Full disclosure: My brother-in-law works for Mind Springs.
Pitkin County Commissioner Greg Poschman had been waiting for this moment for almost two years. It marked the first time Poschman, a lifelong resident of the Roaring Fork Valley, had laid eyes on the newly completed West Springs Psychiatric Hospital in Grand Junction, which had opened its doors for business only weeks prior.
Poschman had scheduled a tour of the facility with Kim Boe, executive vice-president for West Springs, and Roger Sheffield, vice-president of development. Poschman was clearly excited. He had been working pretty much since he was elected to the Pitkin Board of County Commissioners in 2016 to help raise funds for West Springs.
It might seem a bit strange that a member of the Pitkin BOCC was so involved in helping to raise money for a psychiatric hospital located 122 miles from Basalt. Not only are there good reasons for Poschman’s interest, but those reasons are enthusiastically shared by mental-health professionals and law-enforcement personnel from one end of the Roaring Fork Valley to the next.
First, some orientation.
Mind Springs Health and West Springs Hospital are separate entities operating under Mind Springs Inc. Mind Springs Health is the outpatient division, while the hospital provides inpatient services. Mind Springs Health is the largest provider of mental health and addiction treatment on Colorado’s Western Slope, offering a full continuum of care from 24/7/365 mobile crisis response to therapies and services for all ages and diagnoses.
In fiscal year 2018, West Springs Hospital admitted 1,280 patients. The previous year, that number was 1,096.
In 2018, Mind Springs assisted 2,531 clients between its two Garfield County offices and 846 clients in Pitkin County.
Next, it is inaccurate to call West Springs Hospital “new.” It is more accurately a substantially expanded, redesigned and upgraded psychiatric hospital that replaces its antiquated predecessor, which Boe does not describe in the most flattering terms.
“The old facility, which opened in 2005, had two cramped buildings covering about 16,000 square feet with two separate 16-bed buildings,” she says. “There was limited space for visitation or privacy. It was dark and awkwardly designed and was surrounded by a tall safety fence. There were no private baths. There was no kitchen. Staff had very limited space and no bathroom or breakroom.”
Boe says the process to expand and upgrade West Springs began five years ago, “when we saw that need started to outpace bed availability. People were forced to wait to get lifesaving treatment they needed and we found that unconscionable.”
A fundraising effort began in earnest. And we’re not talking small potatoes here. According to Sheffield, the expansion project cost $34 million. Of that, about half was financed. The other half came from philanthropic gifts from a wide array of sources.
This is where Poschman comes in.
“Shortly after I came on board the BOCC, West Springs made a presentation to us, asking for funding for their capital campaign to finish the hospital,” he says. “I learned that our valley depended on the hospital for care for a significant number of people over the years, and I was confused by the financial gap between what the county [government] granted them — $50,000 — and what they required [at that time] to finish the hospital — $4 million. I decided to visit the hospital, took a tour, met Kim Boe and some staff, and came away with a sense of urgency to help them get the hospital completed. I thought that if any community in Colorado can pitch in to get this hospital finished, it should be this one.”
Poschman went to work helping to raise that remaining $4 million.
“I had photographed my visit to the hospital and, after my visit, I posted about their situation on Facebook and how I was committed to helping them get it built,” he says. “I asked everyone to help, however they could. Several local people saw my social media post and contacted me with everything from offers of small grants, to moral support and suggestions on how to get it done and who to contact. One friend in particular, Laurel Catto, suggested that we create and announce a challenge grant to the benefit of Mind Springs Health — West Springs’ parent — with John and Laurel Catto’s family Alpenglow Foundation as the first donor in.
“Having that challenge grant to start with helped us convince people of the import of the task, and that we were serious about getting it done,” Poschman continues. “We received commitments from people in the Roaring Fork Valley, Eagle Valley and all the way to Grand Junction to donate matching funds to Mind Springs, ranging from $250 to $10,000, then $20,000 up to $200,000, then $1 million grants. It was mind-blowing.”
The Alpenglow Foundation, a fourth-generation family foundation that is a successor to the Catto Charitable Foundation, has been active in Roaring Fork Valley philanthropy for decades.
According to Basalt resident Laurel Catto, one of Alpenglow’s five directors, “The foundation's mission is ‘To improve the quality of life of everyone in our community.’ Our community is primarily the Roaring Fork Valley, and also includes the Canyonlands Utah area, and the Bluegrass region of central Kentucky.”
You may notice that nowhere in that statement are found the words “Grand Junction.”
Which begs an obvious question: Why all this interest from the Roaring Fork Valley in a psychiatric facility way over near the Utah border?
That answer is easy: West Springs is — shockingly — the only inpatient psychiatric hospital between Denver and Salt Lake City. It is the only place where local mental-health professionals and law-enforcement personnel can take people in crisis for inpatient treatment. (According to Boe, the average length of stay for a West Springs patient is seven days. The longest was 150 days.)
“The West Springs project is beyond our normal geographic area,” Catto says. “But we are convinced that our valley has a compelling need for the additional inpatient mental health beds and will directly benefit from it.”
And, before the recent expansion, West Springs was fairly bursting at the seams.
Catto says her foundation was a latecomer to the West Springs’ capital campaign, becoming involved in late 2017, after West Springs had raised about $13 million of the $17 million needed to fund the project. The balance of the $34 million total construction cost, she says, is bank-financed at a low-interest rate, to be repaid from the hospital’s operating income, which comes from a variety of sources including government contracts, Medicaid, Medicare, private insurance, self-payers and donors.
“The West Springs expansion addresses a severe shortage of inpatient mental health beds serving Western Colorado,” Catto says. “Before the expansion, there were only six beds per 100,000 population, an 80-plus-percent shortage versus the national average of 35 beds [per 100,000 population]. West Springs has the only licensed mental health hospital beds between Denver and Salt Lake City at a time when the West Slope is ravaged by exceptionally high addiction and suicide rates. It’s so bad — especially among adolescents — we’re becoming known as the ‘suicide belt.’ We all have friends and neighbors that have been personally and tragically touched by this epidemic.
“It was clear to us from the start that our valley would hugely benefit from the expansion, and that it is more cost-efficient to concentrate these highly specialized services in one first-rate facility than spread one or two licensed beds among several local hospitals,” Catto continues. “It was equally clear that our valley had yet to ante up our share of the cost.”
Catto joined Poschman to work with West Springs to structure a “closer’s campaign” to raise the last $4 million needed to complete Phase I funding.
“We set out to build a consortium of large donors — mainly other family foundations interested in joining forces with Alpenglow — to create a pool of $2 million to match, dollar for dollar, the final $2 million needed,” Catto says. “We hoped a collective challenge gift would appeal to first-time West Springs donors, allowing them to double their money and see the project cross the finish line. Alpenglow pledged $500,000 toward the $2 million challenge pool.
“We began by developing impact-focused messaging directed to large donors, and we got an early boost at a gathering in Vail that Greg and I spoke to, raising $200,000 on the spot from an East Coast family foundation with ties to the Vail Valley,” she continues. “Greg then made a number of personal appeals, with great success. His efforts rightly earning Colorado Volunteer of the Year honors. The $2 million matching funds pool was raised in mid-2018 and the $2 million challenge was completed in December, finishing off the campaign.”
According to Sheffield, there were many other donors, including “individuals throughout Colorado and another nine states, various family foundations, community foundations including Aspen Community Foundation and Western Colorado Community Foundation, health care and other philanthropic foundations, community hospitals including Aspen Valley Hospital, Valley View Hospitals, Vail Health, St. Mary’s Hospital, Community Hospital and Montrose Hospital, county governments including Pitkin, Garfield and Eagle, and businesses and corporations.”
The result: a shiny, 63,000-square-foot hospital with 48 beds in the new facility and 16 beds in the older facility, for a total of 64 beds — which doubled the previous occupancy of 32 beds. There are separate adult and juvenile wings.
The majority of West Springs’ patients come to the facility on involuntary, 72-hour commitments. It is therefore a secure institution, but it more resembles a suburban high school than a prison.
There is a gym. There are outside courtyards and rec areas accessible to patients and visible from numerous inside locations. There are nooks and crannies where patients can find solitude. It is modular in its design, in that patient rooms can be modified to meet group and individual needs. There is a cafeteria, conference rooms and places where patients can visit with family, friends and counselors. Interiors are decorated with paintings of natural scenes. Interior colors are designed to be relaxing.
It is, in short, dignified.
Given its mission, there are some padded rooms. The doors and fixtures are ligature proof. The clank of doors being unlocked and then locked again forms something of an unavoidable institutional soundtrack. But West Springs does not come across like a place where patients are being punished for the sin of experiencing mental-health crises.
Much of the design input, according to Boe, came from a surprising source.
“Patients had a say in the design of all spaces relevant to them, including dayrooms and group rooms,” Boe says. “They suggested the private reading nooks in each unit and the outdoor planters to garden in. They requested separate exercise space, separate quiet space, lots of natural light and a safe outdoor space. All requests were met in the new design.
“Staff requested some space of their own, where they could take a legitimate ‘break,’ so a breakroom and locker room were both added,” she continues. “Staff entry includes a ‘one-stop’ approach prior to entering the patient areas — their communication badge, keys and timeclock are all located near the locker room directly inside their entrance.”
All told, West Springs employs 150 people, making it a major employer in Grand Junction.
And make no mistake, its geographic remove notwithstanding, West Springs serves the Roaring Fork Valley in a big way.
“In fiscal year 2018, West Springs Hospital served 13 patients from Pitkin, for a total of 128 bed days, with 15 percent being children/adolescents,” says Nan Sundeen, director of human services for Pitkin County. “The year before, 14 patients were served for a total of 138 bed days, with 100 percent being adults.”
Pitkin County Manager Jon Peacock, who used to serve as county manager for Mesa County, where Grand Junction sits, adds, “We have a number of residents every year in need of residential mental health services, and West Springs Hospital is an important component of our continuum of care. In the absence of this facility, those people either end up in a facility far from home and the support networks that are so important for long-term health, or in a facility that can’t provide the care they need, such as the jail or emergency room in the hospital. The facility was deemed important enough for Pitkin County to both contribute capital monies and ongoing operating support for operation of the facility.”
“As a county commissioner, Greg [Poschman] was hearing desperate reports from our first responders and local hospitals forced to warehouse critically ill people — by definition people who are a danger to themselves and others — until a West Springs bed freed up,” Catto says. “It’s downright medieval to strap a critically ill patient to an emergency room bed, or lock them in a jail cell, with no one on hand to properly care for them.”
“There are times for people in our valley — like everywhere else — when a mental health crisis is so severe that the individual must be taken to a safe place where they cannot harm themselves or others,” Poschman says. “Our emergency room at the hospital is often the first place they go, but ERs are not really intended for anything but short-term care of mental health patients. The Pitkin County Jail is the other place where people in mental health crisis can end up, and although the jailers do their best, all they can really do is lock them up, dispense medication as prescribed and wait for a more appropriate place to send the patient. Both the hospital and the jail will benefit greatly from having a new hospital with more capacity and a staff who can provide actual therapy to stabilize and hopefully improve the condition of the patient. Having this hospital only 100 miles away helps keep families and the patient’s community closer, so they can participate in the therapy and recovery.”
Few people are happier to see an expanded psychiatric hospital within driving distance of the Roaring Fork Valley than Pitkin County Sheriff Joe DiSalvo, whose jail has often served as the facility of last resort for people experiencing mental health crises.
“A lot of these people end up in jail, when they really need to be placed in a psychiatric hospital,” DiSalvo says. “I’m not sure what percentage of our inmates are suffering from acute mental health issues, because some are faking it, but I can say that we always have at least one inmate, and usually more, who are experiencing mental health issues, some of which are very severe. Where else are they supposed to go? Our jailers are not trained mental health experts. Neither are our deputies. I am pleased the West Springs has expanded.”
Adds Basalt Police Chief Greg Knott, “The West Springs facility is in closer proximity to people residing in the Roaring Fork Valley. Prior to the opening of their new facility, individuals needing care would be taken to the Front Range. The West Springs facility is much closer to our valley and allows patients to work more closely with local mental health providers. Having a facility closer to our valley will reduce transport times and allow people to stay in closer contact with local family members. This ‘local’ facility will also allow clinicians to stay in closer contact with clients to provide additional follow-up care.”
Poschman could not be happier.
Admittance procedures for West Springs Hospital
Given that it serves a wide array of patients suffering from a wide array — and degree — of mental-health issues, West Springs psychiatric hospital adheres to a stringent and institutionalized set of admittance procedures. Here we ask Executive Vice President Kim Boe to answer a few admittance-related questions.
RFWJ: If a person is in the Pitkin County Jail for, say, disorderly conduct or resisting arrest and, in the mind of the jail staff, is displaying clear indications of mental illness, you would consider admitting that person so long as you were confident he/she did not put your facility/patients at risk?
Boe: We would consider admitting, provided we are able to determine that the resisting arrest behaviors or disorderly conduct behaviors would not put our other patients at risk or disrupt the milieu. We also would need an understanding of disposition upon completion of hospitalization –—back to jail, or …
RFWJ: Could you go through your admittance protocol? How you determine if you are going to admit someone and what happens once you have decided to admit someone?
Boe: We receive a referral from an agency, which includes jails. We gather the clinical information from them that should support a psychiatric hospital admission. We present that clinical information to the psychiatric provider at WSH who makes the decision that the clinical information indicates hospital admission is appropriate, or determines the information does NOT support hospitalization. If it is clear hospital admission is appropriate, the admission team alerts the referral source that the individual referred is “accepted” for admission and transportation is discussed and determined. The admission team also alerts the referral source if a referred individual is determined NOT to require hospitalization. We make sure we have a bed.
RFWJ: Does any of the admittance process occur before a potential patient is brought to the facility?
Boe: The coordination with the referral source takes place prior to the patient being brought to the facility.
RFWJ: Once you have decided to admit someone, what’s the orientation process (or whatever you call it)?
Boe: Upon arrival, the remaining admission work is completed — mostly paperwork. The individual’s belongings are inventoried and stored for them. The patient is escorted to the adult unit or adolescent/child unit, introduced to staff and the other patients and oriented to the unit activities, what to expect, etc.
RFWJ: How do you decide when it’s time to release a patient?
Boe: The team working directly with the patient meets daily to discuss patient progress toward discharge. The decision to discharge the patient is made by the team, but ultimately by their treating psychiatric provider, either psychiatrist or psychiatric nurse practitioner.
RFWJ: Where do released patients typically go and what typically happens after that? (Follow-up of some sort?)
Boe: All patients leave with an aftercare plan in place to include follow-up appointments with the appropriate care providers. Dates, times and addresses of those providers are included on their aftercare plan. Discharging patients go to their home, family members, friends, back to their placement, etc.…
RFWJ: Most of your patients are there mandatorily, correct?
Boe: The majority of our patients come to us on an involuntary, 72-hour commitment, but we do have patients who come to us voluntarily.
RFWJ: You have had incidents with patients, yes? What happens if a patient, say, acts out violently?
Boe: Our facility has space set aside to help us deal with patients who act out violently. Additionally, our provider team can offer and provide medication to assist violent patients