"I Spent Three Months On A Waiting List:" Title 25 Problems On Display At Wyoming State Hospital

Apr 17, 2015

Part 4 of our Title 25 series. Listen to the entire series here.

Janell Hanson and her son Adrian live in a sunny house just steps away from the historic Ivinson Mansion in Laramie. Their house is gorgeous--it’s actually older than the mansion. But on the day WPR visited, the beautiful oak front door was marred by a hole in its stained glass panel, temporarily sealed with duct tape.

The subject came up near the end of the interview. Adrian confessed the damage happened after a fight with his mother. But, he explained, he had meant to shut the door with care. “The air pressure outside blew the door shut,” he said. “I didn’t even know the pane of glass was broken until I got back.”

His mother Janell, sitting on the other side of the couch, had a different idea about what happened.

“I think [he] was angry and, well, he slammed the door,” she said.

“No I did not,” Adrian shot back. “I absolutely did not; you are mistaken.”

This sort of family squabbling is probably familiar to most families. But with this family, there is another dimension: Janell is not only Adrian’s mom, she is his caretaker as well. Adrian, 30, suffers from seizures, Tourette's Syndrome, schizoaffective disorder, and quite a bit more. “He’s been diagnosed with just about everything,” Janell said.

For years Janell has tried to get Adrian into a group home in Wyoming: a place where he can get treatment and also live something like a normal life. But the state has little in the way of mental health services. So a few months ago, when Adrian was having an episode, Janell did the only thing she could do: she called the police and Adrian was taken against his will for mental health treatment, or “Titled.” At first, he went to Ivinson Memorial Hospital in Laramie. From there he was supposed to be immediately transferred to the Wyoming State Hospital in Evanston to for court ordered treatment.

The Wyoming State Hospital is the only one in the state specifically set up to deal with Title 25 patients, and it’s where all of those patients are supposed to go if they are court ordered to get more than a few days of treatment. But lately it’s not easy for Title 25 patients to get into the state hospital: the average wait time has gone from 15 days in 2008 to over 50 this year. It isn’t easy to get out, either: the average length of stay has almost doubled in the last five years.

Janell and her son Adrian didn’t know about this wait time when Adrian was Titled, but they quickly found out. “I had to stay at Ivinson Memorial Hospital for three months,” Adrian said. “Just on a waiting list [to enter the Wyoming State Hospital].”

Lately a waiting list to enter the Wyoming State Hospital is standard for Title 25 patients. This is primarily due to two reasons: the first is that Wyoming’s local mental health services can’t handle increasing demand. So instead of being a last resort, the Wyoming State Hospital has become a catch-all for many who struggle with mental health issues. The second reason for the delay is that Wyoming courts cannot order follow up care for Title 25 patients, making it extremely difficult for the state hospital to discharge them safely.

Wyoming State Hospital Administrator Bill Sexton freely admitted to these problems during a tour of the State Hospital’s 160 acre campus in Evanston. Though he points out that patient treatment at the hospital has improved dramatically in its more than a century of existence. He said that, currently, the hospital has around sixty five Title 25 patients at a given time. “In 1968, the highest census year here, there were over seven hundred and fifty [patients],” he said. “People would come here for the rest of their lives.”

Thankfully that is no longer the case--Sexton says the goal is always to reintegrate their patients back into the community. But  there are still over three hundred and fifty full-time employees here, and right now they’re stretched thin. Title 25 court orders are up by sixty percent in the last three years.

The unit where Title 25 patients stay is a long hallway with sunlight streaming through big windows. It’s pleasant---patients are chatting, and there are board games and stationary bikes. But Sexton tells WPR that the place is heavily monitored, and staff are always on the watch for violence or potential escape attempts--ubiquitous signs warn that “no patients are to be left alone AT ANY TIME.” Sexton pointed out the unusually smooth doors on a patient’s room.

“We have what’s called a piano hinge,” he said, “which goes from the floor to the top. And what that does is make sure someone can’t use the door as a litigator--something they can hang themselves on.”

Nursing Director Donna Mullenax said that, here, these safeguards are necessary.

“We get patients who aren’t able to fit anywhere, else so to speak.”

That makes discharging them back into their community difficult. The average Title 25 patient sent to the State Hospital stays there for one hundred and twenty six days--almost double what it was five years ago. Wyoming officials have budgeted millions of dollars in the next few years to grow the Wyoming State Hospital, but Director Sexton said that money would be better spent elsewhere.

“Ideally, if some of that money could be funneled to the community, that would be a better utilization, and it would better serve the population.”

Those changes may come soon--the Wyoming legislature is considering whether to rework Title 25 this year. But for Janell and her son Adrian, they can’t come soon enough.

“I mean its been 12 years we have been fighting this,” Janell said, exhaustion creeping into her voice.  “It’s been going to the emergency room, coming back, and we are right back where we started. My question is where did that path [Adrian] was supposedly on go?”

During our meeting, that question felt especially fresh. A few weeks ago Adrian was discharged from the Wyoming State Hospital to a group home in Colorado Springs. But after only a week there, he had a seizure, and they forced him to leave. Now he’s back where he began, at home.