Nearly a third of Wyoming's involuntary psychiatric hospitalizations originated in Natrona County in the 2015 fiscal year, new data shows.
Wyoming judges issued 357 involuntary hospital orders during the 2014-15 fiscal year, which ended June 30. Of those, 112 came from Natrona County.
The figures were presented Wednesday as lawmakers and executive branch employees met at Casper College to study Title 25, the state statute on involuntary hospitalization.
People are involuntarily committed if they are a danger to themselves or others, or are unable to care for themselves. The commitment occurs after a series of hearings and evaluations. Most are already in the hospital when they are committed, said Stefan Johansson, a Wyoming Department of Health policy analyst.
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The group is studying the issue due to rising costs, increased numbers of involuntary commitments and the process’s variation by county. Committee members on Wednesday formed a subcommittee that will discuss drafting bills for consideration by the Legislature in 2016.
Natrona County led the state with 112 involuntary hospitalization orders. Sweetwater County had 76 and Laramie County had 35, Johansson said.
Lawmakers wanted to know why Natrona County had so many more involuntary hospitalizations than the rest of the state. Johansson said there wasn’t a clear reason, except possibly the county’s large population compared with other parts of the state and higher awareness of mental health conditions due to a large medical community in Casper.
Philip Willoughby, a Casper attorney who represents people at commitment hearings, said he keeps meticulous records and about 30 percent of the people who have hearings in Natrona County live outside the county and state.
Some of the potential patients are transients, he said. Casper has the state’s only stand-alone mental health hospital, the Wyoming Behavioral Institute. Willougby described one family that drove a loved one to Casper because they didn’t trust the local county hospital to keep him safe.
Conflict of interest?
Doctors employed by WBI testify at the involuntary commitment hearings, and it is in the hospital’s best financial interest to fill beds with patients, Willoughby said.
Willoughby said he didn’t mean to disparage the hospital, but there is an inherent conflict of interest when doctors provide testimony that could result in a person continuing to stay at the hospital. WBI is owned by Universal Health Services, a publicly traded company that owns over 200 hospitals.
But Dr. David Martorano, of WBI, later told the committee there will always be a conflict of interest in all medical services.
When WBI physicians evaluate whether to recommend someone for involuntary hospitalization, they use 2003 guidelines from the American Medical Association, he said.
“I think that those are what guide us along the danger-to-self, danger-to-others premise,” Martorano said.
Willoughby said the answer is more crisis centers throughout the state for people who need help for a life event such as a divorce, which is difficult but doesn’t make them a candidate for hospitalization.
It would cost the state money to fund crisis centers, but there would be long-term savings, he said.
“I think you can save a couple million dollars here if you can set up these emergency crisis centers,” he said. “Let the person sober up. Let the person get over breaking up with their husband or wife.”
Commitment process
The involuntary hospitalization process usually begins in the emergency room or with police, said the Health Department's Johansson.
An officer or doctor signs a form saying a person is mentally ill and must be detained, usually at a hospital. The person has to be medically evaluated in 24 hours and must have a hearing within 72 business hours, in which a judge will decide whether the patient should stay in the hospital for another 10 days.
By the end of the 10 days, there is a hearing where a judge determines whether the person should be involuntarily committed.
Not everyone who gets detained ends up involuntarily committed. Many people get better. Others agree to voluntary hospitalization, which prevents the need for the Title 25 process, said Martorano, of WBI.
The subcommittee that is drafting bills might look at adding to state law court-ordered outpatient care, which currently doesn't exist in Wyoming, on the recommendation of Dr. Jason Collison, president of Wyoming Association of Psychiatric Physicians.
Collison said court-ordered outpatient care could help some people if they’re not an eminent risk of harming themselves or others but who are at risk of re-entering the Title 25 system.
A study found outpatient treatment costs about half as much as inpatient care, he said.
Without a court-ordered outpatient option, people can be released 72 hours after arriving at a hospital. It’s up to them to see doctors and take medications. If they don’t, they may end up in the ER again, Collison said.
“This would be a potential place to have huge cost savings,” he said.
Laramie resident Courtney Hucke, a survivor of a suicide attempt and mental health advocate, said a stigma about mental illness exists in small towns, and people solve their worries by purchasing a six pack.
She asked the committee to consider effects on patients before making changes.
“I know we have a budget to adhere to, but also let’s think what are those lives worth?” she said.