Committee examines mental health, substance abuse
Northern Wyoming Daily News - 6/19/2018
SHERIDAN - The Legislature'sJoint Labor, Health and Social Services Committee heard testimony from mental health and substance abuse stakeholders during its interim meeting last week to weigh options for improving treatment outcomes and extending access to treatment across the state.
Rep. Eric Barlow, R-Gillette, the House chair of the committee, said the testimony helped him get a sense of which treatment programs were working and could potentially be applied to more of the state.
"The state of Wyoming has dedicated a tremendous amount of resources, money and personnel toward substance abuse and mental health," Barlow said. "What is not clear is, are we getting the best value? Meaning, are we investing in the best practices? And are we putting the resources in the places where they'll give us the best return?"
Much of the focus of the meeting in Buffalo centered on identifying programs that can help the state provide and improve preventative treatments, particularly for populations that have been incarcerated or committed because of issues with mental health or substance abuse.
Erin Johnson, the executive director of the Wyoming Association of Mental Health and Substance Abuse Centers, said the state has seen an increase in recidivism in recent years after the Legislature cut funding to the Department of Corrections in response to the economic downturn. The programs hit hardest by those cuts were mental health and substance abuse treatments for criminal and incarcerated populations.
Barlow noted that the increase in recidivism costs the state more in the long-run because the state ends up having to respond to crisis situations with incarceration, involuntary commitment or emergency services, all of which are expensive. Programs that provide lower-level care to populations that carry a high risk of recidivism due to substance abuse or mental health issues could save the state money by preventing crises and rehabilitating people suffering from those issues. He added that he attended a public safety forum in Cheyenne Monday where the costs and threats to public safety caused by recidivism were also a central topic of discussion.
"It became very apparent quite early we need to do a better job at directing our services at those folks who will impact public safety," Barlow said.
Going forward, Barlow said his committee would have to collaborate with the Judiciary Committee and the Appropriations Committee to identify, and fund, programs that can address recidivism issues.
Northern Wyoming Mental Health Center director Paul Demple said the center has experienced success locally with its gatekeeper program, which tracks local Title 25 cases. Title 25 allows for involuntary commitment if a patient is a danger to him or herself or others and looks for opportunities to treat those patients locally on an outpatient basis; NWMHC employs two gatekeepers who work to avoid crisis situations and costly involuntary commitments by steering Title 25 cases toward local treatment options when appropriate.
Demple said since the program started last July, 90 patients from the four counties the center serves have entered into the Title 25 process and of those, 61 have been released to local voluntary outpatient care. He also said the program has helped NWMHC reach out to new patients - 78 percent of the people local gatekeepers worked with had never been to the NWMHC.
While treating and rehabilitating high-risk populations is a priority in the state, Wyoming is facing issues with providing its broader population with access to treatments as well. Both Johnson and Demple said the purpose of community mental health centers is to ensure all citizens have access to treatment.
"One of the foundational components of being a community mental health center is providing access to behavioral health services to all Wyoming citizens regardless of their ability to pay," Johnson said.
However, there is a shortage of mental health care providers nationwide, and the trend is especially pronounced in Wyoming's smaller, rural communities because it has proven difficult to recruit providers who want to live in those areas. Demple said he has been able to slowly fill staff needs in Sheridan but has had a much harder time filling positions in Johnson, Weston and Crook counties.
"I think we're pecking away at it and making some headway, but I think there is going to be a lot of demand for these kind of jobs not just in Wyoming, but elsewhere," Demple said. "And the younger generation likes to gravitate towards bigger areas."
Barlow said his committee is researching ways to address the provider shortage.
One change in the works, he said, is streamlining the licensing process for providers who are licensed in another state and move to Wyoming.
Recruiting providers to the state, though, would likely require more incentives. Barlow said the committee is also considering the possibility of a loan repayment program for providers who move to the state, though he also noted that Wyoming used to offer a repayment program to physicians in general, but it was discontinued due to the state's limited budget. He said the committee would research the feasibility of offering certain categories of practitioners - psychologists, psychiatrists and family practitioners, for instance - loan repayment, but that research is in its preliminary stages.
Johnson said, going forward, the most significant action the Legislature can take to improve treatment in the state is restoring funding to groups like Wyoming Association of Mental Health and Substance Abuse Centers. She explained that funding for mental health groups has been cut in the last several state budgets, amounting to a loss of tens of millions of dollars. During the 2018 budget session, the Legislature restored $2 million in funding to suicide prevention. In 2016, however, the state had over $4 million budgeted toward suicide prevention and chose to cut that funding to zero, so the funding for suicide prevention is still less than it was in 2016. Demple agreed that funding would be important but said he was encouraged by the efforts the Legislature and the state are making to address Wyoming's shortages.
"One of the most important things is the Legislature, the Department of Health and the community health centers are all working toward the same goal; that hasn't always been the case," Demple said. "That's probably the most critical thing."
The Joint Labor, Health and Social Services Committee will meet again in October to consider these issues ahead of the next legislative session in January.