Wyoming Mental health care strained, providers say

SHERIDAN — Several mental health care providers expressed concerns about the viability of Wyoming’s mental health care during the afternoon session of the Sheridan County Chamber of Commerce’s Legislative Forum Nov. 23.

The goal of the assembly was to provide Sheridan County agency leaders the opportunity to discuss issues with Wyoming state legislators directly, ahead of the legislative session set to start in February. 

Paul Demple, CEO of Northern Wyoming Mental Health Center, said he’d never been more concerned about the viability of Wyoming’s mental health system. In particular, Demple was concerned about additional cuts to mental health services in the next five years, cuts that would require his staff to “do less with less.” Even now, Demple said, his current staff at NWYMHC has dwindled to 39 from 60, less than two-thirds what it used to be. 

Volunteers of America Northern Rockies Chief Operating Officer Heath Steel echoed several of Demple’s concerns. Steel emphasized he and other mental health and substance use care providers currently operate with extreme staffing shortages. Steel said 10% of positions at VOANR remain unfilled, despite the organization paying its highest recruitment bonuses ever. 

Steel said VOANR is also maxed out in terms of provision of care; his organization, he said, maintains a three- to four-month-long waitlist. 

“I have never seen the level of weakness [currently in Wyoming’s mental health system],” Steel said before the legislators. 

Some bills approaching the Legislature in the upcoming session, Demple said, may impact or improve Wyoming’s mental health and substance use systems, like HB0038’s reprioritization of individuals receiving mental health care and facilities providing that care. Steel said reforming Wyoming’s mental health system requires serious investment in communities. 

Significant mental health capacity concerns also stemmed from ongoing burdens caused by Title 25, Wyoming’s involuntary commitment law. Mike McCafferty, Sheridan Memorial Hospital CEO, said Title 25 places serious capacity and financial constraints on the hospital. 

Title 25 enables law enforcement or medical personnel to place an individual who is a threat to themselves or others on an emergency hold, which right now occurs at SMH.

While he emphasized SMH staff try to provide a safe environment for people on Title 25 holds, McCafferty said the upcoming legislative session offers the state an opportunity to continue exploring options for potentially dangerous behavioral health patients, which stretch hospital staff thin. Wyoming as a whole, McCafferty said, lacks the psychiatric care capacity necessary to care for Title 25 patients. 

McCafferty also emphasized the financial impacts of Title 25 holds on SMH. McCafferty said Sheridan County pays the hospital a flat fee of $200,000 per year for Title 25 care. The actual cost of this care for the hospital, meanwhile, is about $2 million annually. 

“You should be very proud of your hospital,” McCafferty said, referring to SMH’s ability to offset Title 25 costs. 

Meanwhile, mental health facilities, Demple pointed out, have no way to recoup the costs of expensive patient care. 

Some upcoming legislation may impact these Title 25 issues. For instance, a bill amending cost burdens and other elements of Title 25 is currently working its way through the Legislature’s Joint Judiciary Committee. The committee is tentatively scheduled to meet via Zoom Dec. 17 at noon to continue discussing and amending the bill. 

Demple and McCafferty proposed the possibility of creating a regional emergency mental health facility in Gillette, which is home to more psychiatrists than Sheridan, or a crisis stabilization center locally. Sen. Dave Kinskey, R-Sheridan, said American Rescue Plan Act and other federal funds may be available to help build and staff such a facility and implored local mental health professionals to start outlining plans. 

Demple stressed, however, focusing on emergency care — and only emergency care — is insufficient. The state must invest in mental health care at all levels, Demple said, to limit the number of people requiring Title 25 holds or other forms of emergency care. 

Legislators will continue refining Wyoming’s statewide mental health system in response to local concerns.