MHSC CEO Jerry Klein Discusses Current Title 25 Process in Wyoming; Delaying Patients From Receiving Mental Health Treatment They Need

MHSC CEO Jerry Klein Discusses Current Title 25 Process in Wyoming; Delaying Patients From Receiving Mental Health Treatment They Need

Title 25 provides a foundation and structure for the State of Wyoming to evaluate, detain, and hospitalize persons who with acute mental illness. Several different county, state, and private agencies and organizations are involved in the Title 25 process in order to ensure that client’s rights are protected and that there is consistency in the treatment of persons when they are the most vulnerable. The Title 25 process requires that these agencies collaborate and coordinate services to ensure timely and humane interactions with individuals who are a danger to self, danger to others, or unable to satisfy basic needs as a result of a mental illness.

SWEETWATER COUNTY — During the monthly Memorial Hospital of Sweetwater County Board Meeting CEO Jerry Klein explained that psychiatric hospital transfer and treatment of Title 25 patients is being held up due to a lack of resources at the State level and outlined a plan to help alleviate the problem.

Title 25 is the law that governs how certain authorities can involuntarily hold a person they believe to be a danger to themselves or others. Those granted authority under the law include law enforcement officers and medical professionals.

According to the Wyoming Department of Health, “Title 25 provides a foundation and structure for the State of Wyoming to evaluate, detain, and hospitalize persons who with acute mental illness. Several different county, state, and private agencies and organizations are involved in the Title 25 process in order to ensure that client’s rights are protected and that there is consistency in the treatment of persons when they are the most vulnerable. The Title 25 process requires that these agencies collaborate and coordinate services to ensure timely and humane interactions with individuals who are a danger to self, danger to others, or unable to satisfy basic needs as a result of a mental illness.”

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The law specifies that a person can only be held for up to 72 hours before having a hearing in a court. Although that time period can be extended due to holidays and weekends that make the court unavailable.

According to Klein, in recent years the number of Title 25 patients being treated at the hospital has increased dramatically while the in-state resources to treat them have not been keeping pace, resulting in a backlog that is hampering patient recovery and costing MHSC a significant amount of money.

Klein explained that after a patient has had a hearing and the Judge has decided they in fact can be held under Title 25, MHSC runs into an issue of bed availability at a psychiatric institution that can provide the full range of services required by the patient. When this happens,  a patient can essentially become stuck at MHSC until a bed opens up at a psychiatric facility.

Sweetwater County is obligated to pay for the first 72 hours of a Title 25 patient’s stay at MHSC. Anything after that is reimbursed by the State at a rate of $782 per day, which doesn’t even cover the average room rate.

Title 25 patients often require additional services such as a physician and psychiatrist along with a behavioral health monitor to watch over the patient to protect the patient against self harm, in addition to any medications or other services required.

“Typically, we can’t place the patient into a proper treatment facility the day the judge remands them,” Klein said. He explained that the wait to get a patient into a psychiatric facility can be as high as 30 days.

While the patient is at MHSC their care cannot be advanced because the order of the Court is that the patient should receive care at a Licensed Psychiatric Hospital, which MHSC is not.

“So not only are you delaying the patient’s ability to get treated and get well, it’s not cost-effective for Memorial Hospital, Sweetwater County or the State,” Klein said.

Klein said that because of the demand for bed space in state psychiatric facilities, patients often find their stays cut short to make room for new arrivals. Klein said that the short stays can result in a patient being released before they are truly ready.

The early release often results in the patient being readmitted at MHSC through the Title 25 process after experiencing a re-occurrence of their mental health issue.

 

Could There Be Another Solution?

Klein said that one solution is to look beyond the borders of Wyoming. Klein said that nearby facilitates such as the University of Utah Neuropsychiatric Institute (commonly referred to as UNI) can accommodate the patient load. “They have every level of service for every age group and complexity there is and they have open beds. If we have a patient that needs treatment they could take them that same day.”

Klein explained that in order to make use of a facility in another state the law would need to changed, “The Court in Wyoming has decided to detain that patient, so when you cross the border you need some sort of arrangement to detain them in Utah,” Klein said that the detention issue seems workable but the bigger problem they are facing is that right now the State of Wyoming will not pay an out-of-state facility to treat a Title 25 patient.

“We are trying to open discussions with the Dept. of Health and Human Services at the state level or the Legislature to denote UNI as a deemed status facility. Which would mean we can send a patient there and the State would pay for their care,” Klein said.

Klein explained that the advantages are obvious, “Now you can see the advantages, if we use the Wyoming system and the hospital has a patient we can’t get in anywhere, often we have them here for let’s say an average of a dozen days, so the patient isn’t moving on in their care. The hospital isn’t getting paid for services provided. So nothing good is happening. If you had a patient being detained and a Wyoming system that would allow the patient to cross state lines I could have them down to UNI that same day. In the same twelve days the patient could be in a psychiatric facility, fully treated and discharged the way they need to be treated. This also improves patient care and saves the hospital and the State of Wyoming money.”

Klein explained that they need to be sure that patients can be sent across state lines and that UNI will inevitably be paid, “That’s what we are trying to do by clearing out those two obstacles.”