Matt Vogl prepared to torpedo his career in public health. A former standup comic, he had told many stories on stage, but this one — uncharacteristically typed out, with a picture of his two sons attached — was the most painful and personal. Vogl looked down at the photo of his boys, then looked out at the 500 people in the audience at the Denver Art Museum, including colleagues, bosses and benefactors of the Helen and Arthur E. Johnson Depression Center as well as its umbrella organization, the University of Colorado Anschutz Medical Campus. And he started talking about how close he’d come to suicide.
Before this, Vogl had only opened up about his bipolar diagnosis to a handful of co-workers. But he’d been working at the Depression Center for five years, since shortly after he’d been diagnosed, and the hypocrisy had started to grate.“How can I fight stigma,” he asked himself, “if I’m keeping my own shit hidden?” He was ready to pay the professional price.
As Vogl puts it, “I can’t go back, so I may as well be a zealot.”
But instead of ending his career, Vogl’s raw honesty opened a new chapter. Four years later, he heads the National Mental Health Innovation Center, an Anschutz Foundation-backed, $10 million startup of his own design.
In the center’s office at the Anschutz Medical Campus, the glass walls are scrawled with Expo-marker plans for proposed partnerships between academia, industry and community leaders, mapping out projects that will make mental health care more accessible and, in the process, dissolve the stigma that surrounds it. “When we get to the point that we can talk as matter-of-factly about bipolar and suicide as we talk about arthritis,” Vogl says, “then we’ll be somewhere.”
So when Vogl, as a philosophy undergrad at Marquette University in the late ’80s, found that he could skip sleeping for three days straight, he chalked it up to being a night person. And he attributed self-medicating with cheap beer and taking semesters off as the typical existential throes of young adulthood.
The cycles of energetic activity followed by depression continued after college, as Vogl made his way toward a career in health care — teaching at an alternative school tailored to the culture of its indigenous students; enrolling in the University of Minnesota’s master’s program in public health; implementing a new, research-vetted intervention for mothers and children in the Louisiana bayou for the Nurse-Family Partnership; working at what was then University Hospital in Denver. As the bouts of sadness grew progressively deeper, Vogl tried to will himself out of what he thought of as a temporary rut. The slide into profound depression was like driving a car whose brake pads have worn thin so gradually that you don’t realize how your car’s safeguards have dwindled away until you duck into the driver’s seat of someone else’s vehicle, he says today.
On the surface, Vogl’s life seemed good. At least, that’s what a longtime friend, Harrison Rains, tried to tell him when Vogl shared the thought that he might be depressed in one spur-of-the-moment conversation in 2002. The two were co-founders of Mile High Sci-Fi, a film-criticism/comedy show in which they ragged on so-bad-they’re-good ’80s movies. Despite the fact that the gloves came off for those on-stage sessions and they’d opened up to each other on other occasions, the discussion of depression made Rains uncomfortable, Vogl remembers. Maybe, his friend told him, going on a hike would give Vogl a brighter perspective.
Instead, Vogl’s outlook grew bleaker. With a strained marriage to his wife, Sarah, whom he’d known since grad school, when he volunteered at a women’s shelter where she worked; an infant son, Sam; a mother with rapidly advancing Alzheimer’s; and an unfulfilling job in skin-cancer prevention when he wanted to pursue comedy professionally, “I just gradually started to collapse under the weight of it,” Vogl recalls.
He began rationalizing why the people in his life would be fine without him. He would finish a cynical set at the Comedy Works, then research what caliber gun he should use to kill himself. Ultimately, suicide seemed not just logical, but as a mercy even for six-month-old Sam. It would “spare him having had me as a dad,” Vogl explains.
And so in early 2003, Vogl stood on the doorstep of his home in Highland, crying, a revolver purchased and a suicide note written. His name would have become an obituary listing were it not for a neighbor who came over and asked Vogl what was wrong. He brushed her off. But their neighborhood was tight-knit, with block parties and dog walks inevitably punctuated by conversations, and she knew Vogl. She’d also been through suicide-prevention training, so she persisted, insisting that he open up. Eventually, Vogl revealed that he had a suicide plan and was about to act on it. But by the end of their thirty-minute conversation, he’d promised to seek treatment instead.
Navigating the mental health care system, however, presented a whole new hellscape. Vogl called the behavioral health line on the back of his insurance card, but “no one answers that one,” he recalls, ruefully. After listening to long minutes of hold music, he talked with specialists who were not accepting new patients, didn’t take his insurance or offered to put him on a six-month wait list. “Therapy works. We know that,” Vogl says. But for it to work, you need to get in the door. Finally, Vogl decided he’d go outside of his insurance system and cover the costs out of pocket.
Even then, he spent a year sitting in various waiting rooms, only to wind up in another blind alley. The anti-depressants that different doctors prescribed didn’t help as tangibly as he’d hoped. And at one late-afternoon appointment, the therapist typed on his Palm Pilot and then dozed off, only to respond with a hasty “I wasn’t sleeping!” when Vogl kicked at his desk. As he struggled to get treatment and let other aspects of his life fall by the wayside, he and Sarah wound up divorcing.
Vogl’s hurdles in seeking health care weren’t unusual. A 2011 survey found that nearly one-fifth of visitors to a mental health professional used an out-of-network provider, double the rate than for other health-care issues.
“When we can talk as matter-of-factly about bipolar and suicide as we talk about arthritis, then we’ll be somewhere.”
And while the Affordable Care Act made behavioral health one of ten Essential Health Benefits, building upon the coverage expansion of the Obama-era Mental Health Parity and Addiction Equity Act, that progress now seems shaky under a Republican-controlled legislature.
According to the 2015 Colorado Behavioral Risk Factor Surveillance System, one in ten adults reported that their mental health was “not good” for fourteen or more days out of a thirty-day period. Mental illness and substance-use disorders are the top sources of disease burden in the United States, surpassing cancer. Yet despite the widespread impact of mental health problems, recent Kaiser Family Foundation data indicates that only a third of adults with “serious psychological distress” visit a mental health practitioner in a given month.
And even if they seek a specialist, there’s a provider shortage: In a 2015 survey of state mental health agencies, Colorado responded “No” to the question, “Does your state have a sufficient workforce to meet current service demands?” Vogl used to joke that “the best place to get care in our state was Denver International Airport.”
Finally, Vogl found two practitioners who converged on a diagnosis of bipolar II. (Bipolar II is marked by hypomania, less wired than the full-fledged manic periods that typify type I.) He had his answer, but a brain-tumor diagnosis would have been more welcome news. “That label killed me,” he remembers. After the appointment, he called in sick to work and returned home to Highland to cry.
Both specialists suggested Lamotrigine, an anti-convulsant that dramatically changed his outlook in a way that anti-depressants never had.
Four years after his diagnosis, Vogl saw an article about the brand-new Helen and Arthur E. Johnson Depression Center; he applied for a job there and got it. The Depression Center “was where I really came into my own,” Vogl says. Working there, he started taking his role in safeguarding his mental health seriously for the first time, and eliminated parts of his life that might impede recovery. He realized that he was sacrificing sleep for late-night stage time; the standup scene smelled like boozy breath. And all too often, drug use and unaddressed mental health issues underlay the laughs. “I don’t think there would be standup if it wasn’t for bipolar,” Vogl says.
After emceeing for Jimmy Fallon’s 2008 appearance at Comedy Works South, Vogl quit the comedy business. (He stayed with Mile High Sci-Fi, now Mile High Movie Roast, until 2013, and will still do an occasional guest appearance for favorites like Star Trek II: Wrath of Khan.) Comedy is pain crossed with creativity, he explains, and many comedians first honed their humor for a very specific purpose, such as garnering attention when you’re at the tail end of a large group of kids or coping with a complicated family life.
Vogl certainly had that: He’d subdivided his home so that he and his ex-wife could lead separate lives while co-parenting Sam. Vogl would use the back door while Sarah came in the front; equipped with a door to each parent’s half of the house, “Sam’s room was kind of Switzerland,” Vogl recalls. As he recovered from depression, he began to reassess his divorce. Slowly, he and Sarah realized that co-parenting took at least as much work as marriage. They exchanged new wedding rings in their back yard, with only a neighbor officiating and Sam, then six, in attendance. And Sam soon had a baby brother, Mark. The couple now celebrates this December anniversary, not their old one.
More and more, Vogl saw how pervasive the stigma was against mental illness. At a breakfast meeting, a local CEO volunteered to double his contribution and volunteer his marketing team’s time if the Depression Center would change its name. “The word ‘depression’ was just so offensive and horrible to him that he was willing to spend another $10,000 just so he didn’t have to look at it,” Vogl recalls with frustration.
But even though he’d been diagnosed with bipolar and now worked in the field of mental health, Vogl only spoke about that diagnosis in very specific settings, with trusted colleagues. “I felt like a fraud,” Vogl says. Finally, he was ready to share his story — even though co-workers warned that it would wind up on the Internet, and all the parents of his kids’ friends would know about his condition.
He remembers his speech at the Denver Art Museum as an almost out-of-body experience. The chancellor of the School of Medicine at Anschutz and two deans sat directly in front of him. As he told his story about being bipolar and his almost-suicide, he looked out at them and the rest of the audience. People were dabbing at their eyes with tissues or nodding. “It was completely liberating,” he says.
After the speech, Vogl’s inbox was flooded. Some people wrote of similar experiences, others professed support. One of the emails came from Don Elliman, chancellor of the CU Anschutz Medical Campus, who said that Vogl’s story made him proud to work there.
From that moment, Elliman “became a believer” in prioritizing mental health, Vogl says. In his 2016 State of the Campus address, Elliman declared: “Mental health is unquestionably the biggest unmet and/or underserved need in American health care today.”
Colorado had a definite mental health problem. At 19.7 suicides for every 100,000 people in 2013, the state’s suicide rate exceeds the national average of 12.5. If you map this data across the nation, Colorado as well as other Western states and West Virginia are tinted rust red, indicating that they have the highest suicide rates in the U.S. In these states, a “frontier mentality” — and lenient gun laws — prevail, Vogl notes. “You don’t ask for help. You pull yourself up by your bootstraps.” When applied to mental illness, this stoic mindset can be fatal.
But despite Colorado’s grim statistics, the state Office of Behavioral Health was ranked 27th in spending in 2013, shelling out only $98.80 per capita on mental health, well below the national average. “It’s a holy mission but a losing business,” says Elliman.
And Vogl was ready to take it up. In December 2015, he asked Anschutz and the Anschutz Foundation to take a $10 million gamble on a center that would prioritize new ideas and partnerships in mental health care, trying out different projects to see what might work. His 29-page proposal flew in the face of both conventional, slow-paced university research and the traditional therapy model; it proposed the creation of an organization that “will transform Colorado into the national leader for aggressive inclusion of mental health and substance use disorders as part of what health care routinely attends to.”
As terrified as he’d been to talk about being bipolar two years before, making this pitch was far more terrifying. To Vogl, the stakes felt monumental.
But the speech was persuasive, too: The Anschutz Foundation bought in, and the chancellor’s office promised to fundraise to match its donation.
Vogl soon moved down a floor in the building that housed the Depression Center and designed a workspace that, with its think pods and standing desks, would be more at home in Silicon Valley than a stuffy medical center. Then, in a move straight out of the bad sci-fi movies he once ribbed, Vogl built up a team that now numbers ten people, full-time, and got to work.
The center officially opened its doors exactly one year ago, as the National Behavioral Health Innovation Center. Just this week, its board changed the organization’s name to the National Mental Health Innovation Center, to remove any suggestion by the word “behavioral” that there’s an element of choice to mental illness.
The inaugural project was consulting on a new mental health court in the 18th Judicial District, modeled after a longstanding one in San Francisco. Today its roster of projects continues to evolve, like that of any startup. Drawing on CU Boulder Associate Professor Sona Dimidjian’s work in behavioral activation, the NMHIC helped implement Alma, a peer-mentoring program to reduce perinatal and postpartum depression among Latina moms in Carbondale. Closer to home, the center worked with CU’s Leeds School of Business and School of Dental Medicine to embed mental health in their coursework.
“Mental health is unquestionably the biggest unmet and/or underserved need in American health care today.”
Vogl counts the final presentations of an introductory marketing course for undergraduates at Leeds among his most gratifying moments on the job: As the students shared their approaches on how to better integrate mental health into the workplace and on campus, one by one the aspiring business leaders opened up about their own experiences with mental illness.
Another exhilarating moment came last winter, when virtual-reality pioneer Walter Greenleaf jumped on board within an hour of meeting with Vogl; the Stanford-affiliated researcher said he wanted his three decades of work to be used to help others. This month, the Depression Center began sessions with a specially trained therapist using a VR headset. The equipment, which has been on the market for only a year, resembles a set of futuristic ski goggles and two base stations placed up high; the immersive gear they use retails at $599 after a recent price drop, but there’s no extra charge for patients who use it. Studies suggest VR has untapped potential for mental health, including increasing mindfulness (center staff recently demonstrated a game by Realiteer that requires the player to catch twining strings of black and white orbs with their joysticks in a practice that evokes tai chi), uncovering PTSD triggers and building empathy. VR can also help patients overcome phobias through therapist-supervised exposure therapy. Director of Digital Initiatives Mimi McFaul and Greenleaf are now working to partner with industry and research teams from Dartmouth, Stanford and the University of Southern California to create more therapy-oriented VR environments, and also to launch Tech Innovation Network, a nexus of researchers, industry buffs and mental health practitioners committed to tech’s mental health applications.
Sometimes ambitious center projects stall, like the on-and-off collaboration with the behemoth team behind Pixar’s Inside Out, an education project that grew out of a correspondence between the animated film’s director and a center affiliate. But at other times, they really take off. One such success story is ResponderStrong, a program designed to increase the mental health of emergency responders that’s spearheaded by one of the center’s own.
Being an emergency responder is “just a tremendous amount of exposure to trauma,” she explains. But firefighters and other responders pride themselves on being as impervious as their personal protective equipment. “It’s just, ‘Put that away, put that away, put that away,’ and then one day, you realize that the closet’s full and you can’t close it anymore,” Kelly says.
But compartmentalization can also be a killer: One hundred-thirty Colorado emergency responders died by suicide between 2004 and 2014. Data collected by retired firefighter Jeff Dill shows that suicides outnumbered line-of-duty deaths for firefighters and paramedics in 2014, and a 2011 study conducted by the National EMS Management Association found that the suicide rate among medics was ten times higher than in the general population. But that rate dwindles by nearly half if a workplace provides “full support and encouragement,” according to a recent study in the Journal of Emergency Medical Services.
And the stressors keep mounting, which makes ResponderStrong’s work essential. “When I first came on, the older guys used to talk about ‘that call’ — the one call in their career that really haunted them,” Kelly says. Now those calls are “pretty much in regular rotation.”
Before facing fires, Kelly worked with ice as a technician in Antarctica. In 2000, after an elaborate array of background checks, physical tests and a polygraph, she started at the Aurora Fire Academy, one of three women in her class. The recruits learned to throw a ladder, pull hose and quickly suit up in the 55-pound bunker gear and air packs, but mental health practices went entirely uncovered. The academy, she says, is about “learning to identify and best manage hazards…but all of the hazards that we’re being taught to manage are the external hazards.”
For the first three years, the adrenaline, firehouse camaraderie and purpose behind the job fueled her through “standing 24”-hour shifts, but then the sleep deprivation and the bad calls — pediatric or whole-family deaths, especially — started to catch up with Kelly. Between the electronic tones that signal firefighters to get in the rig and go, she wasn’t able to sleep in her bunk, replaying scenes or worrying how administrators would view her in-the-moment decisions. She’d do burpees or push-ups to burn through the adrenaline, or type out as thorough a report as possible on the office desktop.
Steeped in stereotypes of the mustachioed, truck-driving, union T-shirt-sporting “salty old dog” career firefighter, firehouse culture didn’t cater to talking about emotional trauma. Being upset or shaken over a call could lead to co-workers handing you an application for a job at Burger King, Kelly recalls. The term “mental illness” was even more taboo; to firefighters, that concept conjured memories of calls where they’d encountered someone sleeping in their own waste on the streets, incoherent. Instead, they coped with the mental toll of the job through dark humor; you’d know a call had really shaken them if the truck fell silent on the way back to the firehouse.
“My personality was starting to change,” Kelly recalls. She noticed herself growing jaded and struggling with depression. Her part-time work as an ER and psychiatric nurse took a toll, too. Even as the head of the peer-support team, she went to see a counselor at Nicoletti-Flater Associates, the largest public-safety psychology group in the country, whose headquarters are in Lakewood. That helped, and later, after stints as a psychiatric and emergency nurse on the side, Kelly became Aurora Fire and Safety’s Health and Safety Officer, given free rein to make changes to the department but constrained by a minuscule budget.
But an after-midnight call following the Aurora theater shooting made mental health a priority: Aurora’s fire chief was worried about the tragedy’s effects on his firefighters. Kelly organized a slew of meetings and trainings; she invited Vogl, whom she knew from his work at the Depression Center, to one of them.
Kelly had already told Vogl before about the mental health issues that came with her profession. Earlier that summer, she’d driven her point home in a baptism by fire: She’d taken Vogl to the Rocky Mountain Fire Academy, a facility that borders an asphalt plant, and had him suit up before they walked into a 650-degree inferno. The accelerant-boosted fire, feeding on pallets and straw, clogged the air with smoke. Vogl sat against the wall with Kelly as firefighting recruits fought the blaze — but he needed to leave just ninety seconds later, his system so overwhelmed that he went to the ER worried he might be having a heart attack. Later, he tried to explain his burn-building visit to colleagues, but despite all his storytelling experience, he couldn’t put it into words. Not being able to communicate with people who didn’t share his experience “really drove home the importance of culturally competent care,” Vogl recalls. Kelly knew that he finally got what she’d been talking about. That was one of the challenges firefighters faced in getting care: No one, not their therapists or even their spouses, got it. Instead, Kelly would hear stories about counselors breaking into tears when an emergency responder unloaded their trauma, or a significant other who’d get frustrated with a firefighter’s seeming apathy when, after a day full of high-stakes choices, he or she didn’t have the energy to decide where to go for dinner.
After NMHIC became a reality, Vogl called Kelly. “I think we can take this conversation to another level,” she remembers him saying. So in early 2016, she left the fire service and the counseling program she’d been enrolled in at the University of Denver and started planning a trans-agency mental health program that would bring together the isolated efforts already taking place in different pockets of the responder community. That group became ResponderStrong, after a vote among several paramilitary-sounding names (another contender was Mental Armor). Now, a little over a year old and boasting around 500 members, ResponderStrong is one of NMHIC’s largest projects. “People are just coming out of the woodwork for this,” says Vogl.
“It’s just, ‘Put that away, put that away, put that away,’ and then one day, you realize that the closet’s full and you can’t close it anymore.”
Kelly and her team have targeted six community-identified needs to address. Working groups for each initiative meet monthly and leave with agenda items to accomplish before the next meeting, and the entire cohort gathers quarterly to share progress. To prepare counselors to better help emergency responders, they’re re-envisioning the existing Employee Assistance Program to be more informed by emergency-responder culture; interested counselors will also be able to participate in a lengthier program for board certification. ResponderStrong is trying to weave stress management and resiliency material into the 2018 curriculum of the Community College of Aurora, which trains more than half the emergency responders in Colorado. It’s also building a website that will host a video archive with similar trainings and provide a plethora of resources, connections and self-assessments. The group has teamed up with Colorado nonprofit Status: Code 4 Inc. on a documentary, Lifelines, that details emergency responders’ struggles with trauma so that their families can better understand and support them — another of ResponderStrong’s big-picture goals. A collaboration is in the works with West Coast Post-trauma Retreat in California to establish a responder-oriented Colorado satellite. And finally, there’s the creation of a new, responder-specific keyword for the crisis text line (741741) that will provide the team with data for future research.
It’s a monumental task, but despite a culture she calls “image-conscious” and “defensive,” Kelly says that her group doesn’t have to sell people on the fact that there’s a problem. In fact, there are a lot of people and organizations already working to fix it; ResponderStrong’s job is to bring all of them — dispatchers, law enforcement (including corrections officers), paramedics and firefighters, rural or urban — together. And while it’s an uphill battle, the battle seems to be turning: At the annual engraving ceremony at the Fallen Firefighter Memorial in Colorado Springs this September, names of firefighters who’d died by suicide were etched into the stone, recognized as line-of-duty deaths.
Nurse-Family Partnership. She remembers him as an out-of-the-box creative who kept things light with humor.
Decades later, still unwaveringly committed to public health, Hill was chief operating officer for the Colorado Behavioral Healthcare Council when Vogl called her, the excitement in his voice palpable. He told her that he’d talked to the Anschutz Foundation and thought they had the chance to drastically accelerate mental health care. Once the proposal for the center was approved, Hill became NMHIC’s deputy director. Just as they did two decades ago, she and Vogl now figure out whose political influence might push a project forward, meet with community leaders and make crucial introductions. Above all, they work to nip public health problems — once home environment and parenting style, now mental health — in the bud instead of waiting until the fix is late and costly.
The Colorado School of Public Health — a collaboration between CU, Colorado State University and the University of Northern Colorado — is in the process of creating what would be only the third master program in the country (and the first in the region) to offer a master’s degree in public health with a focus on mental health. It is also planning the country's second doctoral public health program with that focus.
At NMHIC, Vogl’s job as executive director involves countless conference calls, an inbox with an intimidating “unread” count, navigating university politics, travel (three work trips this month alone) and facilitating collaborations; it spills over into work late at night, after dinner and his sons’ baseball and soccer games.
Between meetings in the bright-walled office that he designed, Vogl leans in the doorway of a conference room, makes a gun with two fingers, and pantomimes shooting himself in the temple. The gesture speaks to the hectic pace of his job, but also to the reason he’s so committed to it: Vogl has recovered enough from his near-suicide to treat it with humor. He’s put his diagnosis permanently on his skin in a :(: tattoo. It’s a reference to both the emotional pendulum of bipolar and his brush with suicide: The colon is a nod to the semi-colon symbol for a life touched by suicide, he says — the idea being that, unlike a period, the semi-colon implies continuation.
Being public about being bipolar doesn’t keep Vogl from having bad days, of course, but he’s come a long way from the day when he first heard his diagnosis and despaired.
Next to his workspace, the baseball buff keeps a red chair from the old Busch Stadium, historic home of the St. Louis Cardinals, and a bat signed by Jimmy Piersall, a centerfielder from the ’60s who was openly bipolar at a time when mental illness was a taboo subject. And on his desk, Vogl displays a photo sent by a Castle Rock mother whose thirteen-year-old daughter took her own life while on a five-month waiting list for care. Day after day, her image reminds Vogl of why his work matters, shows why the mental health-landscape system needs to shift. And with NMHIC and its devoted staff, Vogl is determined to make that change. “I find myself getting excited on Sunday nights because I get to go back to work,” says Vogl. “We have been entrusted with this once-in-a-lifetime opportunity.”
The National Suicide Prevention Lifeline is available 24/7 at 1-800-273-8255. For state-specific support, Colorado Crisis Services can be reached by phone at 1-844-493-8255, or text “TALK” to 38255.