In the mountain towns of Colorado's high country, behavioural healthcare access and support have often been shaped by geography. From rugged mountains to long stretches of forest-dense land, communities are scattered across the scenic valleys and resort towns. However, these areas are sometimes hours away from specialist healthcare in larger cities. In rural mountain towns like Vail, in Eagle County, Colorado, visitors and workers cycle in and out as the skiing season comes and goes. With this ebb and flow of people, the strains on healthcare facilities – and the community as a whole – rise and fall.

Additionally, the residents of Eagle County have to contend with rising costs of living, which can exacerbate health problems. "It's very expensive in these mountain communities," says Will Cook, CEO and president of Vail Health. "What you've done is undermine the very reason you moved up here, which is to ski or to bike or to enjoy nature. You're watching other people coming in who are on vacation, who are doing that thing that drew you here in the first place, which is having fun. And it's sort of like rubbing salt in the wound."

But, during the past six years, a shift has emerged. Rather than surrendering to challenges, or shifting the blame to potential funding limitations, the community, led by Vail Health, has come together to transform behavioural health from a fragmented system into a coordinated, community-driven model of care that works for everyone.

"This wasn't about one organisation solving a problem," says Cook. "It was about an entire community aligning around a shared vision for what behavioural health could look like."

Under the leadership of Cook, Vail Health is rethinking what behavioural healthcare and healthcare as a whole looks like in a rural, tourism-driven region. "We have to do a better job of getting upstream," Cook explains, adding that he wants to do more than provide life-saving care when someone is sick. Vail Health is trying to help people stay healthy in the first place. "Making people healthier, trying to get out in front of chronic disease… it really does require a holistic view."

Traditionally, healthcare systems have been reactive, he says. Patients enter the system when something goes wrong – a diagnosis, an injury, a crisis. But Vail Health is increasingly investing in the "holistic view" which takes into account behavioural health, an approach that targets prevention, early detection and the broader factors that shape wellbeing before problems arise.

But infrastructure is only part of the story, and the importance of collaboration and a shared goal also underpins Vail Health's success.

In partnership with local law enforcement and first responders, Vail Health has introduced new models of crisis response care designed to intervene earlier and more effectively. The creation of a Crisis Co-Response Model, for example, has changed how acute mental health episodes are handled. Instead of relying solely on emergency departments or law enforcement, trained clinicians can respond directly, de-escalating situations and connecting individuals to appropriate care. At the community level, this initiative which provides 24/7 free suicide crisis helpline, educational programming and training with the non-profit organisation SpeakUp ReachOut has played a critical role in reducing stigma and encouraging people to seek help.

The organisation also works closely with schools, housing groups, charities and local government agencies to address issues such as food insecurity, childcare and education. Behavioural health clinicians are embedded in schools, while partnerships with community organisations ensure support reaches underserved populations.

Nonprofits deliver services in mobile home parks, after-school programmes support working families, and food banks operate alongside clinical facilities. In some cases, Vail Health provides funding, staffing and coordination rather than direct ownership.

"It's about community, collective impact and partnerships," says Cook. "Leaning in and collaborating is the secret to success." This collaborative model has been central to the organisation's success. Of the $126 million (£94m) raised to support behavioural health initiatives, a significant portion has been directed to partner organisations, recognising that many of the most effective interventions sit outside traditional healthcare.

Vail Health's investments into behavioural healthcare span across many services. From its Crisis Co-response Model to its dedicated inpatient behavioural health facility, each initiative has contributed to shaping how care is delivered throughout the region and has become a core part of the community's wellbeing.

For Cook, who became CEO in 2019, the transformation at Vail Health is already shaping the organisation's future. Alongside traditional care, Vail Health is exploring innovative therapies and research partnerships, aiming to expand the boundaries of what community healthcare can offer. He hopes that the system Vail Health is building in Eagle River Valley, will be adapted across rural communities throughout the US, demonstrating how rural healthcare systems and community-wide collaboration can initiate real change, and drive innovation.

Yet Cook is cautious about declaring victory. The challenges – from affordability to mental health – are ongoing, and progress requires sustained effort. "There's no endgame," he says. "This is something you commit to in perpetuity."