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The Continuum of Care Is An Important Part Of The Mental Healthcare System. But What Is it Exactly?

The Celebrating Healthy Communities office.

Over the last year, the pandemic has certainly highlighted the importance of reliable healthcare coverage. That’s why we’re working with reporter Sydney Melson to cover healthcare for KSJD News. Sydney also works with Celebrating Healthy Communities, an organization that works in substance abuse and suicide prevention in Southwest Colorado. Through her work there, she’s become familiar with the mental healthcare system firsthand. She says, one essential piece of the mental healthcare system that often gets overlooked is called the continuum of care.

Sydney Melson: The continuum of care can sound obscure, at first. Essentially, it’s a term for strategies on tackling behavioral health. And most of the time, the continuum of care is something we see, hear about or do without thinking about it. Like Alcoholics Anonymous or a training in suicide prevention. Even a billboard encouraging you not to drink and drive is an example of the continuum of care. Breeah Kinsella is the executive director of Celebrating Healthy Communities, a nonprofit that works in the prevention of substance and alcohol use, as well as suicide. 

Breeah Kinsella: if you were to see the continuum of care in front of your face, it looks a little bit like a rainbow broken up into little slices of pie that provide us a visual of the types of services. 

Melson: In other words, each piece of the pie represents a stage in the continuum of care. It starts with promotion, and includes things such as Celebrating Healthy Communities’ Ride Responsible. That program works to promote safer alternatives to driving under the influence, including paying for public transportation during events with lots of drinking, 

Kinsella: Those are all promotional pieces of prevention work. What those do is try to give the community members some information about the problem behaviors that we're seeing in the region, whether it's impaired driving or suicide or substance use. 

Melson: The next stage in the continuum of care is prevention. Prevention is what it sounds like: strategies aimed at a target audience to reduce the risk of a behavioral health problem. There are three subcategories of prevention: Universal, selective and indicated. 

Kinsella: Universal is any big group of people. So it's Mancos or it's the Southwest region of Colorado. Or it's Durango Schools.  The next stage is “selective.” And those are people from that larger group who have been selected because potentially they run a risk of having that problem behavior.

Melson: For example, Kinsella says in the Southwest region, working class men aged 30 to 65 are at the highest risk of suicide, so any services provided for that range of men is considered selective. The last stage in the prevention portion of the continuum of care is called “indicated.” This stage is for people who have participated in problem behaviors before.  

Kinsella: So if we're talking about youth substance use, it might be a student who has had some issues with substance use or has shown that they might start having issues with substance use. And so organizations provide services to those students directly instead of a larger classroom or a larger school. 

Melson: The middle part of the continuum of care, which is known as “treatment,”  has two subsections: identification and treatment. Kinsella says people using treatment services are deeply involved with a problem behavior, such as addiction. The last section of the continuum of care is recovery services, which includes groups such as Young People In Recovery, Alcoholics Anonymous or Narcotics Anonymous. Long-term support programs can be essential to a person’s recovery. 

Kinsella: It also goes into post-vention. Post-vention is not a word that many people are familiar with, but post-vention is the thing that happens after recovery to make sure a person doesn't go back to the very beginning, doesn't go back to use.

Melson: Kinsella says post-vention is especially important in cases of attempted suicide, or even when people die by suicide in the community. She recalled a sharp spike in youth suicides in 2017 and 2018. Over time, she says, Southwest Colorado has gotten better at understanding the continuum of care because of it.    

Kinsella: One of the primary concerns that we heard from community members when we got people together was that they didn't understand what was being done in the community to stop this. They didn't understand what we could do. Or that we could do anything.

Melson: The best way to solve those problems, she says, is to turn to behavioral health experts who will use the continuum of care. But the experts still need the community every step of the way to provide custom tailored services within the community’s means. 

Kinsella: If you want more programs for your kids or you want a different kind of messaging or you saw the sticker and it made you want to be a part of this cool movement for suicide prevention when you're invited, show up. Because we don't want you to be the public health expert. We don't want you to be the social worker. We want you to be you. 

Melson: In the spirit of Celebrating Healthy Communities, Kinsella always looks to the bright side.

Kinsella: I know that in Durango, you can use your food stamps at the farmers market, and they'll even double them up for you. And that is because of the hard work that people on this continuum of care have done. The farmers love it and the community loves it and it feeds our families and it makes us connected.

Melson: Kinsella notes Southwest Colorado has the fortune of being close-knit, which helps protect its people from behavioral health problems. For KSJD News, I’m Sydney Melson.

Health and prevention reporting on KSJD is made possible by Southwest Health System, The Montezuma County Health Department, and Celebrating Healthy Communities.