By LEO WOLFSON
When a Title 25 mental illness hold is brought to the Park County Detention Center, it is seen by all involved as an insufficient solution for both the patient and the jail staff.
“You can’t tell me that’s going to help a person,” Sheriff Scott Steward said.
Patients flinging feces on the walls, attempting to commit suicide by stuffing their mouths with toilet paper, throwing objects at deputies; these are just some of the scenes Steward said he has seen at his facility.
“It’s a legitimate medical condition,” Steward said.
If people exhibiting signs that show they are a risk to themselves or others commit to receiving mental health treatment, they are released. Those who refuse are typically placed on a Title 25 hold.
The Wyoming Department of Health reports in 2016 there were 16 involuntary hospitalizations in Park County, 2017 brought three, 2018 four, and in 2019, 12 people were put into detention.
The Department of Health only tracks tallies for Title 25 patients who enter into the state hospitalization system, but Park County Attorney Bryan Skoric said he has seen initial holds increase since first elected county attorney in 2003.
Typically, Title 25 holds are reserved for local hospitals such as Cody Regional Health and Powell Valley Healthcare, but Steward said these entities have not been holding up their end of the bargain.
“We have hospitals where, if the person is a little bit agitated or the person is acting out or they’re more hostile or more aggressive, they don’t want to take them,” Steward said. “The first thing they do is stuff them in the jail, which to me is sad. These people don’t belong in jail.”
Steven Humphries-Wadsworth, service line director at Cedar Mountain Center – the Cody Regional Health facility for mental health and substance abuse treatment, said Cody Regional –Hospital does not have psychiatric staff inside the facility and is not properly equipped to manage Title 25 holds. He wants the state to initiate quicker transfers of patients to the Wyoming State Hospital.
Thirty-one holds took place at the detention center January-July 2019, a 600% increase from the same time period in 2018. Steward said a substantial portion of Title 25 holds are placed in his facility.
“We are taking constitutional rights from people that we shouldn’t,” Steward said. “There is no crime in mental illness.
“We as law enforcement, as medical examiners, doctors, physicians, mental health professionals – need to quit abusing the system and quit putting Title 25s on people just because we don’t like the way they’re acting or we don’t want to deal with the problem anymore.”
Detention Center holds
Wyoming state law stipulates that Title 25 holds must, “be provided in the least restrictive and most therapeutic setting available.”
When a local patient is determined by hospital staff or law enforcement to be unfit for the hospital, he or she is sent to the Park County Detention Center for a Title 25 hold. Here, patients are often put into solitary confinement inside a padded cell. The mustard-colored room has no windows, no sink and no toilet. All that a patient is given is a padded shirt and a thin mattress to sleep on.
In the center of the 10x10 foot room is a metal grate where patients are to defecate in, and the room carries a strong odor.
“If I’m in a situation where I have a mental illness and I’m in a crisis I think that’s going to push me further,” Steward said.
Jackson Engalls, a supervising attorney general with the state’s attorney general office, said although detention centers are not the most ideal place to keep a patient, the rural nature of Wyoming creates a scenario where these locations are the best place, “unfortunately or unfortunately not.”
One of the biggest problems ailing the Title 25 system is backlogs at the Wyoming State Hospital, where people must wait weeks, and sometimes even months, for a bed to open up. Steward said one patient was recently kept at his jail for 45 days for threatening to blow up property on the South Fork.
“The state needs to step up and start taking care of these folks,” Steward said. “What are we doing taking away his constitutional rights and freedoms?”
He said it was only twice during those 45 days that the patient received mental evaluations, describing the lack of attention as, “Out of sight, out of mind.”
He said private entities like Yellowstone Behavioral Health Center are remiss to assist patients like this that are destined for the State Hospital because they only receive funding for evaluations, not ongoing care.
Judson McKee, a staff therapist at YBHC, does not necessarily deny these charges.
“We would be financially at risk to incur greater debt by taking on these added cases without funding” McKee said.
He said his organization did receive grant money to provide these services at one time, but funding was stripped in the State Legislature years ago.
“If these people in the mental health field keep wanting to say they’re all about advocacy for ... mental illness and all this stuff, why are they not coming in here because they’re not getting paid?” Steward questioned. “They’re getting all this grant money, they’re getting all this stuff, but they don’t want to come in here and take care of these people because it’s not beneficial to them.”
Tom Keegan, a local appointed attorney for Title 25 patients and court commissioner, said YBHC provides much-needed services in the Title 25 process. “YBHC is the only (mental health) agency at these (Title 25 court) hearings,” he said, “and if they’re not there physically, they are always available by phone. They always have a lot of background, a lot of knowledge on these cases.”
He said mental treatment options are extremely limited within a jail setting, due to the fact that most contact must occur through a glass window.
Steward said he is so fed up with the inflow of patients to his facility he is considering no longer accepting Title 25 holds at the Detention Center.
“If it ends up in a battle … at least we’re bringing attention to the problem,” he said.
Solutions on the horizon
Although statewide Title 25 hospitalizations have dropped by 39% since 2016, those declines are more reflective of a drastic increase in Title 25 cases 2015-2016. The Department of Health anticipates a total of $10 million in state Title 25 spending from 2019 through the end of 2020, an increase of $700,000 when compared to what was paid out in 2012. These numbers do not include county costs.
The State Hospital is attempting to address the issues of delays and Title 25 backlogs with a $182 million project that will build new facilities at the State Hospital campus in Evanston and the Wyoming Life Resource Center in Lander. Although the project will only add two more beds to the State Hospital, Stefan Johansson, Wyoming Department of Health deputy director, said the construction will allow for more efficient use of the hospital space with only single occupancy rooms on-site after the project is completed. Currently, every room is a double-occupancy but often patients must be left by themselves, so the facility will be able to house up to around 30 more patients in the future.
“We often have to fill a double-occupancy room with just one patient, and that takes a bed offline,” Johansson said. “When that improves we’re reasonably confident we can improve that population.”
Although the facility is currently and will continue to be licensed for 183 beds, Kim Deti, public information officer at the Department of Health, said what a hospital is licensed for is “nothing more than a technicality,” and that the hospital has not had 183 beds “for a very long time.”
“It is a holdover from the decades when mental health care did not include the emphasis on community treatment that we see in today’s world and when care standards were much, much different,” Deti said. “It is not uncommon for health facilities to be technically licensed for many more beds than they operate.”
The new facility in Lander will allow the State Hospital to transfer over more intermediate to long-term patients, where Johansson said they will be better served with added skilled nursing staff and human service specialists. He said this construction will also allow for a higher patient population.
The State Hospital facility is due for completion by this spring, while construction at WLRC is tentatively set for a late 2021 completion.
But this construction will likely not realize its desired purpose without more money from the State. Even though the State Hospital renovation will add capability for more patients, without more staff, Johansson said it will only be able to serve about five more patients at the State Hospital and at WLRC, only up to about 10 more.
The Department of Health is now asking the Wyoming Legislature for $14.9 million in biannual funding in its upcoming session to support 49 new employees at the two facilities.
Johansson said these facilities have been historically under-staffed due to a lack of budget and ability to attract qualified candidates.
He also added these new facilities will not lower costs for counties in regards to the 72-hour rule. Under that rule local counties pay for all hospital expenses related to Title 25 holds for the first 72 hours of detainment.
But what Johansson says it will reduce is the pressure felt by local hospitals and jails, waiting to discharge involuntarily hospitalized patients ordered to the State Hospital system, but held up by a full occupancy backlog.
“We think that can be dramatically improved,” he said, but added any financial improvements would be contingent on the State supporting staffing at an ideal level.
David Cote, a clinical social worker at YBHC, would like to see more funding given to private, community mental health centers like his, to provide patients community-based mental health treatment, and for employee training.
Steward would like the opposite. He wants the county to pull money from what it gives private entities and nonprofits and redirect it to the Department of Health to better operate the State Hospital, or send it to the Detention Center to improve its small psychiatric component. Currently, the county gives the Detention Center about $5,000 to contract a mental health nurse practitioner to help at the facility 40 hours a year.
The county provided YBHC $50,000.
YBHC offers a wide range of mental health services including substance abuse counseling, outpatient mental health services, suicide prevention treatment and psychological testing.
To volunteer with the Suicide Prevention Team of Park County, visit healthyparkcounty.org.