SHERIDAN — Sheridan Memorial Hospital CEO Mike McCafferty urged legislators to keep their eyes open for development of a new coalition that would work to improve the model of behavioral health care in Wyoming at the legislative forum Friday.

McCafferty said the existing health care delivery system — especially related to Title 25 cases — is still facing significant challenges.

Inconsistency in delivery methods between counties and lack of facilities and qualified providers creates inefficiency across the board, he said.

SMH lacks the resources necessary to treat many patients brought to the hospital under Title 25, he said.

McCafferty said he has brought similar concerns before the legislative forum for the past decade but the process is still flawed.

“I know you guys believe that as a state legislature, you spend a lot of money on behavioral health services,” McCafferty said. “We’d like you to spend that money but in a different way — and potentially look at some capital along the way if we have opportunity to introduce a better model of service delivery.”

Title 25 allows law enforcement or medical professionals to execute an emergency hold, detaining a person who is determined to be a threat to themselves or others as a result of mental illness.

McCafferty said 138 involuntary holds are expected in Sheridan County in 2019 and the number is expected to climb in future years.

About 10% of patients in Sheridan County detained through Title 25 present a serious risk to themselves or health care staff, McCafferty said. The hospital is not equipped with the resources to provide the high level of care those patients require, he said.

In the past five years, the hospital has added two 24-hour security guard positions to help protect staff from violent individuals, or patients from themselves, McCafferty said.

The Sheridan County Sheriff’s Office has received requests from the hospital to hold individuals in the jail because of understaffing or safety concerns, Sheridan County Sheriff Allen Thompson said.

Technically, the statute allows someone placed under involuntary hold to be held in jail under extreme circumstances. Thompson said he has hesitated to heed those requests because jail isn’t the appropriate place for a person suffering from severe mental health issues. But Sheridan County doesn’t have a proper facility for people who present a danger to themselves and others, he said.

The combination of medical and legal perspectives involved in maintaining an involuntary hold on a patient can cause inefficiency and arbitrary decision-making in a person’s health care plan, McCafferty said.

“We are going to explore pulling together resources with county attorneys across the state, as well as hospitals, and talk about a model of service delivery that would decrease waste, improve efficiency and really get the patients what they need in a more expeditious fashion,” McCafferty said. “We’re looking to upend the system of delivery and care for patients who are put under involuntary hold in the state of Wyoming.”

One of the barriers to health care is the financial burden on individual counties for Title 25-related mental health services, McCafferty said.

In 2016, the Wyoming Department of Health was asked to reduce its budget by $90 million, including a 14% cut to daily Title 25 rates. The Wyoming state budget request for the 2019-2020 biennium includes $6 million to cover Title 25 costs. The first 72 hours of a hold are funded by the county in which a person was detained, then the state becomes financially responsible for the hold. SMH subsidizes a substantial amount of the cost of care for Title 25 patients because of lack of financial resources within the county, he said.

“We have no other choice — these people have to be cared for,” McCafferty said.

McCafferty said the hospital receives about a quarter of a million dollars per year from the county as a contribution to Title 25 services, which represents about a quarter of the total financial burden for which the county is responsible.

Senate File 58, passed in 2016, was intended to offer an alternative to hospitalization and tap into the $100-million fund for community-based mental health treatment, according to the Wyoming Medical Society. SF 58 also added a gatekeeper position to the emergency detention process. A gatekeeper is a non-clinical individual who coordinates and guides an emergency detention, according to the Wyoming Department of Health. If the gatekeeper determined it to be appropriate, patients could obtain mental health care at community-based facilities rather than at overbooked hospitals. Adding a gatekeeper hasn’t improved challenges facing hospitals at all, McCafferty said.

Rep. Mark Kinner, R-Sheridan, supported the idea of developing a statewide coalition of all Title 25 stakeholders to develop recommendations for busy legislators to consider.