SHERIDAN — In the last couple years, the amount of severely mentally ill patients admitted to Sheridan Memorial Hospital has doubled, straining a facility that lacks the space and staffing to provide the best possible care for such patients.
As a result, hospital staff, County Attorney Matt Redle, county staff and commissioners, and representatives from Northern Wyoming Mental Health and local law enforcement have recently held meetings to discuss how to handle psychotic patients who are involuntarily admitted to the hospital under what is known as a 72-hour hold, as allowed by chapter 10, title 25 of Wyoming State Statute.
In the last week, Sheridan residents have expressed worries that the hospital is considering no longer accepting any 72-hour hold patients. Those patients can sometimes include suicidal subjects or less mentally ill patients who are often released from the involuntary hold once an evaluation within the first 24 hours indicates the problem may be a short episode or an illness that can be treated locally with outpatient therapy.
Redle and Chief Nursing Officer Charlotte Mather both confirmed that is not true.
Mather said the group of the “sickest of the sick” that the hospital is considering alternative forms of care for comprises about 20 percent of all patients who end up in a 72-hour hold.
“We have not talked about eliminating any type of service,” Mather said. “That is not our goal. Our goal is how do we best meet needs of mental patients in our community?”
Redle said involving the hospital, law enforcement and Northern Wyoming Mental Health is a way to explore a variety of options to treat the wide range of mentally ill patients who need help and often seek it in the emergency room at SMH.
“This would not effect the other 80 percent of cases and may not affect some within the 20 percent,” Redle said. “There may be things we can do to help provide greater support locally so that some of those milder cases we may be able to deal with locally in an appropriate way or may be able to do things on the preventative side that may keep those patients on track so they don’t fall off the rails.”
In order to be placed in an involuntary 72-hour hold, a patient must be determined to be a danger to themselves or others or, because of their mental illness, be incapable of caring for their basic needs.
Following the evaluation within the first 24 hours of holding, a patient may be released or may be held longer for additional testing and stabilization. At that time, courts must appoint an attorney to represent the patient, and within 72 hours a hearing must be held to determine if continued detention is required after the initial 72-hour hold.
The county attorney is the one who files an application for an involuntary 72-hour hold and he or she represents the state at the hearing.
Mather said prior to 2012, the number of psychotic patients requiring a 72-hour hold with 24-hour psychiatric treatment and monitoring in a secure room at the hospital was approximately 10-12 per year. Since 2012, that number has increased to 20-25 per year.
The hospital is equipped with two safe rooms for patients placed on a 72-hour hold. In these rooms the bathrooms, beds, walls and floors look different and are set up so the patient is safe, Mather said. There are no things in the room that can hurt a patient or that a patient can use to hurt someone else. The rooms can be locked and feature video monitoring.
In short, they work, but they are not ideal.
“They don’t look homey, or feel comfortable, and in a unit truly set up for this kind of care, the environment would look more therapeutic than we can offer here,” Mather said.
Also, psychotic patients require 24-hour attention and intense therapy, which the hospital is not staffed to do.
Northern Wyoming Mental Health, which is involved in the initial diagnosis and follow-up care for a mentally ill patient at the hospital, also is not equipped for intensive, inpatient therapy, County Manager for Northern Wyoming Mental Health John Olenyik said.
However, in his discussions with hospital CEO Mike McCafferty over the last three to four months, Olenyik said the mental health center would like to provide more consistent therapy between diagnosis and the end of the 72-hour hold, which may enable a patient to stay in Sheridan and receive more ongoing care.
On the other hand, for patients who need intense care for a longer time than 72 hours, the hospital and county are considering sending them to Gillette or Casper where appropriate care can be given immediately after admission.
At this point, all parties involved are in the fact-finding stage, Mather said.
Redle said there are a lot of legal and operational considerations if a patient is moved, including how to transport them and where the first hearing should be conducted. If the hearing is conducted in the county to which a patient is moved, video feeds may be used, which can pose problems, Redle said, or the county attorney in that county will need to be compensated through an agreement between Sheridan County and the receiving county.
“It’s not a simple process,” Olenyik said. “The issue becomes for hospital, as well as everyone, is that we want to look for what is the best care for these folks.”