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First Mental Health Urgent Care Clinic In State To Open In Cheyenne This Fall

in News/Business
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By Ellen Fike, Cowboy State Daily

A mental health urgent care clinic, the first of its kind in Wyoming, will open sometime this fall in Cheyenne, its company’s president told Cowboy State Daily on Wednesday.

Emily Loos of LIV Health said the clinic will open on the northern side of Cheyenne likely around the end of October, but much work has to be done before she can give an official date.

“We’re going to offer both immediate psychiatric health care and then our goal is to later have aftercare,” Loos said. “We’re going to have a psychiatric nurse practitioner and mental health therapist for the immediate intervention. But we also want to follow up with people either for mental health or case management. We can bridge that gap between now and ongoing care.”

The team at LIV Health in Cheyenne will serve patients five years and older. The mental health needs treated at the clinic will be a wide range, from LGBTQ-related issues to substance use to sleep-related disorders.

The difference between a clinic such as LIV and a “typical” urgent care clinic is that if someone is suffering from a mental health crisis, they can speak with a counselor at LIV that day.

LIV has been in business in Colorado for about eight years, but Loos has had her eye on expanding to Wyoming for a while.

The need for mental health services has been growing over the last several years, but the COVID-19 pandemic exacerbated the problem, Loos said.

But after reading an article from a therapist who opened his office to patients without requiring an appointment beforehand, she got the idea to expand mental health urgent care clinics in the Front Range region.

“This has really been a labor of love for the last couple of years with the planning and trying to find the space in Cheyenne,” Loos said. “A big part of our planning is making sure our team has all the tools and education they need to be able to manage any type of crisis that may come through the door.”

Once the clinic opens, Loos intends for it to be open seven days a week, although the business’ hours will be shorter on the weekends.

“We’d really like to be able to open this up for everyone in Wyoming to be able to access us, at least through telehealth,” she said. “Suicide in Wyoming is a big issue and we want to have the biggest impact on our patients. We want our team to really be able to reduce the number of suicides in Wyoming.”

There are not many other mental health urgent care clinics in the nation. An internet search showed similar ones in Des Moines, Iowa, Sacramento, California and Bridgeton, Missouri.

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Wyo Lawmakers Struggle To Find Answers To Fix Mental Health Care Problems

in News/Legislature
Rep Sue Wilson. Photo by Matt Idler.
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By Leo Wolfson, political reporter
Leo@CowboyStateDaily.com

In a rural state like Wyoming, with limited funding and even sparser population centers, it can be difficult to fill in every gap when it comes to providing adequate mental health care. When a jail is the only place a person having a mental health care crisis can be brought, few would disagree a problem exists. 

“We can all agree that a jail is not somewhere for someone to be treated and we don’t want someone’s situation spilling into other parts of the community,” Labor, Health and Social Services Committee Chairman Rep. Sue Wilson (R-Cheyenne) said during a committee meeting on Friday.

Over the past year, the Wyoming Department of Health has contracted with Missouri-based health organization MTM Inc. to analyze how Wyoming could improve its crisis care and residential services in both the short and long term.

“We want this work to feed into that larger, behavioral health redesign,” Stefan Johansson, director of the Wyoming Department of Health, said before the Labor Committee on Friday.

MTM has worked with WDH to develop a Certified Community Behavioral Health Clinic readiness assessment for all the state’s providers. This certification requires mobile – none of which currently exist in Wyoming – and in-patient crisis services.  

“We believe it dovetails nicely with behavioral health reform,” said Andi Summerville, executive director of the Wyoming Association of Mental Health and Substance Abuse Centers.

Wyoming Is Unique

Summerville said it’s unlikely Wyoming will be able to emulate what bigger states do for their crisis care, so finding a scalable fit for the state’s needs is the next best option.

There are four state-funded crisis stabilization programs to serve Wyoming’s 23 counties currently. These facilities host a combined 27 beds and nearly $4 million biennial budget. They are located in Rock Springs, Casper, Cheyenne and Worland.

“Having a facility in every community would be difficult to scale in a place like Wyoming,” Johansson said. 

Summerville said having only four facilities in the state creates for long drives and gaps in service for people. 

“If somebody is in Jackson and they’re in need of crisis intervention services, that’s a long trek (to Rock Springs),” she said.

These short-term residential facilities are designed to handle mental health crises, which if left untreated, could lead to placement in a more intensive clinical setting like a hospital or the Wyoming Behavioral Institute in Casper. Sometimes people from those facilities are brought to the crisis stabilization facilities as a form of a step-down before reintroduction into the public, Johansson said. 

Summerville said the goal of these facilities is to provide stabilization for a patient so they can return to their community. She said there is always a “tug-and-pull” between the needs of county and regional-level facilities.

1/3rd Of Facilities Gone

Over the last three years, six of the 17 nonprofit community mental health organizations serving Wyoming have gone away, Summerville said. In 2020, 317 people were served at these facilities statewide, an improvement from the year before.

She said there is a massive shift occurring in the healthcare industry as far as what it takes administratively to serve patients, which the COVID-19 pandemic and inflation only exacerbated. Crisis stabilization services are even more scarce.

“The smaller, each county having their own mental health care agency, it’s not sustainable anymore,” she said.

Recently, the legislature appropriated $7 million in America Rescue Act Plan funds for construction specific to crisis stabilization or women’s residential facilities. Summerville said this is still being studied, but it’s been at least a decade since any changes to mental health group homes were made in the state. 

“If they’re coming out of crisis care but they need that step-down care, but we can’t move anybody because we don’t have beds or have the right spot, it just bottlenecks the system,” Summerville said.  

Which Facilities

There are many different variables when it comes to determining which patients are brought to certain facilities in Wyoming. 

Summerville said a more cohesive overarching system is needed for Title 25 patients- the official term for involuntary mental health holds in Wyoming. Ideally in the long term, she hopes Wyoming can develop a statewide partner plan and recruitment strategy.

“The realities are, we have to collaborate on that care,” Summerville said.

Johansson said gaps exist within handling mental health crises when it comes to emergency and services for adolescents and children, resources and staffing, community stakeholder and resource agreements. He also said there is a lack of evidence-based intervention services in Wyoming, which include 24-hour crisis stabilization and suicide hotlines, mobile crisis services and crisis intervention teams.

Johansson said behavioral health should be reformed through the development of crisis group homes and other related facilities, to reduce Title 25 involuntary hospitalization admissions in the state. He would also like to see better support for a 24/7 crisis call center based in Wyoming, which does not exist. 

#988

On July 16, people will be able to dial 988 to be connected to a crisis center from the National Suicide Prevention Lifeline.

“We can’t underscore how important that component is, and how important it is that we tie the appropriate back-end services to 988,” Summerville said. “Some of those calls are going to be how to get those people into crisis stabilization services.”

Summerville said 65% of all crisis calls result in an individual being placed into a facility. 

In many communities, behavioral health organizations exist through municipal and county funding and other local dollars.  This requires collaboration between law enforcement, elected officials, judges and health staff.

“Improving that as much as we can would be a good way forward,” Johansson said.  

Often, acute mental health situations and Title 25 holds devolve into a law enforcement issue for many smaller communities. Johansson said officers are often the first person called on to address a health care crisis.  

These individuals are often brought to the local jail if they are too combative or if there isn’t space available at their local hospital. Avoiding that result, Summerville considers a cornerstone to behavioral health reform.

One solution, she said, would be to build small, two-bed, short-term inpatient facilities in each county.

“This could help significantly,” she said.

Johansson said there has been progress made in training officers for dealing with crisis calls.

“I think incorporating that more into the day-to-day work for these agencies, while probably frustrating for these agencies with other things to do, has become more of the reality,” Johansson said, noting that many agencies took the initiative to fund training for these situations. 

“We can’t understate the critical role law enforcement plays in all of the crisis care continuum,” Summerville said.

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Wyoming “Off-Track” When It Comes To Road Safety, Mental Health

in News/Transportation/Health care
File photo
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By Ellen Fike, Cowboy State Daily

Wyoming is off-track when it comes to roadway safety and mental health services, a recent National Safety Council summary concluded.

In the NSC’s state of the response executive summary, the organization analyzed how well the 50 states protected their citizens during the ongoing coronavirus pandemic.

The report assessed state efforts in five key areas: employer guidelines, testing, contact tracing, mental health and substance use and roadway safety.

Wyoming was considered one of the 10 off-track states, which also included Florida, South Dakota, Montana, Kansas and Oklahoma.

Mississippi and South Dakota received the lowest overall rating.

Wyoming also was singled out as being off-track when it came to roadway safety (alongside Montana, both of the Dakotas and Massachusetts) and for addressing mental health issues (alongside other states such as South Dakota, Alabama, South Carolina and Kansas).

Only 12 states received an “on-track” rating, which included California, Oregon, Washington and Illinois. The other 29 states were considered “lagging.”

Although the pandemic has claimed more lives than accidental drug overdoses, motor vehicle collisions and falls combined, the state of response report uncovered “an inconsistent approach that has jeopardized safety due to the pandemic’s impact on issues such as addiction, traffic and workplace safety.

The NSC provided recommendations for states to improve their scores, such as ensuring access to medically-necessary treatments, including the availability of behavioral health services and substance use disorder treatment through telehealth and continuing focus on improving the safety of roads.

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Wyoming Coronavirus: Social Isolation Could Lead to Increase in Suicides

in News/Coronavirus
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By Ike Fredregill, Cowboy State Daily

Wyoming’s suicide rates could rise as income loss and isolation caused by the coronavirus pandemic hits home, but for now, suicide hotlines are reporting normal call volumes, a Wyoming Department of Health spokesperson said.

“One of the risk factors for suicide is social isolation,” said Lindsay Martin, the WDH Injury and Violence Prevention Program manager. “So, with the state of things, that’s something we’re keeping an eye on right now.”

Based on the most recent data collected nationally, Wyoming is second only to New Mexico in highest rates of suicide per capita in the nation. With no state-sponsored suicide call center currently in place, Martin said the WDH uses data from the National Suicide Prevention Lifeline (NSPL) to gauge which regions are more at risk than others.


MAP: Suicide Death Rates for U.S. Counties


“They have said that not only has there not been an increase of calls from Wyoming,” Martin said. “But, no state has seen a notable increase in calls.” 

Martin stressed information from the calls is confidential, but the NSPL reports the date and location of calls.

People aged 55 and older are in Wyoming’s highest risk bracket, followed closely by middle-aged males, Martin said. While social distancing is a prominent factor for seniors, she said loss of income is the primary reported trigger for suicide among middle-aged people.

At a time when social distancing and loss of income have become the new norm, Martin said WDH is approaching suicide rates with hyper-vigilance.

“The Mountain West Region was dubbed by the media as the ‘suicide belt,’ because we have such high rates in the surrounding states,” she said. “So we are always in a high-alert state of mind. But, we know there are a lot of things at play here, and we’re doing everything we can to be as proactive as possible.” 

Suicide prevention and awareness involves everything from coordinating with school counselors to working alongside the Wyoming Department of Workforce Services as well as supplying counties with community prevention specialists, Martin explained. 

“We oversee community prevention grants in 22 of Wyoming’s 23 counties,” she said, adding Platte County was the outlier. “Each county has their own committee and approaches prevention a little differently.” 

With no indication suicide rates are being affected by the pandemic, Martin said she is focusing on maintaining strong communication with her community prevention specialists and supporting other essential services for people facing financial insecurity. 

On the home front, Wyomingites can step up their own suicide prevention efforts by keeping in contact with loved ones and neighbors.

“One of the first things you can do is educate yourself on risk factors,” Martin said. “And, if you observe a loved one that is acting in an unusual way, don’t be afraid to ask that tough question or use the ‘suicide’ word.”

The WDH advises anyone in immediate danger of harming themselves, or who knows of someone in immediate danger of harming themselves, to call 911 for emergency services. Anyone experiencing suicidal thoughts is encouraged to call the U.S. National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text “WYO” to 741-741 for the Crisis Text Line.

 “Call each other, do FaceTime or go get groceries for a neighbor and leave them on the porch,” Martin said. “It’s really about making everybody in a community feel like they are a member of that community.”

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Airmen urge service members to lean on fellow ‘wingmen’ for suicide prevention

in News/military
2017

As the U.S. Air Force reports that suicides among airmen have increased in 2019, two women serving at Cheyenne’s F.E. Warren Air Force Base are urging service members to rely on their “wingmen” for help when they are hurting.

Senior Airman Abbigayle Williams and First Class Airman Aiesha Bass are on a mission to stop service members from taking their own lives. Both encouraged their fellow members of the military to turn to one of their fellow service members for help.

“That wingman concept, it’s a good thing,” Bass said. “Somebody needs somebody to lean on. Whether you’ve got one wingman or you’ve got a whole 15 females in here you’ve never seen a day in your life. But they’re there.”

Bass, a former juvenile supervision officer, said providing help can be as simple as listening.

“If you don’t want me to say anything back, you just want to talk, I’m going to listen to you,” she said.

Williams encouraged troubled service members to approach their fellow airmen.

“Stop me on the road,” she said. “I may not know you, but if you need someone to vent to, if you just want someone to cook you food … then I will definitely cook a meal for any airman or anyone else who needs it. Sometimes, you just need to sit down and talk.”

Encouraging someone to do something to lift their spirits also helps, Bass said.

“If they’re not thinking positive, try to help them think positive,” she said. “Try to come up with something to do, especially if someone just sits in a room and doesn’t get out much, (ask them) ‘You want to get out to eat, you want to go walk in the park, you want to go just do something simple just to get you out of this gloomy mood.’”

Cheyenne VA services remain intact a year after administrative downgrade

in News/Health care/military
Cheyenne VA services remain intact a year after administrative downgrade
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By Ike Fredregill, Cowboy State Daily

Services at the Cheyenne Veterans Affairs Medical Center remain largely intact a year after the Department of Veteran Affairs downgraded an administrative ranking for the facility, a VA spokesperson said.

“Our lower complexity level has not affected the quality or services we provide,” said Sam House, the Cheyenne VA public affairs officer. “It didn’t affect our funding. The only thing it did was should we get a new director, they would be hired at a lower pay rate.”

According to the department, VA facilities are categorized by “complexity levels,” which are determined by characteristics of the patient population, clinical services offered, educational and research initiatives and administrative complexity. 

“It’s a system of looking at hospitals, and what they are capable of doing,” House explained. “They assign numbers to them, and they base the hospital director’s pay off that number. That’s all the complexity level means.”

The complexity system consists of three levels with level one and its subcategories being the highest and level three being the lowest. The Cheyenne VA, with a budget of $185 million in 2018, was downgraded from level two to level three early in 2018, which House said signifies no research is being conducted at the facility.

“We don’t have a focus on research,” he added. “Our focus is on mental health, primary care and geriatric care.”

House said one service was changed by the downgrade — orthopedic repairs. While the facility still provides othorpedic surgery, its staff no longer repairs orthopedic implants.

Wyoming Veterans Commission Director Steve Kravitsky said he was initially alarmed when he heard about the downgrade, but his fears were allayed after talking to Cheyenne VA Director Paul Roberts.

“(Roberts) assured me not only were they not going to decrease any services, but they were still bringing more services online,” Kravitsky said. “As director of the veterans commission and a veteran myself, I receive care at the VA, and I haven’t seen anything to the contrary.”

Built in 1934, the Cheyenne VA originally employed 100 staff members and provided 100 beds for primary care.

Nowadays, the facility’s area of service, also known as a “catchment” area, stretches from Rawlins to Sydney, Nebraska, and from Douglas down to north of Denver.

About 79,000 eligible veterans live in the catchment area, House said, but only 29,000 used the facility’s services in 2018, a 3 percent reduction from 2017.

House explained that the VA is made up of three entitles to administer three areas: Healthcare, benefits and the national cemetery.

Most of the services offered at the Cheyenne VA are centered around primary healthcare, but all three divisions of the department have offices on the grounds. 

“Recently, we’ve expanded our nursing home and hospice care facility,” House said. “The average age of Cheyenne VA users is 61. Our youngest user is 19, and our oldest is 102.”

A large portion of the facility is dedicated to offering primary care, including physical therapy, orthopedic surgery, cardiopulmonary lab work, audiology and otorhinolaryngology, or ear, nose and throat care.

The Cheyenne VA also provides some emergency services through its emergency room.

“Our ER is open and staffed 24/7, 365,” House said. “But we’re not a trauma center.”

Because of this, ambulances do not deliver patients to the Cheyenne VA, but rather, veterans are transported to Cheyenne Regional Medical Center, and the VA reimburses the medical center for the care provided.

“Because we have CRMC, we don’t have a trauma care unit in our ER,” he added. “We are in partnership with our community, not competition.”

Additionally, the facility offers limited dental care and was the first in the region to install a women’s clinic.

“The need for women-specific care is something I think the VA has really realized in the last nine to 10 years,” House said.

Laramie County is home to the largest concentration of veterans in Wyoming, and as such, the Cheyenne VA is well-placed to provide them with vital services, Kravitsky said.

“There are 12,085 vets living in Laramie County, according to the VA,” he said, “which is about 25 percent of the 47,472 living throughout Wyoming.”

Without the Cheyenne VA, veterans would need to travel to Denver or Sheridan for veterans services, Kravitsky added.

“With 20 veterans committing suicide every day, quality care close to home is essential to potentially reducing that number,” he said.

The veterans commission files veteran claims with the VA benefits division and is occasionally charged with reviewing inquiries into the VA’s quality or frequency of care. 

“Those inquiries are infrequent,” Kravitsky said. “We don’t get a lot of negative feedback about the Cheyenne VA.”

‘Rugged individualism’ may contribute to high Mountain West suicide rates, says expert

in Uncategorized/News/Health care
A sense of “rugged individualism” may contribute to the fact that the Mountain West states have some of the highest suicide rates in the nation, according to an expert in Cheyenne.
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By Cowboy State Daily

A sense of “rugged individualism” may contribute to the fact that the Mountain West states have some of the highest suicide rates in the nation, according to an expert in Cheyenne.

Linda Goodman, the chief clinical officer at Peak Wellness Center in Cheyenne, said people suffering from depression or other issues in Wyoming and other rural states resist seeking assistance from counselors.

“The rugged individuality is a big piece of it,” she said. “The mentality that ‘I just need to cowboy up and be tough.’ That rugged individualism says ‘I need to be able to handle my problems by myself.”

In 2017, the Centers for Disease Control set Wyoming’s suicide rate at 26.9 per 100,000 people, the third highest ranking in the country. Wyoming joined Montana, Utah, Idaho and Colorado among the states with the 10 highest suicide rates in the nation.

Nationally, suicides have contributed to what was reported in a Detroit newspaper as a reduction in the life expectancy of Americans.

Author Mitch Albom wrote that death rates are rising among working class people who are middle aged and older, largely from what he described as “deaths of despair,” suicides and complications that arise from alcohol and drug abuse among people who believe they cannot achieve the “American dream.”

Goodman said she believes such feelings are often seen among the children of families who survived the Great Depression and World War II and vowed to give their children everything they needed to live the American dream.

“And for some of us, that is looking less and less like the American dream we had envisioned,” she said. “For some Americans today, it means having to let that dream go and if you don’t have the resilience to have another dream that emerges, then you are left with despair.”

Many people found themselves homeless or broke with the turbulent economies of recent years,” Goodman said.

“For people that had the ability to say ‘I’m going to drop back … I’m going to get back on my feet,’ that was fine,” she said. “But for people who did not have that, they turned to ways to avoid having to deal with those problems. That can be through the use of alcohol, it can be through the use of drugs, it can be through depression …”

Goodman said one thing that can help someone suffering from despair is for those people to help others who are less fortunate.

“There’s nothing that will help you more to feel like you have meaning in your life than to help someone else,” she said.

This story has been updated. A previous version of this story misstated the suicide rate.

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