Friday, November 06, 2009

Mental health care for Wyoming teens is usually far from home

Let's say that your 16-year-old daughter announces in the dead of night that she wants to commit suicide. It's nothing to trifle with. You rush her off to the local hospital emergency room. The staff psychiatrist, psychologist and social worker assess her and decide that she needs to be evaluated at the nearest residential treatment center. She's a threat to herself and can't go home. Everyone agrees, including the parents.

Their choices are limited. The adolescent unit of the Cheyenne Regional Medical Center's behavioral health center was closed last year. The nearest in-patient centers are in Fort Collins, Colo., and Laramie, Wyo. -- each about 50 miles from Cheyenne. Easy drives for six months of the year. Not so easy the other six months, especially the jaunt over the mountains to Laramie's Ivinson Hospital. Next closest choice is in Denver. Next closest Wyoming choice is Casper, 180 miles away on I-25. This is a bit less than the driving distance between our nation's capital and New York City. Traffic is lighter, though.

These only are options if you have insurance. As we know from recent statistics, more than 70,000 residents are uninsured, including 13,000 children. The Wyoming Department of Health has what it calls the Children's Mental Health Waiver. This allows parents of modest income to receive treatment for their mentally ill teen using Medicaid dollars. The waiver plan considers only the teen's income -- and not the parents' -- to qualify. Once you qualify, the plan kicks in where your insurance coverage leaves off. It covers both inpatient and outpatients treatment. If you're in a residential center, the waiver also pays for educational costs provided through the local school district. These are teens, after all, and they have a lot of classes to keep up with.

The waiver program recently changed. Now psychiatric care is considered separately from educational costs. Not sure why that happened. Maybe because Medicaid dollars are running short. Maybe it's due to governmental infighting. Who knows? I do know that our daughter received more than $150,000 dollars of residential center care in 2008 and thousands of dollars more in aftercare expenses in 2009. We're on our own as of Sept. 30. That was about 18 months of our government picking up the tab for a disturbed teen. We had to fill out paperwork and put together a wraparound care team and check in with therapists. But we didn't have to worry every day that our insurance coverage will reach its 45-day limit (which it did) and our bipolar daughter would be booted out into the street. That brought some peace of mind as we drove 360 round-trip miles each weekend to visit Annie and participate in therapy sessions.

Most Wyoming parents with troubled teens don't know about the waiver. I only knew about it because I'm on the board of UPLIFT, the Wyoming affiliate of the Federation of Families For Children's Mental Health. I've told other parents about it. Some have checked it out but only a few have actually gone through the process of using it. They may think of it as a government handout. They may be intimidated by the process. Some parents have their own mental health issues. Others are just busy trying to make a living.

It would be very helpful if we could take our teens to a local residential treatment center rather than shipping them all over creation. These are kids, after all, and they need to be close to their support system which is family in its many forms. It is difficult in this state of few people and wide open spaces. But there must be a way to do it. Act locally, think globally. That's a good slogan for our times. Local treatment for our kids would be good for our community. But where to start?

The scenario at the start of this piece was real. What choice did those parents make? They decided to keep their daughter at home. They will keep up with therapy appointments and make sure that her daughter gets the right medications and takes them regularly. They are doing all they can. They also harbor fears that they may not be doing enough of the right things for their child. They also wonder if it wouldn't be better to leave this state of many natural wonders for life in a place with better health care facilities that are closer to home.

1 comment:

bigfrank said...

That is what comes with living in a unpopulated state.
I would tend to think if this girl in the dead of night came up and said to the parents she wanted to kill herself the parents have been asleep for a VERY long time.