Monday, December 22, 2008

Wyoming mental health care hinges on travel to far-off places

Yesterday in Casper, I paid $1.18 per gallon of gas. That's with my King Soopers discount card. As the fuel flowed into Chris's Saturn, my bare hands absorbing the below-zero Wyoming cold like meat sponges, I marveled at the drop in gas prices since we'd been making the almost weekly trips to Casper in August. Now at $1.21 a gallon, what were they back in August? Two dollars. Maybe $2.50? CNN says that Cheyenne has the lowest gas prices in the nation but I can tell you that Casper's prices beat Cheyenne's. That's not the reason we make the 360-mile round trip each week. "Hey Chris, let's drive though this blizzard to get some cheaper gas in Casper."

We go to Casper to see our bipolar daughter who's in WBI, a residential treatment center. It's the closest place -- with the best treatment for adolescents -- in Wyoming. She's been there since August 4. Before that, she spent six months at Poudre Valley Mountain Crest in Fort Collins, just 45 miles south of Cheyenne. We could drive to Ft. Collins in 35-40 minutes, as it's downhill from Cheyenne. Casper takes from two-and-one-half to three hours, as it's uphill and down, and the headwind can sometimes be ferocious.

Our daughter needed a different type of treatment. That became clear to her psychiatrists and therapists and eventually to us. You may be surprised to learn that the switch had very little to do with insurance -- or lack thereof. My insurance with the state is adequate for most needs, although it falls way short when it comes to mental health treatment, including that for drug-and-alcohol dependency. Once our daughter entered treatment in January for suicide threats and some very real cutting, the clock was ticking. We figured the insurance would cover a couple months and we would tighten our belts for the co-payments. We had no idea what we would do after that.

Horror stories are rampant when it comes to teens' mental health. We know people who withdrew their mentally ill kids from facilities because the insurance ran out and they were as afraid of financial failure as they were of the fate of the kids. You can see the fear in their eyes. They desperately want help for their kids but don't want to lose their house in the process. They don't know where to turn for help. The mental health bureaucracy seems like a fortress when you look at it from the outside. You don't see an entrance anywhere and you wonder if you have the strength to climb the walls.

I found a way inside, I'm happy to say. The Wyoming Department of Health's Mental Health and Substance Abuse Services Division sponsors the Medicaid Waiver Program for children and adolescents (collectively called "youth"). It makes up for insurance shortfalls in mental health care. It relieves at least one of the burdens of families whose kids are going off the deep end. Program administrators help you negotiate the bureaucracy and sign all of the paperwork. Be forewarned -- there are mounds of paperwork. But the results are worth it.

I had some advantages when our daughter's problems erupted. I've been a board member on a non-profit social services agency for a decade. I've served on the Governor's Mental Health Advisory Council. Our son had his own problems six years ago, so we had some experience in finding proper care. I work in the state government, the same one which houses the Mental Health Fortress.

All that said, I had no clue about the ins and outs of this Medicaid Waiver -- and how it could help our daughter. I didn't know that it could pay for care inside and outside the state -- and also provide support after our daughter's discharge.

We hope that comes soon. Nobody else can claim that they are Annie's parents who love her very much and are willing to travel to Casper each weekend to be with her. We talk to psychiatrists and therapists and nurses and state personnel. We have to somehow know what is right for our daughter and what feels strange. We get the phone calls that say Annie's taken a turn for the worse, that she's carved her arms or freaked out and had to be restrained. We also get calls that say she's making progress and could be home in early 2009.

On Sunday in Casper, I fueled the vehicle that brought back Annie from her weekend pass. We dropped her off, knowing she's getting better and that we will make the trip again this Wednesday for a four-day Christmas pass. It's sad to leave her behind -- again -- but we know there's an end to these long, cold but strangely fuel-efficient trips.

P.S.: More on this subject in future posts, including lists of resources.

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