EDITORIAL: Title 25: an expensive necessity

Posted 5/12/15

Title 25 has been around for many years. Its current version was approved by the 2011 Wyoming Legislature and went into effect in 2012, but its impact took a few years to strike and solutions are in the works.

How do you help someone who is a …

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EDITORIAL: Title 25: an expensive necessity

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Mental health is a sensitive subject, and treating it is costly — combine the two under a state law, and it becomes particularly contentious.

Title 25 has been around for many years. Its current version was approved by the 2011 Wyoming Legislature and went into effect in 2012, but its impact took a few years to strike and solutions are in the works.

How do you help someone who is a threat to themself or to others? Who is responsible for getting help for those who aren’t in their right state of mind — for whatever the reason may be: mental illness, drugs, alcohol, or just as a victim of intensely stressful circumstances?

This is where Title 25 steps into play.

Park County commissioners recently signed an agreement that makes Cloud Peak Counseling Center in Worland an option for Title 25 patients, and that’s a positive change for families impacted by mental health issues and for financial impacts brought on by the law.

Title 25 patients previously found themselves shipped off to hospitals across the state, creating financial burdens for the counties and the state, and emotional burdens for families.

Mental health matters

State mental health statistics are a sobering reminder that although Title 25 may not be perfect, there is a need for the state to address mental health issues.

On a national scale, Wyoming usually is in the top five for the number of suicides per 100,000 individuals.

Suicide is the seventh leading cause of death in Wyoming, with 128 instances in 2013, according to the Wyoming Department of Health’s “Wyoming Vital Statistics: Annual Summary 2013.”

For men, it is the fifth most common cause of death, with 111 cases in 2013. It is not in the top 10-list for women.

Suicide is the second leading cause of death for teenagers in Wyoming, and an estimated 10-15 percent of Title 25 patients are minors.

In Thursday’s edition, the Powell Tribune printed a guest column about the importance of talking to kids about bullying.

Cost

Title 25’s pay structure is a double-edged sword. On one hand, it is imperative that everyone have access to care — but on the other hand, it’s an expensive state mandate that often leaves counties footing the bill.

Patients without insurance or the ability to pay for their care are covered by the county for the first 72 hours of the individual’s hold, and then the state picks up the cost after the first 72 hours.

That 72-hour timeframe is intended to function as a period for stabilization, since many Title 25 patients are merely reacting to stressful circumstances or are under the influence of drugs or alcohol.

Those cases usually end with the patient sobering up or calming down, then going home with some out-patient checkups. Patients who are violent or intoxicated currently are not accepted at Cloud Peak as Title 25 patients.

The Cloud Peak Counseling Center’s executive director, Mark Russler, said Title 25 patients typically stay at the facility around eight to 10 days before returning home for ongoing care.

The state provides about $795 per day for covering the cost of treating Title 25 patients, but Cloud Peak is not a state-designated facility, so it doesn’t receive state reimbursements for care past the first 72 hours.

If a deal could be worked out so facilities such as Cloud Peak could receive state funding, then Title 25’s burden could be significantly lighter. Under its new deal with Park County, Cloud Peak charges $325 per day, less than half what the state currently pays per patient.

But, as is often the case with healthcare, nothing is that simple — just like getting access to specialized healthcare can be.

Hospitalization under Title 25 includes 24-hour care with psychiatrists and nurses. Not only are those facilities few and far between in Wyoming, they also are expensive.

The Wyoming State Hospital budget for Title 25 is a little over $4.3 million annually, said Kim Deti, the Wyoming Department of Health’s public information officer.

Title 25 patients may receive aftercare or follow up treatment at a state-funded community behavioral health provider under a sliding fee based on income after being discharged from the hospital, Deti said.

Who pays

The hospital can ask the patient to complete an affidavit to show that he or she does not have insurance or is unable to pay. This relieves the hospital’s obligation to collect the costs from insurance, the patient or other programs.

At this point, the county becomes responsible for the cost of the first 72 hours of detention plus any weekend or holiday that falls within the 72-hour period. So hypothetically, a person could be in care for nearly a week if there’s a holiday and a weekend — and the state says the county has to pay for it, even if the patient is not a resident of the county.

Once the 72 hours are up, the Wyoming Department of Health becomes responsible for emergency detention costs.

The same payment provisions apply to transportation during that time, along with any court and attorney costs. If the person is not a resident of Wyoming, then the Wyoming Department of Health covers the court and attorney costs.

No vacancy

There still is a lack of beds across the state for Title 25 patients.

It’s not uncommon for Title 25 patients to end up on waiting lists along with 25-30 other people before they can go to a psychiatric hospital.

There are about 250 beds available for the entire state, including the state hospital, the Wyoming Behavioral Institute in Casper, Pine Ridge in Lander, Campbell County Memorial Hospital and Cheyenne Regional Medical Center. The Wyoming State Hospital has 75 designated Title 25 beds, Deti said.

Cheyenne and Laramie and the state hospital have beds available for patient transport, but those numbers are limited.

There were 131 possible Title 25 patients assessed in Park County at the Yellowstone Behavioral Health Center and holds were placed on 18 of the patients last year. Cloud Peak has five beds and plans to expand to eight in the future.

In the past, local patients had to be treated in Casper or simply held at West Park Hospital in Cody or Powell Valley Healthcare until a bed opened up at the state hospital in Evanston.

Cheyenne has no problem making new laws, but making the facilities available to adequately follow laws like Title 25 is a different story.

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