May 02, 2012 News » Cover Story

Pointe of pride 

What if the best treatment a doctor can provide is a job? A local nonprofit shows what it means to go the extra mile for patients

First came drugs and alcohol.

Addiction gripped 15-year-old Jennifer Given like a vise, but that was just part of what would rule her life for nearly two decades. The rest of her misfortune came knocking a year later, when she met the man she'd be with for the next 17 years, the father of her child — and her tormentor.

"I'd say I was beat probably once every two weeks," says Given, now 42. "...Everything fueled it. The drugs fueled it, the alcohol fueled it, the abuse fueled it, the unfaithfulness fueled it. So it was pretty much a horror show for 17 years. Pretty much.

"So how it finally ended up was, after all those years of abuse and domestic violence charges, finally he went to jail for eight months. And it was during those eight months that I thought, 'I can't do this anymore.'"

But the problems didn't end there. When he left, the drugs, alcohol and unhealthy relationships continued. Finally, Given reached a breakdown.

It was 2004. Given's mom, who until then had paid her daughter's bills and turned a blind eye to her problems, stopped by. Given then sliced a 9-inch gash up her arm and fell to the floor in a pool of blood, with her mother standing over her, aghast.

The scar is still there — big and angry, clearly visible just below the three-quarter-length sleeve of Given's floral cardigan. But it's difficult to imagine her all those years ago. Her long, reddish hair falls down her back. Her smile is kind and maternal, even as she uses the enthused, fast-paced speech usually reserved for teenagers.

And yet, Given says, the scar is as big as it is because she wouldn't sit still to have it sewn up in the emergency room. She swung herself around furiously until they gave up and glued it shut. Then it was off to the Lighthouse, an inpatient care center run by what was then called Pikes Peak Mental Health Center.

"The first two or three days I was extremely belligerent and angry and, 'Why am I here, there's no way that you guys can help me and you just don't understand,'" Given remembers. "By the fourth day I got to a place where enough people had talked to me that I thought, 'Maybe they do get it, and they really can help me.'"

A few days later, she was released and sent directly to the group's outpatient care center, where she'd start years of therapy and treatment. As it turned out, Given had yet another problem — borderline personality disorder, one of the most serious mental illnesses, and particularly destructive if left untreated.

In addition to therapy, Given took classes and began unlearning all the behaviors of those horrible years. In May 2008, she began volunteering for the organization that had helped her so much. Six months later, she was hired as a peer specialist to help others navigate the same hell she'd endured.

She remembers her new boss telling her, "We know you still have issues. We know you're going to still have some days that aren't great. But my expectations of you are the same as for any other staff member."

To Given, that was a good thing. "I need to be held accountable for my actions," she says. "I need to be held accountable for my responsibilities."

At the organization now known as AspenPointe, Given has undergone a radical transformation. And she's shared it with an audience whose ear she probably never believed she'd have during those years of abuse and addiction: a room full of congressmen and women in Washington, D.C.

Given had flown there in 2009 with top executives (who were advocating for more funding) to share her personal saga, and the story of the nonprofit that had finally been able to put the pieces of her life together.

One-stop shop

When an arm breaks, you wear a cast.

Minds, however, aren't so simple to fix. A drug might work. Therapy might work. A major lifestyle change might work.

Far more likely, however, is that it'll take all three.

This truth has radically transformed AspenPointe. Over the past couple decades, as its name has changed from Pikes Peak Mental Health Center to Pikes Peak Behavioral Health Group to AspenPointe, the organization has gone from a traditional center that treats mental illness to a provider of a "continuum of care" that earned $48.6 million in revenues in the 2010-11 fiscal year.

Structurally, AspenPointe is no longer a single entity; instead, it's an umbrella organization that houses three nonprofits, including a separate business nonprofit known as a social enterprise.

That portion, AspenPointe Enterprises, runs a series of commercial endeavors: furniture assembly, cooking schools and cafes, GED courses, art classes for injured veterans, custodial and maintenance services, peer advocacy services like the one Given works for. In AspenPointe Enterprises' last fiscal year, it served 3,288 people, graduated 1,300 people from programs (including GED testing), and placed 155 people in jobs. In the same time, the businesses generated $6.45 million in total revenues (just $176,506 of which were grant funds).

The mission is simple: Train those with mental illness and others with disadvantages to work in an industry. Then employ them, or help them find jobs elsewhere. The businesses — or social enterprises — aren't there to make money, though they do. They're there to further AspenPointe's mission of healing the mind.

Why jobs? Well, AspenPointe COO Kelly Phillips-Henry explains, jobs provide routine to people living with mental illness, and that allows them to get back to normal.

Unfortunately, it can be tough for people with mental difficulties to find and keep jobs, because they may act erratically, not show up for a few days, or say something they shouldn't.

"I think folks get scared by severe mental illness and/or folks with traumatic brain injury, because they act different," Phillips-Henry says. "But what we know is, when folks go into treatment and they actually get care, that helping them get into either a volunteer opportunity or a job ... keeps folks so much more structured during the day that they tend to do much better managing their mental health conditions."

Since its beginnings in 1991, AspenPointe Enterprises has grown to include nine businesses. And in the last decade, it's branched out to help not only those with mental illness, but also people with disabilities, the homeless, at-risk youth, seniors and military members and veterans.

The basic tenets, however, have remained the same: Give people a hand up, create jobs, and increase understanding.

Core mission

For people with mental illness to succeed on the job, you have to manage a lot of variables, says Jennifer DeGroff, AspenPointe's director of adult and rural services.

"Is the person on a certain medication where they can't be awake before 10 o'clock?" she asks. "Are there certain noises or stimuli that they can't be around? We [clinicians] can help with that component. And then [the enterprises] can say, 'These are the types of jobs,' and we as a team together are looking at the jobs, as opposed to just a vocational or just a mental health approach."

AspenPointe can tailor a job specifically to a person's needs and abilities, then monitor him or her. And at AspenPointe Enterprises, there's leeway to see what will work; a blowout won't automatically lead to a pink slip. These businesses can act as testing grounds.

That said, Jonathan Liebert, vice president of enterprises, says AspenPointe Enterprises wants its businesses to feel very similar to any other businesses. Thus, only about 50 percent of enterprise employees have a disability or mental illness; supervisors are experts in their field, not mental health professionals; and there's real work to be done, real profits to be won or lost. Though AspenPointe Enterprises was originally conceived as way for AspenPointe to "hire our own people," as Liebert puts it, "We figured out really quickly we can't hire them all."

So, since 2001, AspenPointe Enterprises has been creating and expanding programs that train people to be good employees for any company, anywhere. The YMCA of the Pikes Peak Region, for instance, recently contracted with AspenPointe Enterprises for custodial services in four centers. The organization was comfortable with the professionalism of the work, and excited that some veterans would be given jobs through the contract.

"It's not about, 'Give us a handout or do us a favor,'" says Stacey Burns, AspenPointe's director of career and development services. "It's about, 'You're getting a well-trained, well-groomed employee, and another whole set of staff behind them.' But we're going to make sure they're a good fit for a job."

Robert Fetsch, extension specialist and professor in human development and family studies at Colorado State University in Fort Collins, says models like AspenPointe's are sorely needed. Unemployment in Colorado sits at 7.8 percent, and Fetsch points out that just as mental illness can lead to unemployment, widespread unemployment can lead to greater rates of mental illness.

"I would think with all the stresses and strains we've had over the past several years since the Great Recession, that the cognitive and the physical strains on people have been higher," he says. "There's some evidence of that, in terms of, if you look at the suicide rates here in Colorado and Texas and other places, our suicide rates are going up."

In 2009, Colorado's suicide rate outpaced the national average of about 12 deaths per 100,000 people, with more than 18 deaths per 100,000. Fetsch also notes that an estimated 1 in 5 Americans at any one time have clinical depression.

Ordinary job programs may not be effective for those with mental illness. At Pikes Peak Workforce Center, Michelle Graham, business and community initiatives director, says the center has many programs to help people find work, but will occasionally offer a scholarship to a client to attend AspenPointe Enterprises' programs. The center can help with a lot of problems, she says, but not dealing with mental illness.

"At the end of the day," she says, "I'm just really glad AspenPointe exists."

Learning a new way

In 2009, Sally McDermitt had just lost her mother and inherited the caretaking role for her schizophrenic brother. It would have been hard to blame her for lashing out a little at an annoying co-worker. But she did more than snap at him. She screamed at him, and hit him with the door of her vehicle.

That's when she called her doctor. "I said, 'There's got to be something you can do! I'm on the verge of killing myself for no reason.'"

McDermitt, 55, believes the majority of her family likely had or has a mental illness. Her life growing up was chaotic, and as a young woman, she soon discovered she had bipolar disorder.

"I would take the little tests out of the magazine that say, 'Maybe you need to talk your doctor about Prozac if you answered yes to eight or nine of these questions,'" she remembers. "If you answered 10 and are putting some more down on there..."

She laughs heartily. McDermitt has smiling eyes that suit her tinge of a Texas accent, and it would be easy to mistake her as carefree. But in reality, it's been a hard life. Left untreated, bipolar disorder leads to rapid mood swings and unpredictable, destructive behavior. She's fit that bill many times.

The mother of four has been married to the same man for decades, but until recently, they rarely talked. He lived in the basement and she upstairs. At times, she recalls, he used to leave her on the side of the road when she'd launch into hurtful tirades while they were driving. They've separated more than once.

At work, McDermitt tended to jump from one job to the next.

Things seemed to be getting worse in 2009, when her doctor referred her to AspenPointe. She expected the usual patch-up: counseling and better prescriptions. But after coaxing from AspenPointe's employees, she decided to start taking classes at the clinic. AspenPointe course subjects range from leadership skills to appropriate attitudes, and they hooked McDermitt.

She discovered that not only was mental illness affecting her life, but so was a whole set of bad behaviors learned in her childhood.

"I would spend pretty much all day here," she remembers. "And I'd go home and feel empty. Because I still didn't know how to act at home with family, because of the bad behaviors I'd learned before. I was learning how to undo them, how to get good behaviors, but it takes time."

Something else was missing: McDermitt was unemployed, her last job having been temporary. AspenPointe Enterprises hired her as a custodian last fall. At first, McDermitt had to work with supervision, and she wasn't sure how much or what kind of work she could handle. Sometimes she'd get upset and call her boss, crying and screaming.

"Ten years ago I'd either walk out on a job or I'd get fired right there," McDermitt says. "Three times [at past jobs] a manager just walked up to me, told me to get out now. I didn't even have to wait for my paycheck; they had it waiting for me before I hit the door."

But at AspenPointe, they helped her illness, behavior issues and work problems concurrently. All the channels were connected.

Things began changing. Her husband took her out to dinner for the first time in 30 years. Her work began to fall into rhythms. Recently, she began cleaning a building alone on a regular shift.

"If anything goes wrong, I'm responsible," she says, with obvious pride. "And if everything goes right, I'm the one who gets a pat on the back."

Branching out

At AspenPointe Enterprises' main south-side office on Ruskin Drive, clients' artwork decorates the wall.

One is a close-up interpretation of the stars in Van Gogh's "Starry Night." The swirls of light contain the names of famous people through the ages who struggled with mental illness. Another, done by a recovering young vandal, shows intricate, blue, graffiti-style tags forming the words "Community" and "Repair relationships."

Clients-turned-workers constructed cubicles and furniture throughout the building. The floors are shined by cleaning crews made up of people like McDermitt; walls were painted by maintenance workers, many of whom once needed maintenance themselves. In a downstairs room, four walls are covered with framed GED certificates, each with the smiling face of a graduate, most young, some middle-aged.

The Career and Development Services office in this building teaches job and interviewing skills. Education Services offers GED testing, tutoring, and career education programs. Creative Expressions is an art therapy program. The Peer Navigator program pairs military members about to re-enter the civilian world with experienced veterans. Youth Directions helps troubled young people through restorative justice programs and life and career skills development.

The programs are funded through earned revenues, fees, contracts, insurance payments and, to a lesser degree, grants. Since some programs can be expensive, AspenPointe Enterprises looks for ways to give scholarships for pay programs whenever possible.

And AspenPointe, on the whole, asserts that it helps people regardless of their ability to pay. But not everyone in the mental health community sees the organization in such a light.

Detractors say AspenPointe has strayed too far from its original mission of helping the poor in the community access mental health. They say it's grown too large and rich, that it overpays its executives, and that the underinsured and uninsured aren't likely to be able to access its services.

That said, none of these people were willing to go on the record for this story. They claim AspenPointe's considerable power over the administrative boards of organizations and grant distribution make it too formidable an enemy.

A few things, however, can be independently confirmed.

First, AspenPointe is certainly large, with main and partner offices and enterprise business locations stretching out over 18 locations. Of its $48.6 million in revenues last fiscal year, 48.8 percent was "sub capitated premium revenue" (a type of ongoing, per-member, per-month fee from insurance companies); 21.1 percent was from the state and federal government; 9.18 percent was from local government contracts; 8.2 percent was from net client and third-party payments; and the rest came from other sources.

Another point on finances: AspenPointe has taken flak for recent money decisions. In 2009, for instance, it shut down its 20-bed detox facility, despite the center having been built with some public funds just 10 years before. El Paso County, which had chipped $1.3 million into the original effort, ended up taking over the program and building a second center with more public funds.

While AspenPointe officials claimed at the time that detox was simply too expensive to keep going, the organization announced that same year that it would spend up to $100,000 to rename and rebrand itself. (At the time, it was still known as Pikes Peak Behavioral Health Group.)

Executive pay, too, could be considered high. According to public tax documents, Morris Roth, CEO of AspenPointe, made $761,980 plus $71,675 in benefits in the 2009-10 fiscal year. Eleven other administrators listed on the tax documents made between $129,975 and $298,079, plus benefits.

As for the most inflammatory claim — that underprivileged patients can't easily get care — Phillips-Henry says via e-mail that AspenPointe tries to serve everyone. The organization accepts most major insurances, most notably Medicaid, and works to get people accepted even if their insurance company isn't initially inclined to pay.

The state government, she writes, provides funding to cover 879 uninsured AspenPointe patients annually, but with about 30,000 uninsured people in El Paso County, it's not nearly enough. Worse, she says, the state dictates how those funds are spent, divvying them up between age groups, which means less flexibility.

Despite the challenges, Phillips-Henry writes, "Over the past 6 years, we have provided services to 3,000-4,000 uninsured clients. This past year, we served even more — reaching 5059 uninsured clients in the El Paso, Teller and Park Counties."

In the future, she says, national and state legislative changes are expected to fill out the insurance rolls and increase the number of people AspenPointe can serve.

She also notes that while there is no wait list to enter the AspenPointe system, patients have at times had to wait for adult psychiatry visits. Phillips-Henry says the organization was adding two or three new doctors at the end of the summer to try to alleviate the issue, and was already offering weekend clinics to try to get patients seen sooner.

People > profits

When the enterprises began, no one at what was then Pikes Peak Mental Health Center knew they were helping pioneer what would later be called the "fourth sector." Social enterprises and other business models focusing on positive outcomes for people and the environment (such as the Benefit Corporations in "Friends with benefits," cover story, March 8), are fast becoming an innovative new sector of the economy.

Last November, Heerad Sabeti wrote for the Harvard Business Review: "With formalization of the for-benefit structure, we will see the emergence of a fourth sector of the economy, interacting with but separate from governments, nonprofits, and for-profit businesses. The rise of that sector is likely to reshape the future of capitalism."

The Social Enterprise Alliance, the nation's largest trade group for social enterprises, has been scooting along since 1997. Now with 900-plus members, the alliance sees the social enterprise as the model of the future, combining the best of traditional business, nonprofit and governmental roles.

According to its website: "Social enterprises are businesses whose primary purpose is the common good. They use the methods and disciplines of business and the power of the marketplace to advance their social, environmental and human justice agendas."

Nonprofits and for-profits can both fit the bill. On the for-profit side, TOMS Shoes is an oft-cited example. The company was founded with the idea of putting shoes on the feet of poor Argentinian children. The goal has been achieved by giving away a pair of shoes for every pair bought by consumers. Since the primary goal is serving the common good, TOMS qualifies as a social enterprise.

On the nonprofit side, Goodwill is the obvious example. One of the nation's earliest social enterprises, it has run businesses to provide employment for those facing disabilities, unemployment, low education and work skills, and poverty. Discover Goodwill of Southern and Western Colorado, an independently run social enterprise, employs 412 in-need people at nine thrift stores. The local branch also has contracts to do laundry and cleaning services that offer jobs for the disabled and disenfranchised.

As a mental health center, however, AspenPointe, is largely unique. While most mental health centers across the nation offer job-placement services, and some offer job training, AspenPointe executives say their research and experiences at conferences show it's quite rare to find one with a social-enterprise component aimed at providing those jobs. For his part, Fetsch, of CSU, was fascinated by the model, which he had never heard of.

According to the alliance, it would be helpful if there were more AspenPointes out there. In one report, the alliance estimated that a single job generated by social enterprise had a net value of about $80,000 to a community. Its website notes that social enterprises have major advantages over other business entities.

"For example, a nonprofit that earns 50 [percent] of its budget through its social enterprise is effectively matching every dollar of 'public income' with a dollar of 'marketplace income,' doubling the social return on investment of those public dollars."

Of course, the social advantages don't necessarily equate to economic advantages. While it might seem a nonprofit social enterprise like AspenPointe Enterprises would do quite well in the marketplace — a great story, and none of those pesky taxes to pay — Liebert says it can be tough for AspenPointe Enterprises to compete. There's the image problem that pervades the idea of mental illness. And since AspenPointe Enterprises offers all employees a full benefits package, the prices are competitive, but not cheap.

Still, he sees plenty of reasons to do business with AspenPointe Enterprises.

"People have to buy these services anyway... but we tell folks [to] buy from us," he says. "Why? Because we have a training program. We're going to train people. We're going to put them to work. We're going to help them find jobs. We're going to help them get a GED. We're trying to create these sustainable mechanisms to give people opportunities to become successful."



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