COVID hammers home need for telepsychology, killed by House

Sometimes it’s the bills rejected by the Legislature and the lost opportunities they represent that loom large after a session.

Wyoming is severely lacking in its ability to offer quality mental health services to all who need them. This in the state with the second highest suicide rate in the country, 24 per 100,000 persons. The national average is 14 per 100,000.

Many rural states, includingWyoming, have shortages of mental healthcare providers. Add to that the long distances often required for patients to travel to a clinic. Relatively small city and county populations exacerbate the problem by making it difficult for psychologists to keep their practices economically viable.

A survey last year by the University of Michigan School of Public Health found that Wyoming has only 323 registered psychologists, the fewest in the nation, according to the Casper Star-Tribune. The real figure is actually quite a bit lower. More than one-third are licensed here because of Wyoming’s relatively low fees, and they practice in other states.

If it had passed during the Wyoming Legislature’s recent budget session, Senate File 37 – Psychological interjurisdictional compact would have greatly expanded the number of psychologists who are able to practice in the state by using telemedicine.

The bill would have allowed Wyoming to tap into a system of mental health professionals located in 12 states that belong to PSYPACT, an interstate compact organized by the Association of State and Provincial Psychology Boards. It includes neighboring Colorado, Nebraska and Utah. 

The bill had no trouble clearing the two-thirds vote necessary to be introduced. It sailed through the Senate chamber on final reading, 22-8.

Then it ran into a brick wall in the House, where it wasn’t even assigned to a committee by Speaker Steve Harshman (R-Casper). It died without even having a public hearing.

That inaction is mystifying and disheartening in Wyoming, where politicians from the highest echelons of state government frequently lament the lack of mental health services.

“I believe we have an obligation to improve access to mental healthcare for our veterans, for our first-responders and ultimately for all citizens,” Gov. Mark Gordon said in this year’s state-of-the-state address.

Substance abuse, suicide and PTSD are all concerns Wyoming needs to address, Gordon said. “We can do more in our communities to help support those who are struggling with crisis,” he said.

Senate File 37 would have helped fill that need — which may be more urgent than ever. If the House would have held a committee hearing, it would have provided advocates a chance to tell the public more about the benefits of telepsychology.

“With this COVID-19 outbreak, it’s even more unfortunate that the bill didn’t have a chance to go forward,” said Hollis Hackman, chairman of the Wyoming Psychological Association’s legislative committee. “It could be helpful to our citizens in the immediate future had it been approved.”

Several other groups supported SF-37, including AARP, the Wyoming Hospital Association, the Alzheimer’s Association and the Wyoming Business Coalition on Health. 

Unfortunately, Wyoming lawmakers repeated what’s become an alarming pattern: the failure to recognize how their decisions inhibit already challenging suicide prevention efforts.

The Legislature cut $2 million from the state’s suicide prevention program in 2017. The money was restored a year later, largely through the support of then-Gov. Matt Mead, but the program had to be rebuilt using different providers.

The stigma often attached to seeking mental healthcare — let alone for people who may be in a crisis and have never reached out for professional help before — can keep patients’ from securing face-to-face therapy in a clinical setting.

One of the best aspects of telepsychology services is that it can connect therapists with patients anywhere through a secure broadband internet connection. It’s used to treat patients who are housebound, have trouble arranging childcare or simply don’t want to travel to a brick-and-mortar clinic. 

Some Wyoming patients are already finding help through telepsychology services offered by out-of-state providers. The Veterans Administration contracts with professionals in all 50 states. Veterans account for 18% of the roughly 45,000 suicides in the U.S., according to the Office of Suicide Prevention.

Before retiring, Hackman worked at the Sheridan VA, where mental health professionals use telepsychology to treat veterans. The federal system allowed him to treat patients in any state, and the WPA wants to bring that portability of care to other Wyoming psychologists.

Many combat veterans preferred the video sessions “because they didn’t want to come to the VA, and they felt a certain need to avoid emotional closeness,” Hackman said. 

“Telepsychology is always at least equal, and in some circumstances better, than [in-person therapy],” Hackman explained. “It lends itself to a variety of treatments, including obsessive compulsive disorder and social-type phobias where folks are anxious about even getting out of their house.”

In 2018, researchers at the Texas A&M School of Public Health discovered that more than 40% of rural clients contemplated suicide in the weeks before seeking counseling.

“Thankfully these clients received the help they needed via telehealth,” the Texas study stated. “But we are left wondering about the individuals who are at risk and don’t have the access to care due to geographic or other barriers.”

Hackman, a board member of the Wyoming chapter of the American Foundation for Suicide Prevention, is confident SF-37 could have helped reduce the state’s extremely high suicide rate. 

“People don’t have access to care, and that’s a major problem,” he said. “This is a way to provide people care in their homes. We need to do all we can to get that [suicide] number down.”

There was one legislative achievement this year, Hackman said: partial funding for a statewide suicide call center. “Wyoming is the only state that doesn’t have a suicide hotline,” he said, adding that the Department of Health’s $1.2 million request was initially eliminated by the governor, who reconsidered. The project wound up with a $400,000 appropriation for 2021-22.

Hackman  expects the Joint Labor Committee to re-work SF-37 during the interim, he said, and he’s optimistic it will pass next year. “We’re not abandoning it just because it didn’t receive a hearing,” he said. “We know there were a lot of representatives who supported it.”

Support informed commentary. Donate today.

But why did such an obviously worthy bill fail in 2020? 

“A small handful” of psychologists applied pressure and were successful in preventing the bill from going anywhere in the House, Hackman said.

Opponents claimed the state was ceding its sovereignty for establishing licensure requirements in Wyoming, he said. “That’s really a misperception, because the bill had nothing to do with our existing practice act [for licensing],” he said. The minimum requirement to practice as a licensed psychologist is a doctoral degree.

I understand why people may feel the need to defend the legendary “Wyoming way” of doing business. They think we’re special. Perhaps we are.

But not so special that we can’t put aside some professional protectionism and realize that the more psychologists who practice in Wyoming, the better –— even if they appear on a video monitor, far removed from our enviable high plains way of life.