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Casper Psychiatrist says Wyoming faces mental health challenges

Dr. David Martorano
Courtesy of the Wyoming Behavioral Institute
Dr. David Martorano

It's Mental Health Awareness Month and to discuss that we are joined by Dr. David Martorano who is the Director of Adult Psychiatric Services at the Wyoming Behavioral Institute in Casper. He's a specialist in addictions and he discusses some of the challenges facing mental health care in Wyoming.

Bob Beck: So sort of size up the state of Wyoming mental health care. What tends to be the greatest thing that you worry about when it comes to mental health?

Dr. David Martorano: I think that we don't have an integrated approach to managing mental illness in Wyoming. I think that's a big challenge. I had the opportunity to talk with Governor Gordon last week for about five minutes about my specific concerns. We have major challenges in substance use, we have challenges on how we allocate resources within the state. And so availability of things for people is a real challenge. So I would say that that's one of my biggest concerns.

BB: Are you saying there are some areas in the state that might do a pretty good job with substance abuse and other places not so much?

DM: I wouldn't even say it's just geographical at this point, I would say that the challenges really are manifold, it's hard to just sum up what the challenges are. They include the fact that even within the substance use community and treatment of substance use disorders, there's a wide varying opinion nationally and locally about how you manage substance use disorder. So that's a challenge in and of itself. So then you'll have a variety of different training levels for the people who are providing mental health and experience levels. And that can also be a challenge because as a consumer, it's very difficult to know how you're selecting the care, and what care is most appropriate for you, and what's going to work best for you. So the availability, when I say availability, I don't just mean that there isn't somebody to do the job, I mean, knowing where to go to get something. If you imagine the days pre-Amazon, for instance, if you wanted to buy something back in the old days, you had to go to a place that sold that thing. And you had to know what place to go to buy the thing that you needed, and you had to know what things you needed. A lot of times people in crisis experience symptoms, but they don't necessarily know what the underlying root cause of the problem is.

BB: And that's obviously critical if you want to treat somebody.

DM: Yes. And again, the sad part with mental health at this point, is that people will argue greatly about, even if we know exactly what you have, what the best way of treating that is. Whether it's purely psychopharmacology, or whether it's a combination of medications and psychotherapy, or whether it's something else entirely…some other more holistic approach. You're going to hear many different people argue about that as well. So getting a correct diagnosis was hard, and then getting the best treatment. I don't know if I can even tell you today what the best treatment is, I can tell you what I think something is, but that doesn't even make that the best one.

BB: So how do we get to the bottom of something like that?

DM: I think that having more resources available tends to improve the market. You know, going back to this Amazon idea, if you can only buy one part, and the part has a three star review on Amazon, and you go to buy it, then you'll buy the one part because what are your other options? Versus if you have an array of options, and you read other people's reviews over time, you can then make decisions and determinations about which party is going to suit you best and fit that purpose. So since we have so few resources available, you know, this supply chain crisis in general, I think has highlighted you buy what's there. And then you try to make it work. So I think we need more resources available. And then I think we need more information about how the resources work and how they can work together.

BB: When you look back in the last couple of years, and you look at COVID what did you see as a growth in as far as mental health concerns are? I know, we had an opportunity to maybe visit about this a little bit a few months back, but just for this audience. What did you see and what can you share with us?

DM: Well, now I see more and more hopelessness for people. You know, the great resignation has been termed right. A lot of people kind of quit jobs during COVID. And they're less equipped now to go back. And it leads to substance use and it leads to more depression. They have burned through the last of their resources, they have no money left. They have no kind of safety net of any sort left. They've already used all those different things. And now they feel more desperate than ever and more plus. And I think that that's the hardest part for them.

BB: When you say they're not ready to come back to work, what do you mean by that?

DM: Well, I mean, they're not equipped anymore. Even cognitively, you know, a workweek is a hard thing. And even when you look at your children and adolescents, and then you see your kids get a part time job, and then they get a full-time job. And when I'm training young doctors, you know, initially, even when I was in med school, they would give me four patients, and they would give me a whole day to work up for patients. And now as a practicing physician, it's a multiple of that number. One, if I didn't practice medicine for two or three years, even though I have the education and possibly the qualifications still to help people, I wouldn't have the kind of cognitive mental agility to handle the loads that I do today, because my brain won't work the same way.

I was reading an article today on the housing crisis. The latest thing, which is now the downturn in demand, because housing prices went up so much, but housing prices went up so much, that people don't think of a home as affordable anymore. And there's a whole group of people that just don't really connect to the idea that they'd ever be able to buy a home. And so why work, you know, why do anything if you can't have the things that you'd like to have with those and the motivation? So I think there's a lot of different factors now, kind of resonating through our society that make people feel hopeless.

BB: One of the issues that we've always had in our state is suicide. And as long as I can remember, we've always been one of the tops in the country in suicide. There's been a lot of discussion about trying to solve this and get to the bottom of this. Are we making any progress there at all?

DM: Well, if you look at it relative to the increases in depression, I think we have made some progress. Severe depression is up, as I mentioned previously, 700 percent in the last two years. Suicide, while it's increasing has increased within 10 percent, not, you know, 700 percent. So I would say that we're doing something right because we didn't have a 100 percent or 200 percent increase in the number of suicide attempts.

BB: We have a suicide hotline that we've added in our state, of course, the national one continues to get a lot of attention, how might that help and change things?

DM: Being able to reach out always helps. I think that knowing that someone's there, and someone picks up the other end of a phone helps people who are on the fence. I think, unfortunately, availability of firearms remains a high-risk factor. And then as I've mentioned before, substance use remains a high-risk factor, independent of those things. Because when you decrease people's ability to control their impulsivity, you increase the chances that they'll do something impulsive, like attempt suicide.

BB: How active do you suggest some of us be involved? We all know people who are maybe going through a tough time, what's the signs to watch for to maybe make a call on their behalf or to try and contact somebody?

DM: I think early intervention is the key when people are first showing signs of mental health challenges. And what I'm saying is that when your friend or your loved one calls you on the way home from a bad day at work, or a bad relationship change, or when you see them, you know, you call them up on a weekday and they're intoxicated, or you find out they got a DUI. These are the times that you know really checking in with people and supporting them in changing their lifestyle and habits and reaching out for the help they deserve is so critical.

If you or someone needs to talk you can call the suicide prevention hotline at 800-273-8255 or reach the Wyoming Crisis Text line by texting WYO to 741-741

Bob Beck has been News Director of Wyoming Public Radio since 1988. During his time as News Director WPR has won over 100 national, regional and state news awards.
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