What stops Coloradans from getting the mental health care they need? You can learn a lot by asking them.
That's one of the things we've been doing over the past 18 months, as part of a statewide listening tour.
A new report from the Colorado Health Institute confirms what we've heard.
The report shows that more Coloradans than ever have health insurance. But an estimated 380,000 Coloradans, including 51,500 in El Paso County, still go without mental health care - figures that have barely budged over the last four years.
The single biggest barrier: cost. More than half of those who say they need but do not receive mental health care cite the cost of treatment.
A woman in Fort Collins told us that she and her husband were dedicating their retirement savings to their daughter's mental health care.
The new report does show real gains when it comes to insurance. Four years ago, a lack of coverage stopped roughly 100,000 Coloradans from getting mental health services. Only one-third as many cite that barrier today.
Unfortunately, coverage does not guarantee care. Nearly half of those who need mental health care say they don't believe their insurance will cover it.
Are they right? That depends.
For the time being, federal law makes mental health care an essential benefit under most insurance plans. The law also requires insurers to provide equal coverage for mental and physical care.
But passing a law and enforcing it are two different tasks. We're working with the Colorado Division of Insurance to strengthen the enforcement of mental health parity. And we're urging our delegation in Congress to preserve mental health and substance use services as essential benefits.
Finding mental health professionals who will take insurance can be particularly challenging. Providers regularly tell us that reimbursement rates are too low and that joining an insurance network is too difficult.
The result: wait times that stretch far beyond the seven days state rules allow. The problem is especially pronounced in rural Colorado, where mental health professionals are few and far between.
More than one-third of Coloradans who go without mental health care say they had trouble getting an appointment.
A young woman in Colorado Springs told us the only way she could be sure to get care was to wave a gun in the air. But when she no longer posed a threat to herself or to anyone else, she said, she would be on her own.
Unlike that woman, thousands of Coloradans are unwilling or unable to acknowledge their mental illness. More than one-third of those who lack mental health care say they don't feel comfortable talking with a health professional about their "personal problems" or are concerned about what would happen if someone found out. Those figures are even higher among Coloradans with substance use disorders.
My family learned what can happen when a mental illness goes undetected. My cousin died by suicide two-and-a-half years ago. She suffered, we now recognize, from a severe depression-an illness she couldn't share and we couldn't see.
More than 1 million Coloradans experience a mental health or substance use disorder each year. Statistics do little justice to the lives they lead, the challenges they face, or the value we should all place in their recovery.
How do we make it possible for every Coloradan to receive high-quality care? By bringing down the cost of treatment, improving the recruitment and retention of mental health professionals, educating consumers and protecting their rights - by treating mental health and substance use services as essential benefits not simply on paper but in practice.
Andrew Romanoff served as the speaker of the Colorado House of Representatives. He is now the president and CEO of Mental Health Colorado (mentalhealthcolorado.org), the state's leading advocate for the prevention and treatment of mental health and substance use disorders.