This story is part of a series between OZY and Well Being Trust called Mental States of the Nation, where we explore ways that different states across the U.S. are enforcing and facilitating mental health parity.
Behind the astonishing natural beauty at Yellowstone National Park, Wyoming hosts a dark secret: It ranks fourth-highest in the nation for suicides. According to the Wyoming Department of Health, Wyoming has approximately 21 deaths per 100,000 people each year, compared to an average of 13 deaths per 100,000 for the entire U.S.
This mental health crisis is exacerbated by numerous rural areas with poor access to mental health care. That, and Wyoming voted against expanding Medicaid insurance in 2015, which supports some of the most economically disadvantaged individuals. But despite a difficult year in 2015, Wyoming has made some significant changes to their mental health policy which has helped lower the number of hospitalizations. In fact,
Public records show that Wyoming had just 245 hospitalizations in 2018, compared to 341 in 2015.
According to Stefan Johansson, policy administrator for the Wyoming Department of Health, another reason 2015 was so challenging has to deal with something called Title 25. Title 25 is a civil procedure statute that details both the legal requirements for an emergency detention and involuntary hospitalization for folks who might be a danger to themselves or others. “We saw a sharp increase in the number of people committed compared to previous years,” says Johansson.
Emergency detention typically begins with law enforcement and ends in the court, where judges — not mental health professionals — make the call on whether a person should be released or transferred to the Wyoming State Hospital in Evanston. Between 2012 and 2015, hospitalizations statewide jumped sharply from 208 to 341, and just one year later were up to 357.
“These numbers may pale in comparison to other states, but we are a small population, so it’s all relative,” Johansson says. Increased hospitalizations can put a massive strain on the state’s mental health system (which often has a hospital waitlist of as many as 50 people) and on the Department of Mental Health’s budget to pay for overflow. “We spent $ 18.5 million on Title 25 payments, when we had only about $ 4.3 million allocated,” Johansson explains.
By then, Johansson’s department had raised the alarm and reached out to Governor Matt Mead for help. Mead worked closely with Johansson’s team to establish a joint task force: Together, they reviewed which Wyoming counties were overutilizing Title 25, and captured real-time data on things like insurance sources and private hospital claims to see where the money was going.
Additionally, legislative reforms to Title 25 allowed for what Johansson calls “directed outpatient commitment.” This reform essentially opened up reserved state funding that allowed the Department of Mental Health to offer grants to smaller facilities in an effort to expand their outpatient treatment capabilities.
“We’re so focused on this one issue — finding more psych beds — that we’re missing the whole point: helping the patient and their families first.”
Arpan Waghray, chief medical officer for Well Being Trust
All of these collective changes worked to create a downward trend in Wyoming’s hospitalizations. In 2017 there were only 259, and in 2018 there were just 245. The Department of Mental Health’s costs also dropped from $ 18.5 million to just over $ 10 million.
While these changes are a great start, they won’t solve the overarching mental health crisis. Sheila Bush, executive director of the Wyoming Medical Society, says her association advocates “strongly for the role that preventive strategies can play in addressing cost and delivering the highest-quality services to patients in need.” However, she says it’s an ongoing struggle for the Wyoming legislature, which has to “pick and choose between funding priorities.”
Arpan Waghray, chief medical officer for Well Being Trust, believes that health care systems need to look upstream and proactively help communities thrive before these problems even arise. “We’re so focused on this one issue — finding more psych beds,” he says, “that we’re missing the whole point: helping the patient and their families first.”
Waghray suggests that a way to help is through the implementation of newer models of care, where health care policies and organizations can empower people through things like peer support groups, greater access to primary care through telehealth and educating families on social factors that make people healthy. “If family members had access to good knowledge and quality care early on,” he says, “maybe they could pick up warning signs.”
