SHERIDAN — Medical professionals reiterated the need for quicker services for acutely mentally ill patients involuntarily detained through a Title 25 hold during the Sheridan County legislative forum Nov. 20. In the 2016 legislative session, lawmakers reformed a mental health bill, allowing for gatekeepers to manage acute mental health patient cases and provide direction on proper care. Even with gatekeepers, who started work at Northern Wyoming Mental Health Center in August, the process remains arduous for medical professionals. 

Mental health patients involuntarily detained at Sheridan Memorial Hospital through Title 25 present issues for both the patient and those caring for them. Patients wait to receive proper care for acute mental illness, and medical personnel at the hospital are not trained specifically to care for the patients in the ways they need.

Kristopher Schamber, an internist at Sheridan Memorial Hospital, said taking care of an acutely mentally ill patient in this community goes beyond his formal training. Schamber handles clinical care well, but for the serious cases, he realizes the limitations of the hospital setting.

Through Title 25, law enforcement or medical examiners may detain a person thought to be in danger to self or others or unable to meet basic needs as a result of a mental illness.

Sheridan Memorial Hospital sees between 110 and 130 patients per year in two rooms specified with locks to ensure patient safety. When more than two patients arrive at once, hospital staff utilize other rooms, as it cannot turn away those with acute mental illness emergencies.

The process of transferring patients needing extended care requires a judicial process. The hospital works with its attorney, the county attorney and a judge to ensure transport to facilities that specialize in acute mental health is feasible, such as the Wyoming State Hospital in Evanston or the Wyoming Behavioral Institute in Casper. Once through the judicial system, the hospital must secure transportation for the patient. The hospital used Rocky Mountain Ambulance primarily for transports at the cost of around $3,400 to $4,400, on top of housing costs of $4,026.64 per patient for the average 3.81 days’ stay.

“All that adds up to money that comes out of the state coffers because we have people that are not getting better in the hospital because we don’t have a psychiatric facility,” said chief medical officer, Dr. John Addlesperger. “It prolongs their length of stay. Somebody has to pay for that. We eat a lot of those costs. The state eats a lot of those costs.”

While the costs serve as one of the hurdles of involuntary holds, the physicians main concern is providing proper care for the patients.

“Our particular goal is to try and work to do the things to get these patients to the right places of care,” SMH chief financial officer Nathan Stutte said, “especially for the patients that may be going through a very acute episode and they need very specific types of treatment that are outside the scope of what we feel comfortable providing.”

The hospital utilizes psychiatric care via telehealth from California but has a limited number of appointments and time to see the psychiatrist with the patients.

Addlesperger said housing acutely mentally ill patients takes away from valuable nursing resources because the patients require a lot of attention.

“Ideally, our goal for patients in Sheridan County and the state would be able to get them to the appropriate facility with the appropriate medical care that they really require,” Addlesperger said.

Local legislators provided no set plan for reform during the forum in Sheridan County, but members of the joint labor, health and social services interim committee discussed a bill draft at its Nov. 16 meeting. The bill draft allows for medical facilities like SMH to contract with non-state facilities to provide appropriate services for acutely mentally ill patients entering on a Title 25 hold and reiterate the use of a gatekeeper to guide the discharge of patients eligible to receive services from the non-state entity upon discharge.