Fixes for mental health system crisis stall again

by Joel Funk, WyoFile.com

Wyoming’s Joint Judiciary Committee for the second consecutive year did not produce a bill ready for the full Legislature that would address concerns with Title 25.

It was clear from the start of the committee’s Dec. 17 meeting that a draft bill to change the legal processes for detaining a resident experiencing a mental health crisis would likely stall. 

The committee began the 2021 interim focused on working with some of the state’s county attorneys to address perceived problems with Title 25, though Senate Judiciary Chair Tara Nethercott (R-Cheyenne) told WyoFile the scope of that process was limited. 

“We were not necessarily rewriting how it works or bending the system, but just kind of subtle changes,” she said.

A working group of county attorneys crafted a bill for lawmakers meant to clear up statutory ambiguities and generally make improvements based on past experience, Clint Beaver, Sheridan County deputy and prosecuting attorney, said. But as the conversation unfolded through 2021, it became clear that stakeholders and lawmakers were drawn into larger conversations about Title 25 outside of the committee’s original scope.

Ultimately, the committee tabled the bill for another interim. The result was frustrating, said Rep. Art Washut (R-Casper), one of the few judiciary committee members who had also worked on Title 25 statutory changes during the 2020 interim.  

“I wonder what else we’re leaving unattended while we devote hours and hours to Title 25 and come to a non-productive result for two consecutive interims,” Washut told the committee.

However, Rep. Ember Oakley (R-Riverton), who was new to the judiciary committee in 2021, said that while she appreciated the amount of work that had been put into Title 25, the changes the committee was considering were not a substantial improvement worthy of prime time.

“What I’ve taken from this is that (the problems with Title 25) are systemic, and we’re not going to fix it by taking little pieces,” Oakley said.   

Title 25 of Wyoming Statute addresses emergency detentions for those suffering from mental health challenges so severe that they may be a danger to themselves or others or are unable to meet their basic needs. Stakeholders have asked legislators to fix problems with the Title 25 system for years. 

Wyoming counties struggle to find appropriate facilities for Title 25 patients and to pay for the services they need. Many had called on the judiciary committee to change statute to clarify how counties should move forward with Title 25 cases — relatively narrow amendments to existing law. 

Washut said the judiciary committee had learned a lot about approaching Title 25 changes during the 2020 interim, particularly that lawmakers needed to narrow their focus on the due process changes.  

But the Joint Judiciary Committee in 2021 saw significant turnover from the 2020 interim. On the Senate side, only Nethercott and Sen. R.J. Kost (R-Powell) carried over. Of nine House members of the committee, Washut was the only one present for the 2020 interim discussions on Title 25. 

As a result, Washut said, a lot of the lessons learned in 2020 were lost. 

“Part of the challenge that we faced this interim was that we had to kind of relearn the lessons that we learned the previous interim and we couldn’t just move forward,” Washut said.

Oakley, one of the new House judiciary members, said she understood how there could be frustration with new members from those who carried over. Still, Oakley said, she could not look at making the narrow changes the judiciary committee was considering without thinking of the whole Title 25 system across the state. 

Nethercott said there are inherent challenges with committee turnover that she’s learned to accept as part of the legislative process. 

“There was a lack of historical knowledge,” Nethercott said. “It’s drinking from a fire hydrant. Just getting your arms around any topic is hard enough, let alone this one.” 

Stakeholders at the Dec. 17 meeting encouraged lawmakers not to drop the Title 25 topic entirely, even if that means revisiting it in the 2022 interim. 

“I’m 27 years in the industry and trying to fix this problem, but we’re committed to working with whoever we can to improve access to care to help these patients,” Eric Boley, Wyoming Hospital Association president, told lawmakers. 

Stakeholders from county commissioners to prosecutors to care providers are concerned about aspects of emergency detentions and involuntary hospitalizations under Title 25 in Wyoming. 

Many parts of Wyoming, especially rural areas, lack facilities they can send people to. Staffing facilities that provide mental health services has proven difficult.

Determining which counties will bear the cost of emergency detentions and involuntary hospitalizations has become a constant issue — as has determining which county is responsible for the first 72 hours of care in Title 25 cases, whether it’s the county where contact with patients originated and where they’re being cared for.

Financial questions pop up regarding transporting patients to a designated hospital. Other questions involve figuring out how to get patients back to their homes after an emergency detention or involuntary hospitalization. 

Much of the problem comes down to the differing needs of rural and urban communities. The process through the last two years, Sheridan county attorney Beaver said, has been an education on how different counties’ needs are. 

“There’s only one Title 25 law out there,” Beaver said. “There should be uniformity, but as a practical matter, it’s almost impossible to have uniformity given the variability of each county.”

Nethercott said the message she heard from county attorneys was that the minor statutory changes the committee was considering “wouldn’t make a meaningful difference in people’s lives” given the scope of the challenge. 

“It was kind of, ‘Thanks, but no thanks,’” Nethercott said. “Unless you’re going to do something that’s going to change access to facilities and cost, don’t waste your time.” 

The judiciary committee’s consideration of Title 25 is part of a larger conversation taking place in Wyoming about mental health issues. Several legislative committees  are working on topics that could have an impact on how Title 25 detentions and hospitalizations play out in Wyoming. Nethercott told the judiciary committee she believes lawmakers should “lean heavily” on those doing concurrent work. 

Whether one problem can be solved without solving other problems simultaneously, she said, remains to be seen. 

Some have suggested that developing a statewide approach to Title 25 would be the best way to address systemic issues. While that discussion is in preliminary stages, Nethercott said, it’s worthy of exploration.

It’s difficult to provide appropriate care to patients with the state’s patchwork system of Title 25 across Wyoming’s 23 counties, Andi Summerville, Wyoming Association of Mental Health and Substance Abuse Centers executive director, said. A statewide approach, Summerville said, could make improvements on that front. 

There’s also inconsistency, Nethercott said, with costs from county to county. If the state were the payer, she said it could potentially negotiate a consistent rate across the board. 

There’s no clear vision as of yet for how a statewide Title 25 could be implemented or what the funding structure would look like. 

“I think that it might be a change that could streamline and make it a more efficient process and then give the state the opportunity to be more involved in rule-making,” Boley told WyoFile. “It’s just one option on the table to try and fix the funding side of Title 25.”

Some of the state’s county attorneys also find the statewide approach  appealing, Beaver said. 

“I have definitely heard county attorneys suggest and endorse that idea,” Beaver said. “I have not heard anybody express a negative view toward having the state take on that responsibility.” 

Such a suggestion might have its own challenges when it comes to the full Legislature, Washut said. There’s strong resistance among lawmakers to expanding the size of government. Shifting costs traditionally borne  by counties to the state, could be difficult concept to build consensus for. 

“It’s possible, but I don’t think it will be an easy sell,” he said. 

And while putting Title 25 under the state’s purview might be a step in the right direction, Rep. Karlee Provenza (D-Laramie) said, funding questions will still loom over the conversation. 

“At the end of the day, this still comes back to Medicaid expansion,” she said. “If we want to help Title 25, we need to expand Medicaid.”