Health Department seeks more money to address involuntary commitments - Casper Star-Tribune Online

The head of Wyoming’s Health Department wants some $20 million in additional legislative funding largely because of the high number of involuntary commitments, many of which take place in Natrona County.

“In my budget I have approximately $4.5 million for designated hospital payments for (the two-year budget cycle),” Tom Forslund said. “For the current biennium, we anticipate having approximately $25 million in costs, so I have a projected deficit of over $20 million.

“Needless to say the Legislature has been very concerned with the issue. The governor is very concerned with the issue,” Forslund added.

Forslund made the comments this week at a work session of the Natrona County commissioners, which was attended by health and service agencies.

The state contracts with community agencies for care, as the state hospital does not have the facilities to handle the number of court-ordered cases.

Forslund said some legislators are considering shifting the costs to counties and local governments.

“It’s a local government/community problem, so the money needs to be reallocated over to the state hospital to pay for these costs,” Forslund said, explaining the lawmakers’ thinking.

Commissioner Rob Hendry said the county was in no position to absorb such a high amount.

“Twenty million dollars is half our budget. Now I know that’s not all in Natrona County, but the state’s broke, so we’ve got to fix it,” Hendry said.

More than 800 mental health-related cases were referred for treatment by Natrona County courts in 2015. That’s almost three times as many as Laramie County, which with around 275 patients had the next highest number.

The growth in Natrona County’s patient load has been building over the last few years. Forslund said a task force has been unable to pinpoint the reasons.

The numbers did not fully support a theory that non-county residents were coming to Casper because it’s a hub for providers in the state, he said.

However, many of the patients are treated at the Wyoming Behavioral Institute, and CEO Joe Gallagher said the state data is likely not catching all of the out-of-county patients.

“People who end up at WBI may end up from multiple counties, but they don’t necessarily know where they came from, or they don’t have it identified at the front end, so they are identified as Natrona County people,” he explained.

Local agencies have also been studying the issue. One of the problems is a lack of intermediate care facilities, with the options primarily being involuntary commitment, release and in some cases, jail.

The Wyoming Legislature in its most recent session approved a measure that provides for counties to designate a “gatekeeper” agency that would have the authority to review and track anyone referred for mental health assistance by the courts.

The hope is the gatekeeper could help direct courses of action, particularly when intermediate levels of assistance were appropriate and available. That would, in theory, avoid the high costs of unnecessary emergency room and other hospital treatment or commitment at WBI.

The commissioners were told that the Central Wyoming Counseling Center will be re-purposing one of its wings to provide five crisis stabilization beds for intermediate care and an alcohol and substance abuse detox unit in December and January. The goal is to have up to 12 beds.

Another new component is converting a building owned by the Wyoming Medical Center into a facility where outpatients can receive directed long-term care and also come for initial assistance.

In the meeting, Forslund said his department had selected Natrona County for the pilot gatekeeper program and recommended Central Wyoming Counseling Center as the gatekeeper.

The commissioners gave unofficial approval of that recommendation, with formal approval needed at a regular meeting.