LARAMIE –– Despite a record-high need for mental health and substance abuse services, the Wyoming Department of Health, which provides support for community mental health centers across the state, faces a $7.5 million budget reduction, effective July 1.
A study conducted by the Kaiser Family Foundation (KFF) reported that between April and May 27.2 percent of Wyomingites reported they had anxiety, a depressive disorder or both (compared to 30% nationwide); of them, 22.4-percent reported needing counseling or therapy, but were unable to receive it.
With budget cuts, some centers will be forced to reduce hours or services and discontinue certain outpatient programs, specifically those relating to rehabilitation or substance use.
Other centers may have to downsize their mental health workforce, including psychiatrists and psychologists, psychiatric nurses and addiction counselors.
Heather Barnes, an intern at The Clinic for Mental Health Wellness in Laramie, spoke on behalf of a nurse practitioner who was unable to comment directly to the Boomerang.
“The way insurance works right now with Medicaid and Medicare, it can be really frustrating for providers,” Barnes said, adding even without budget cuts, behavioral health patients have a limited allotment for insured visits. For example, a plan may cover 12 office visits in a single year.
However, if a provider believes weekly sessions are necessary for the care and safety of a patient, state insurance will only cover the first 12 weeks.
Barnes further explained if a patient exceeds that predetermined number of visits, access to mental health services can become very expensive.
In some cases, providers can advocate on behalf of their patient and apply for extended coverage, Barnes said, but the application process is time-consuming.
“These are not small applications … you have to explain why (a patient) needs (extended care),” she said.
Another impact the community may face in the wake of health-related budget cuts is an increased burden on hospital emergency rooms and other first-responders.
Lack of services often fosters worsened conditions and adverse consequences such as frequent emergency room visits, hospitalization, homelessness and youth entanglement in the juvenile or criminal justice system, according to the American Addiction Centers, National Rehab Directory.
Although Ivinson Memorial Hospital’s Emergency Room hasn’t seen a significant increase in acute behavioral emergency visits, ER Director Erin Rumsey said she has noticed an overall rise in patients needing immediate care for substance abuse, which has been a growing issue in Wyoming.
Nearly 7 percent of Wyoming residents reported having an alcohol disorder and .7 percent of people ages 12 or older reported opioid dependence or abuse. In 2020, drug overdose deaths increased from 12.2 per 100,000 to 16.7 per 100,000, according to the KFF.
“We’re seeing a lot more patients who are coming in wanting alcohol detox, or having trouble with drugs and alcohol abuse,” Rumsey said.
She believes this is a direct result of the pandemic and COVID restrictions.
“They get to a point where they’re at their last straw and (the ER) is where they come,” she added.
Rumsey said behavioral health is a matter of concern in Albany County, and she has confidence in the behavioral health unit at the hospital. But she also expressed growing concern for primary care and said further cuts could result in increased crisis response by the ER.
“We’re very fortunate here that we very rarely have to board our behavioral health patients,” Rumsey said.
But she added they only have 11 beds in the ER and average around 35 patients a day — any increase in acute behavioral health patients could cause a bottleneck in services.
She also said caring for mentally ill patients in an ER isn’t necessarily safe. Currently, the ER at IMH has one bed devoted to behavioral health.
“In a sense, it’s devoted because we can make it a really safe environment for patients who might be in acute crisis or aggressive,” Rumsey said, but they require one-on-one care meaning it takes away from the ER staff.
“Because of our numbers and beds, my max staffing is three nurses,” she added, and it can be challenging for other acutely ill patients who also need immediate care and attention.
The ER experiences “a handful” of behavioral health patients every day, Rumsey said, and it increases during certain seasons like Christmas or finals week at the university. If budget cuts continue and volume increases, the ER will feel the effects and consequently have difficulty providing care in a timely manner.
“The ER is not the best place for (acute behavioral patients) to sit and wait (because) we can’t really provide an environment where they get the resources that they need,” Rumsey said, adding, “We’re just there to get them stabilized.”
The KFF stated on its website out of the 30 different mental health services, only 22 are covered for “categorically needy traditional adult beneficiaries.”
Many of the services left uninsured are those relating to substance use disorder, including inpatient detoxification, residential rehabilitation and outpatient rehabilitation.
The millions-of-dollars budget cuts to the Wyoming Department of Health could potentially pose more challenges to individuals seeking substance abuse care.
There is, however, a silver lining Kim Deti, media relations for WDH, mentioned in regard to community mental health centers.
“At this point, we don’t have details, but there may be some additional temporary federal funding available through the most recent federal legislation passed in response to the pandemic,” Deti said, “There may be interest in using this funding to support mental health services.”
In the meantime, community behavioral health reform may be underway as the state health department seeks public input on the current Wyoming behavioral health system.
Through House Bill 38, WDH is required to consult with affected stakeholders as it develops a redesign for the state-funded behavioral health system.
“We see this as a unique opportunity to help set up this system for a sustainable future … target(ing) those most in need,” Deti said, adding that helping those individuals may reduce the burden on hospital emergency care.