A discussion about BHS and Title 25

he article below is part of an educational series to help the community better understand Behavioral Health Services available to them in Gillette, Wyoming.

Healthcare is one of the most heavily regulated industries in the country. For example, Behavioral Health Services (BHS) at Campbell County Health is regulated by the U.S. Department of Health & Human Services, Centers for Medicare and Medicaid Services, DNV, Commission on Accreditation of Rehabilitation Facilities, U.S. Department of Labor,Occupational Safety and Health Administration, and several others. These regulators all have their own little bent on how we will function at any given time. This, at times, presents challenges for us in mental health, but we manage to help thousands of people on a yearly basis. To be specific, BHS did 30,000 contact hours last year alone.

Mental Illness, in its broad scope, is increasing exponentially across the county, not only within our own community. Suicide is also increasing: there may be specific reasons for this but to date there are no real answers, only theories. I will tell you that there are studies regarding suicide being done as we speak and they are finding that suicidal ideation CAN be separate from any form of mental illness. In other words, suicidal ideation is not necessarily the result of a mental illness though one, I guess, could argue that someone feeling suicidal is not in their right mind. None-the-less, just because you may be depressed does not mean you are also suicidal and vice versa.

Over the years the criteria for admission to a mental facility has changed. It used to be that the walking wounded could check themselves into a facility, stay for a month or more, and their respective insurance plan would pay and they would keep their jobs. This has greatly changed. Currently, the only recognized reasons for admission to a facility are:

1. Danger to self.

2. Danger to others.

3. Unable to care for self.

This is the criteria for any kind of admission to a mental health facility. It is also the criteria required to Title 25 someone. (For those who don’t know, Title 25 covers court ordered hospitalizations for mental health and substance abuse patients.) There are many issues with this:

· Mental Illness, as a MEDICAL CONDITION, is not constant. There are ups and downs. A person depressed today may not be as depressed tomorrow, or in a few hours.

· Someone who has been drinking for days and comes to a mental health professional may be suicidal while drunk but as they sober up may not be suicidal.

· There are many types of professionals that can Title a person. This is a convenient way to get someone the help they need but not all of the people listed in the Title legislation are mental health professionals.

· Drugs also play a role. Consider someone that has been up for days smoking meth. As the drug tightens it grip on a person, as the days pile up with no sleep, one can easily become suicidal. Once they get some sleep and away from the drug they no longer are suicidal.

· Consequently, many people come in to the Emergency Department here, suicidal, and after waiting for a period of time, clear to the point where the Title, written by the police, are no longer a danger to themselves or others. The Title 25 at this point is no longer valid and is often dropped. If this person does not follow up for out-patient therapy, or to see a psychiatrist, there is nothing we can do.

· This does not address the many people who come in looking for prescription drugs claiming to be suicidal just to get what they want and in that process clog up the system as a whole.

Jeff Rice is the director of Behavioral Health Services at Campbell County Health. BHS provides professional mental health and substance abuse services to the community through prevention, education, advocacy and treatment for all ages in the community. Appointments are available Monday–Friday from 8 am–5 pm. Call 307.688.5000. Learn more a twww.cchwyo.org/BHS.