The closing of an inpatient psychiatric unit in Lander has highlighted another issue in the state's mental healthcare system. That's the difficulty of transporting a mentally ill patient to and from a hospital.
If a person in northern Wyoming needs inpatient psychiatric care, the first thing they need to tackle is how to get to the hospital.
"When you're having someone, who is suicidal and decompensating and very sick and then has to be transported for three to four hours, that's really difficult," said Mark Russler, the director of Lighthouse, the inpatient crisis stabilization center in Worland.
There are only five inpatient psychiatric units in Wyoming. And four of the five are located in southern Wyoming. The most northerly located one is in Casper. Russler said that limits access for people who are in a crisis.
"Not only does it impact them and their families but how do you transport them there? It's ambulance crews that have to get together and the cost of ambulance crews. It's just a huge problem," said Russler.
It turns out voluntary patients have to figure out their own transportation. Jennifer White, the clinical director at the Northern Wyoming Mental Health Center, said that can be a problem.
"A lot of these folks don't have the resources or the relatives or friends to. . . get them [to] Casper and bring them back home," she said. "There's no system set up for that."
Sometimes mental health centers can help with transportation but that is on a case-by-case basis.
Things are different for Title 25 patients. These are people who are involuntarily committed to hospitalization. For the first 72 hours that person is committed, the county where he or she is located is in charge of transportation and this is usually by ambulance. White said this is not ideal.
"Getting a person to a psych hospital by ambulance is problematic because it costs counties so much money when probably at least 80 percent of the folks that need transport do not require an ambulance," said White.
White said if an ambulance isn't available, a sheriff or a police officer will help with the transport, which sometimes can take hours. The Wyoming Department of Health usually pays for the return trip. The State Hospital located in Evanston has eight transportation officers. These officers are technically charged with transporting all returns home for Title 25 patients. For instance, if somebody from Jackson is in Cheyenne, the state hospital driver would go pick them up and take them home, which means sometimes those drivers are unavailable.
"The only other option that we have is designating our staff…we are stretched thin as it is ...to go two at a time to go pick somebody up and take them home. Or to get a taxi which is hundreds of dollars," she said.
One solution is more community crisis stabilization centers. These are one step below an inpatient psych unit. Northern Wyoming Mental Health Center CEO Paul Demple is a supporter of this solution.
"Optimally it's managed by the mental health centers and you have trained staff on 24/7. You bring people in crisis, and it doesn't need to be as intense as a locked psychiatric unit," he said.
Demple said, most importantly, it would be in the community where the patient is located so transportation wouldn't be a problem. But how to pay for such a facility is a problem. Demple said lawmakers will be looking at this issue over the next few months.