Dougherty told her sister hello and goodbye, but for a disturbed young man's access to guns in Newtown, Connecticut, a New England village that was decked out for a Christmas, that was emotionally obliterating.
Her older sister, Mary Sherlach, a school psychologist, was in the principal's office that morning, mediating between the principal Dawn Hochsprung and the mother of a second-grader.
When gunfire rang out, the pair ran to the danger facing their students, and it cost them their lives, among the six faculty who died with 20 first-graders, a national tragedy that joined the long list of mass shootings since Columbine in Jefferson County 22 years ago last April.
Another spate of shootings shook metro Denver in the last two weeks, wounding more than a dozen, many of them children, not that far from a movie theater where 12 were killed and 70 wounded when a college-aged gunman with deep emotional issues fired on a midnight movie crew, five months before Sandy Hook.
And just a few days ago, a shooting at a high school in Michigan killed four students and wounded seven others, including a teacher.
Colorado Springs high school cancels classes Monday amid social media threats
Mental health advocates are careful to emphasize that most individuals who grapple with mental health do not perpetuate violence on themselves or on others, although it remains a significant risk factor for suicide. Often, they add, individuals with mental health challenges are the victims of gun violence. But they also note that the lack of resources - well-funded intervention programs, for one - is exacerbating the mental health crisis.
The woes, they say, are particularly acute when it comes to behavioral health services for youth and children, and some wonder if society's inadequate response at multiple levels, along with easy access to weapons, has led to the violent mix erupting in the homes and streets of Colorado and elsewhere in the country.
In the nine years since 20 first-graders and six faculty died in Newtown, and the 22 since 15 died at Columbine High School in Jefferson, the American psyche has been challenged by what many acknowledge is a cultural awareness of guns, violence and constitutional rights.
Dougherty, a Littleton seamstress turned anti-gun activist, has seen the toll first-hand.
She keeps a presence at the Colorado Capitol to press for tougher gun laws, though mental health funding and proposals are barely on well-meaning legislators’ agenda. Every anniversary of Sandy Hook, the emotional struggle gets a little easier, but the pain always stings, she said in an interview.
“Every time there was a mass shooting, I call them lost days,” Dougherty told Colorado Politics as another anniversary approached. “I just get physically ill.”
Inadequate response
Colorado's policymakers have responded with some tax dollars and compassionate programs.
This month, Gov. Jared Polis presented budget requests to the legislature that would represent the state's largest investment of his first term, including $32 million to expand residential treatment capacity for youth with behavioral health issues, along with $10 million to hire about 100 staff to expand capacity at the Colorado Mental Health Institute.
The Democratic governor also proposes making $36 million in “community” investments for odds and ends around public safety, such as improved lighting, expanded local mental health resources and school grants for mental health interventions.
The budget requests follows letters in September from, respectively, 21 of the state’s 22 district attorneys and county human services directors saying the state does a poor job providing beds for children, a bedrock resource the state fails to adequately supply.
All the while, at least two generations now have grown up enmeshed in reports of people dying in public places because of guns. At the same time, American kids are called to take sides in adults' bitter national debate over constitutional and self-defense in a time of racial and political unrest.
What's unequivocal, advocates say, is the toll of gun violence on kids' mental health.
“When children hear about shootings in their city, that adds to the ... trauma,” Jenna Glover, a child psychologist and director of psychology training at Children’s Hospital Colorado, told Colorado Politics. Bullying and financial instability, she said, add to that, increasing a child’s risk for developing mental health problems.
"The cumulative effect adds up," she said.
How do you get the kids not to shoot?
Despite Colorado’s leading position in the national discussion on gun violence, the state has produced a patchwork of underfunded solutions that have so far failed to stop kids from shooting each other. Dealing with the violent aftermath isn't getting what it needs, either, despite hundreds of millions of dollars for hotlines, school outreach and new state, federal and local programs each year.
Moe Keller, a former state senator who is now president of Mental Health Colorado, sees gun violence and mental health issues as interwoven.
“Tackle it community by community, whether it’s gun violence or mental health issues," Keller said. "They’re all interrelated and intertwined. Every time a kid hears a gun shot, that’s trauma,” she said. “How do you get the kids not to shoot? It has to be family, church, public health, neighbors, everybody. They have to plan [solutions] and own it.”
Yet such concerns land at a time of intense political polarization and concerns about rising crime, and children are products of their times.
Many see guns at the center of it all.
“The gun violence is just going through the roof,” said Eileen McCarron, a co-founder and president of gun-law advocacy group Ceasefire Colorado, which formed in 2000 in the wake of the Columbine shooting.
State statistics show that, at the end of October, Colorado had reported 7,576 violent crimes involving firearms. For all of 2020, the total reached 7,848. In 2011, Colorado law enforcement agencies reported about half - 3,508 violent crimes that involved guns.
The FBI data put the 2020 violent crime rate at a 25-year high.
The causes are elusive and subject, but Aurora Deputy Chief of Police Darin Parker tried to come up with some theories, including gangs, in an interview Monday night with FOX31’s Joshua Short.
“There’s an incredible amount of guns out on the street," he said, "more so than I think I’ve ever seen in my career."
Research released this month found gun violence disproportionately affects young people living in low-income counties. The risk of dying from firearms rises as the concentration of poverty in communities increases.
A report in the medical journal JAMA Pediatrics found the rate of gun-related deaths is more than four times higher for young people in counties with the highest concentrated poverty than those in the lowest concentration of poverty.
The journal called youth firearm-related deaths a public health crisis in the U.S.
Senseless violence, death and crushing grief are familiar to Colorado, where the Columbine High massacre in 1999 made school shootings a national catchphrase and where answers remain elusive and mental health becomes the usual landing spot.
“Well, the gun people, the pro-gun folks, at the Capitol and everywhere will say it's all mental health. It's all mental health because they don't want any gun bills to pass,” McCarron said.
The common denominator in every shooting, McCarron insisted, is a gun.
“We have a normalization of gun culture that’s not a hunting culture,” McCarron said. “It’s a culture about attacking other humans.”
Influence of access
Ari Freilich, the state policy director for the Giffords Law Center to Prevent Gun Violence, traces gun violence to a series of policy choices that made weapons readily accessible to most members of the public.
That easy access, he said, led to America's young growing up with the chronic exposure to or fear of gun violence.
That violence, in turn, disproportionately affects young men and boys of color, he said.
In many cases, it turns into a cycle of violence.
Freilich said communities have the opportunity to break that cycle of violence with smart policies and significant investments in intervention programs.
Such programs are geared toward promoting trauma recovery, and, when necessary, taking people out of circumstances that placed them in violent situations to begin with, he said.
Freilich noted the majority of shooting victims survive, which means they go back to the same community.
“Unsurprisingly, the person who is shot is likely to be grappling with untreated trauma and significant insecurity,” he said, adding the victim is also more likely to engage in retaliatory violence and vigilante justice, particularly when law enforcement fails to apprehend the suspect.
Cities, he said, have moved toward investing in such programs, such as by pairing the victims with counselors right in the hospital and connecting them with peer support groups that can help with social, behavioral health and job training services.
Freilich said the Colorado legislature has, over the years, approved important legislation that seek to address gun violence, such as restrictions on ammunition magazine capacity, storage requirements and a law allowing local jurisdictions to enact stricter gun laws than the state's.
“There's room to grow,” he said.
Finding answers
The ties between violence and mental health are not clearly defined, and those who seek gun restrictions and advocates of people struggling with depression, anxiety or delusions have had an uneasy time partnering up at the Colorado Capitol.
Keller has no trouble seeing where some of the problems are coming from: social media.
“There’s no question parents are facing huge problems in raising their children in society today that we didn’t have,” she told Colorado Politics. “Social media is a big one. It’s been very detrimental to kids. I know it can do good things, too, but we’ve seen a large spike in children who feel bullied on social media, stressed because of social media, get depressed because of it.”
It’s only gotten worse under COVID, she said. The pandemic shut down the social structure for most children, keeping them out of church, school, sports or other organizations, such as band practice or scouting, she said.
That isolation, in turn, compounds the influence of social media, Keller said.
She noted that Mental Health America, of which Mental Health Colorado is a member, offers anonymous screenings for 10 different situations, including anxiety, depression and psychosis.
Keller said there’s been a spike in the number of people accessing the screenings for depression, up by more than 600% during the pandemic, and by 500% for anxiety.
The biggest demographic group accessing those screenings? Young people ages 14 to 20.
“COVID and isolation and social media work against parents who are trying hard to have a stable, nurturing environment for kids. I feel bad for kids today. They have stressors we never had,” Keller said.
Keller appreciates the efforts of the General Assembly to come up with additional funding or loosen the rules to help families, but the real solution, she says, is for action at the local level.
That will take the efforts of a mayor, the chamber of commerce, churches, civic groups, public health department, law enforcement and local school district, she explained.
It also will take parents and kids being engaged, she said.
“You want to get the kids to come and sit down and talk about what they will do in their neighborhoods to make it safer and to diminish the problems they’re facing,” she said.
Keller says that with federal dollars from the American Rescue Plan Act available to counties for the first time, now is the time to act and plan.
For a community such as Aurora, Keller suggests, it might be useful to break the city into regions or neighborhoods, instead of pursuing a city-wide solution.
Money isn’t necessarily the answer, she said, adding it’s more about ownership of the problem and the solutions.
The gap
It’s not like Polis and the Democratically controlled General Assembly haven’t noticed.
Perhaps the most explosive political times at the Colorado Capitol came in 2013, after the Aurora theater shooting and Sandy Hook the year before. Universal background checks and a 15-round limit on ammunition clips nearly cost Gov. John Hickenlooper a second term in 2014. It did cost three Democratic state senators their seats: two who were recalled and a third who resigned rather than face a recall.
As a result, however, Hickenlooper and the General Assembly created the Colorado Crisis Services, a free, anonymous 24-hour service that connects people struggling with professional help aimed to avert the next school shooter or theater massacre.
On Oct. 27, the Department of Human Services, the Office of Behavioral Health and private partners launched the $9 million I Matter program to provide up to three free counseling sessions a year for Coloradans ages 18 and younger, or 21 and younger for those receiving special education services.
"One of the things I love about this bill is it really brings together the parents with the students with mental health professionals, all working to ensure our kids the mental health care they are asking for," said Republican Rep. Kevin Van Winkle of Highlands Ranch at an April hearing on House Bill 1258, the bipartisan legislation that created the program.
The question is whether COVID and other stressors are outpacing the state’s ability to deal with the challenge.
In 2018, the General Assembly passed an indefinite extension to the Child Mental Health Treatment Act (CMYTA) of 1999. That law allows families with private insurance access to community, residential and transitional mental health services without requiring families to turn over custody to the state or county. The qualifier is that a child must be under 18, diagnosed with a mental health disorder and be at risk of out-of-home placements. Private insurance doesn’t usually cover the cost of residential mental health services. The options were heartbreaking: either go without, pay for it out of pocket, or turn the child over to county custody so they can go on Medicaid and get the services they need.
Zach Zaslow, director of government affairs at Children’s Hospital Colorado, said parents would give up custody to get their child mental health care, “which you would never do for a child with leukemia.” For children at risk of out-of-home placements, the CMYTA dollars would help keep families together, he said.
The 2018 bill provided $1.1 million to pay for services to 99 children in just 20 counties and through a network of 17 services providers.
The program’s funding increased to $1.5 million in 2020 and served 40 children and youth in residential facilities. Another $1.4 million assisted 183 children and youth in community-based services.
A 2020 report from the CMYTA program, however, noted that some Community Mental Health Centers withdrew from the program, citing requirements of the 2018 law that they could not manage, such as pass-through billing and intensive clinical care coordination with multiple providers. Those withdrawals created a “critical gap” in the state, the report said.
To fill in that gap, the program relied on administrative service organizations — akin to a “middleman” — to contract with health care providers, beginning in July 2020.
That’s just one piece of the mental health system that is poorly resourced and understaffed, advocates say.
One-time funding for a surge in need
Colorado received $3.8 billion from the federal American Rescue Plan Act of 2021. During the 2021 session, lawmakers passed a law to set up a bank account of sorts that would direct $550 million of that toward behavioral health. The plan is to enact into law during the 2022 session the recommendations from a behavioral health task force on how to spend those dollars. Children's Hospital and other advocates for youth mental health have already asked that $150 million of that go directly to children's mental health.
The one-time dollars expected to assist with kids' mental health crises will address a surge in cases related to COVID, Zaslow told Colorado Politics.
“We need a surge in funding to work with this current cohort of kids. At the same, time we were in crisis prior to COVID” and those needs won’t evaporate once those federal funds are spent, he said.
“Our hope from those federal funds is a surge in investment related to the current surge in need. The state can then refine and improve on what’s working and continue those programs with other sources of funding. These are systems that have been under-resourced for decades,” he said, adding advocates, patients and their families are grateful for the federal funds.
But it’s also about policy, and not just funding, Zaslow said.
Colorado needs to build a system that is cohesive and coherent, especially for kids with complex needs and who are often involved in multiple systems with programs that don’t work well together, he said.
One bright spot in the system, according to Zaslow, is the creation of a behavioral health administration, which received bipartisan support from lawmakers and which the governor approved during the 2021 session.
Zaslow believes that new agency, which for now is under the state Department of Human Services, will start to unify the 70-plus “siloed” programs that Zaslow calls a “labyrinth” for families to navigate. The new department also will coordinate with Medicaid, which Zaslow said is the largest provider of mental health services for kids.
Support for kids
Glover, the child psychologist at Children's, said children have different mental health needs than adults.
“It’s incredibly important that we treat kids differently,” she said, emphasizing that kids developmentally are different — their needs and support systems change as they get older.
Glover said that requires a family-centric approach that includes services to children, as well as parents.
Many children with acute mental health needs interact with different systems, such as foster care or juvenile justice. Glover said some of these kids get lost in the system because there’s no central way of communicating between those services. They also may end up in residential facilities without the support they need, she said.
Or, she noted, facilities just aren’t available.
Zaslow said there’s no question that kids are falling through the cracks.
“It’s a patchwork system, not one unified cohesive approach for families," he said, adding the services available often depend on one's place of residence, job or insurance.
Advocates say a critical gap is that at any given time, about 70 kids are placed in out of state residential treatment facilities because there’s nothing available in Colorado.
It’s a stable number, Zaslow said, but “it means that’s a lot of kids we aren’t serving in their home communities.”
In order to deal with the crisis in youth mental health, Zaslow pointed to several emergency funding pots provided by the governor and the General Assembly, including $5 million through SB 21-137 for an emergency program to fund high-acuity, 24/7 observation residential beds and staffing. This would serve kids with very complex needs who would otherwise be stuck in hospitals or emergency rooms.
“We’re thankful the governor and legislature understand the problem of extended-stay patients who are boarding at hospitals,” he said, adding the situation has gotten worse during the pandemic.
While the beds already exist, they aren’t yet staffed.
The governor also set aside $12 million for additional residential beds, at a time when the supply is at its lowest and the needs have never been higher, Zaslow said, adding, “It’s a meaningful step in the right direction.”
Another side of the equation is services provided through community-based mental health centers, and advocates say more are needed, especially in rural parts of the state.
Competing public needs
Federal and state laws require parity between mental health and physical health services, but it’s not being enforced, advocates say.
If a doctor is unsure about a diagnosis and treatment for a physical medical condition, additional testing would be covered. But it doesn’t work that way in mental health services, and that leads to kids not getting the full support they need, or not at all, advocates say.
Glover said a patient may have ADHD or a learning disability and needs further psychological testing to come up with a treatment plan, but insurance companies won’t pay for it.
It’s something lawmakers ought to look at, Glover said, adding the viability of large mental health systems is shaky without parity.
Advocates identified several other gaps.
Notably, trainees in mental health have difficulties getting reimbursed for services, and it’s hard to have training without insurance, they say.
“Parity should be examined and improved in our state,” Glover said.
Zaslow echoed the sentiment and added that federal government needs to do a better job of enforcing or strengthening existing parity laws.
The gap in mental health services also shows up at schools. Amie Baca-Oehlert, a school counselor and president of the Colorado Education Association, knows first-hand the challenges teachers and other school personnel face.
She said mental health supports for students are inadequate, counselors have caseloads that are way too large, and, oftentimes, school psychologists and counselors are pulled to do testing or other activities with students.
“There’s a need to invest in mental health supports,” not just for student but for teachers, too, Baca-Oehlert said, adding schools are not equipped to be the sole provider of mental health services for students.
She noted that teachers’ plates are too full, and they aren’t trained on the mental health supports those students need.
There may be some programs in individual schools that deal with mental health and gun violence, but on a broad scale, they don’t exist, she added, calling it yet another burden on understaffed and under-resourced schools, which are being asked to take on those services without funding.
While there has been recent legislation to address mental health, it’s a Band-Aid rather than a comprehensive approach to dealing with the issue, she said.
“We applaud the efforts but at the same time, you can’t put a Band-Aid on a gushing wound and expect it to heal. Same thing with mental health,” she said. “We have a significant need, and we need to come together as a community to prioritize and invest.”
Colorado for Rittenhouse
Dudley Brown, president of the Rocky Mountain Gun Owners, said too much is being made about protecting the minds of young people when it comes to guns.
“I like to point out that if it weren't for 17-year-olds with guns, we'd probably still be under the English crown in this country. Every war has been fought with young folks. I'm not somebody who looks at a 17-year-old who will use the firearm to defend himself as somehow odd or a rule breaker. I always rejected that,” he said.
Brown’s prominent gun advocacy group raised about $76,000 for the mother of Kyle Rittenhouse, the teenager who was acquitted of shooting three people and killing two with an AR-15 rifle during a night of race-fueled protest in Kenosha, Wisconsin, last year.
Rittenhouse told the court he had enrolled in online nursing classes at Arizona State University, where liberal students already have protested his virtual presence there.
Through Rittenhouse’s mother, Brown offered Rittenhouse a job in Colorado
“Life changed for him,” Brown said. “It will be difficult for him to go out and frankly do anything nowadays on a normal job.”
Like McCarron, Brown doesn’t think the government can fairly determine who is entitled to his or her constitutional rights, and added that creating mental health standards is another backdoor to banning legal weapons possession.
Aftermath continues
As to the link between gun violence and mental health, advocates like Glover say there are two important points to consider.
First, people with mental health issues are more likely to be victims of gun violence rather than the ones committing it, although Glover also noted a recent study that shows the majority of mass shooters have mental health problems.
Second, gun violence has a huge effect on kids’ mental health. Glover said major trauma - she calls it big "T" - occurs when a child is directly exposed to gun violence, such as at a school shooting or something that occurs near home. But there’s also trauma - little "t" - that affects kids and leads to both a sense of helplessness and hopelessness, she said.
Dougherty said all schools “desperately” need more psychologists and counselors like her sister, the counselor at Sandy Hook.
“She used to always say help is needed to get to little kids when they had little problems, before they become big kids and have big problems,” Dougherty recalled.
The consequences are left to the families of crime victims who weather grim anniversaries every year, she said, adding random things, such as a dream or discovered photo, reopens the feeling of senseless loss.
“We just kind of drag it around with us and you have to put one foot in front of the other as the years go by,” Dougherty said. “I realize, you know, she'll be 56 forever. My nieces lost their mother. She has two granddaughters she would have adored that she never got to meet. That never leaves you.”