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Mental health care in the Title 25 process

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Wyoming Medical Center

Wyoming Medical Center is the state's largest hospital. Northern Wyoming Mental Health Center offers services for those involuntarily held under Wyoming's Title 25 process. 

SHERIDAN — Despite a deeply flawed system lacking funding, facilities and staff, a team of medical and mental health professionals from across Sheridan County work together to coordinate appropriate mental health evaluation and treatment for those involuntarily held under Wyoming’s Title 25 process, said Jennifer White, clinical director at Northern Wyoming Mental Health Center.

Title 25 establishes a single point of responsibility — called a gatekeeper — to monitor and coordinate emergency detention and involuntary treatment within a particular county.

Aside from offering outpatient mental health and substance use disorder treatment, Northern Wyoming Mental Health Center staff have taken on the role of gatekeeper in Sheridan County.

NWYMHC announced plans to merge with Volunteers of America Northern Rockies in June, with official consolidation of the two organizations Sept. 1. According to VOANR’s website, NWYMHC’s offices in Sheridan, Buffalo, Newcastle and Sundance are still providing services to Sheridan, Johnson, Weston and Crook counties.

When someone is involuntarily detained under Title 25 in Sheridan County, NWYMHC is notified or directly involved, White said. That notification can happen at several points in the Title 25 process.

At times, NWMHC receives direct calls from law enforcement to evaluate a patient, White said.

When a person incarcerated at the Sheridan County Detention Center is exhibiting signs of a mental health crisis, the jail calls NWYMHC directly to evaluate the individual, White said. From there, mental health providers work with the county attorney’s office to determine therapeutic goals for the patient.

Occasionally, Sheridan County Sheriff’s Office deputies or Sheridan Police Department officers will call NWYMHC seeking consultation about someone in the community in a mental health crisis, White said. Law enforcement and mental health providers will work together to determine a course of action in these rare instances.

“Law enforcement in Sheridan County are quite competent in determining an initial emergency detention,” White said. “Ninety-nine percent of the time, they don’t need us for that.”

When a patient has already been transported to Sheridan Memorial Hospital by law enforcement, White said NWYMHC is notified but not involved in the evaluation process. Instead, in-house evaluators at SMH assess the patient’s mental health condition, SMH Emergency Department Medical Director Dr. Luke Goddard said. After medical stabilization, titled patients meet with a social worker or psychiatrist, often via telehealth, for a mental health evaluation.

The mental health assessor reports what level of care is necessary for the particular patient, ranging from an outpatient placement with NWYMHC to an inpatient stay.

White said NWMHC enjoys a collaborative relationship with SMH’s social work team; the two organizations remain in constant communication, working together to develop next steps for patients. When SMH staff release a patient, hospital social workers often call NWMHC ahead to ensure a warm handoff into outpatient treatment.

“It’s really crucial, that relationship. We’re all focused on the same thing, which is just to do the right thing for the patient,” White said.

A similar system works at the Sheridan Veterans Affairs Health Care System to provide care to involuntarily committed veterans, Sheridan VA Licensed Professional Mental Health Counselor Jennifer Fairbanks said.

Interdisciplinary teams work to keep veterans safe and deliver mental health treatment while the Sheridan VA’s mental health treatment coordinator and other outpatient providers are informed of the hold and the patient’s progress, Fairbanks said.

NWYMHC is also authorized to hold patients directly.

If a professional deems a NWYMHC patient an imminent risk to himself or someone else, White said staff can initiate an emergency detention right there. She will explain his rights, why he is being detained and why the hospital is likely the best place for him.

Most of the time, White said she will simply walk over to the SMH emergency room with the patient. In rare circumstances, law enforcement is called to transport the patient.

Finally, White said, NWYMHC is involved in providing court-ordered outpatient mental health treatment to people whose Title 25 cases have been adjudicated.

Deputy County and Prosecuting Attorney Clint Beaver said Sheridan County’s involuntary commitment system favors court-ordered outpatient treatment, in contrast to other counties throughout Wyoming. Beaver said Sheridan County orders about one in 10 titled patients requiring a hearing to outpatient treatment, and most of those patients seek mental health care at NWYMHC.

White said her office heavily personalizes outpatient treatment to fit individual needs but often involves several hours of treatment — which can include individual and group therapies, peer support groups and psychiatry, among others — per week for the first week or two after the patient is released from emergency detention. This system offers the patient additional support while stabilizing, White explained.

“In Sheridan County, we have a good collaborative system between the county attorney’s office, the hospital and us,” White said.

Despite this collaborative system, Wyoming’s lack of mental health facilities and professionals nonetheless leaves gaps in care provision, White explained.


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