Title 25 involuntary holds are still sapping resources at Sheridan Memorial Hospital, and the facility’s chief executive officer voiced his concern for the future of the program to legislators Tuesday.
CEO Mike McCafferty said the hospital accepted more than 100 behavioral health admissions through Title 25 in the last year, and out of those 100 cases around 15 to 20 percent of the patients were ones the hospital was not equipped to give the complete care they needed.
Emergency detention, or an involuntary hold, is a legal process where a police officer or examiner may detain a person thought to be a danger to self or others or unable to meet basic needs as a result of a mental illness, according to a synopsis from the Department of Health. Detention may occur in a hospital or other suitable and appropriate location, but the patient should not be detained in a jail unless there is no other option.
“(Patients under a Title 25 hold) are beyond our ability to care for in a way that keeps them safe and our employees safe,” McCafferty said. “We do not have a psychiatric lockdown unit at our hospital.”
Other hospitals in the state, like Gillette and Laramie, integrate behavioral health services in with their hospitals, including eight beds in Gillette and 10 beds in Laramie, with trained psychiatric staffing at all times. Outside of those resources, the Wyoming State Hospital and Wyoming Behavioral Institute provide intensive care for behavioral health patients.
A majority of the behavioral health patients at SMH do not come into the hospital with medical needs but instead are waiting for transportation to a certified facility elsewhere in the state after working through what McCafferty described as a “convoluted” legal system.
“If you came to the hospital with a cardiac arrest, we would get you where you need to be immediately,” McCafferty said.
“These people are coming with behavioral health issues and languishing with no treatment because we don’t provide behavioral health treatment at our facility.”
After a person is held under Title 25, a hospital representative, county attorney and judge must determine the best next step for the patient. McCafferty shared that he and the group of people involved in the process spent two days in a disposition hearing for one individual to determine where the patient should go and how to transport him to that location.
Paul Demple, CEO of Northern Wyoming Mental Health Center in Sheridan, said the partnership among entities has proven successful in providing the most appropriate plan for the patients; the agency tracks each patient from the initial Title 25 hold until they have completed or been released from treatment. The tracking helps NWMHC better its services and determine what is needed — which Demple believes and a feasibility study conducted by NWMHC with grant funding last year confirms — a crisis stabilization center.
A crisis stabilization center would fill the role McCafferty longs to relieve his staff from — 24-hour crisis care for behavioral health patients by licensed and trained medical professionals in psychiatrics. The hospital CEO provided an example: the hospital held a patient for three months under a Title 25 hold with one-on-one staffing provided for the person. That single person was the cause of several “Code Armstrongs,” where the hospital requires all hands on deck to manage a violent situation.
“We are a general acute care medical facility,” McCafferty said. “And these are the kinds of things that we’re dealing with.”
In Worland, Cloud Peak Counseling Center operates a crisis prevention and stabilization center that houses patients held under Title 25. Demple toured the facility last summer, gaining an education he wants to bring forward to stakeholders in the Sheridan community to create an identical facility.
Both Demple and the NWMHC board of directors labeled this issue as their No. 1 priority in the upcoming year.
One issue is finding the physical space and funding for a building, but another aspect, and arguably the most difficult, is staffing.
“Bricks and mortar and building is one thing, but even when you get a facility built, it’s getting the support in the long run toward operational support in staffing, and finding the right staff,” Demple said.
He said staffing for any occupation often proves difficult in Wyoming but is especially hard for psychiatric positions throughout the state.
The participating entities, with NWMHC leading the charge, have a host of hurdles to overcome before a facility becomes reality.
But for Demple, the No. 1 priority is such for a reason.
“It really will make a difference in people’s lives struggling with mental health issues,” Demple said about the potential implementation of a crisis stabilization center in Sheridan. “I can’t think of anything better to spend my time on, and I think we’re going to get there, but you have to tackle each of these problems head-on.”