"There Are Empty Beds:" Counties Turn To Crisis Center As Alternative To Hospital, Jail

Mar 13, 2015

A bed at Worland's Crisis Center.
Credit Miles Bryan

Part 2 in our Title 25 series. Read Part 3 here.

The Cloud Peak Counseling Center in Worland looks more like a nursing home than a psychiatric hospital. It’s a small building with murals on the walls and a game room with leather couches. In fact it isn’t technically a hospital at all.

It’s a “Crisis Stabilization Center:” a place where Title 25 patients in the area can be taken for psychiatric treatment for the first three days that they are held. It only has a few beds, but here in in the Bighorn Basin, where the nearest psychiatric hospital is hours away, it has had a huge impact. 

“Before the crisis center began accepting Title 25 patients [some] did go to jail,” Director Mark Russler told WPR. “Since we have opened no [Title 25 patient] has been put in jail here in Washakie County.”

Cloud Peak Crisis Center Director Mark Russler.
Credit Miles Bryan

Neighboring Big Horn County and Hot Springs County also send non-violent Title 25 patients to the Worland Crisis Center as soon as they’re detained (violent or aggressive patients are sent to the Wyoming Behavioral Institute, a fully equipped psychiatric hospital in Casper.) Russler said that since the crisis center opened Washakie County’s Title 25 costs have fallen by fifty percent. The Crisis Center charges 325 dollars a day to house and care for Title 25 patients. By comparison, the region’s primary care hospital charges more than one thousand dollars a day for a bed, and it does not provide any psychiatric care.

These savings have been passed onto the state. Russler says that out of over a dozen Title 25 patients admitted to the Crisis Center in the last two years, only one had to go on to a psychiatric hospital. The rest were released before their initial 72 hour holds were up.

The state only starts paying for Title 25 treatment after the first three days that someone is detained--that initial period is the county’s responsibility--so patients released before those three days are over cost the state nothing. Russler says not only has the Crisis Center proved cost effective--it's also just been better for their patients.  “You are treating people closer to home,” he said. “You don’t have to send [the Title 25 patient] on a five and a half hour road trip when they’re sick.”

For now this Crisis Center model for treating Title 25 patients is unique to the Bighorn Basin. But that’s not for lack of facilities. There are two other state-funded crisis centers in Wyoming: Southwest Counseling in Rock Springs, and Peak Wellness in Cheyenne.

They are just not allowed to take Title 25 patients.

That does not sit well with Wyoming’s Department of Health. Chris Newman is a Senior Administrator with the state’s Behavioral Health Division. She told WPR that, while the number of Title 25 patients in the state is going up, “we have [crisis center] beds sitting empty.”

The waiting room at Cloud Peak Crisis Center in Worland.
Credit Miles Bryan

The problem is with how Title 25 is written. The statute says state money cannot be used to pay for treatment provided within the first 72 hours that someone is detained for mental health issues. So even though beds are sitting empty at the crisis centers in Rock Springs and Cheyenne, they can only be filled by patients seeking voluntary treatment.

Worland’s crisis center is only able to take Title 25 patients because counties in the Bighorn basin got so frustrated that they started contributing county funds to pay for the care. Newman says state officials would like to have more flexibility with state mental health care funds, but that would require a change to the statute. “We would have to have a bill going through the legislature,” Newman said. “They would have to approve whatever changes that were made.”

A bill in the 2014 legislative session would have made some of those changes, but it was voted down.

However, the crisis centers in Rock Springs and Cheyenne both indicated that an influx of state funding would not necessarily mean they would immediately begin to accept Title 25 patients. Representatives from both told WPR that they would need to increase their staffing and security levels for that to happen. And while Rock Springs’ Southwest Counseling Center said that it was open to exploring the possibility of taking Title 25 patients, Peak Wellness in Cheyenne was opposed to it, saying that it wanted to focus entirely on voluntary crisis treatment.

Worland’s crisis center has only been accepting Title 25 patients for two years, but it's already garnering attention in Wyoming’s mental health community. If it continues to drive Title 25 costs down, and increase the quality of patient care in the Bighorn basin its collaborative model may inspire other counties to band together. It may even inspire a change in the Title 25 statute itself.