Don’t be cruel: Wyo can afford to treat mentally ill

The Wyoming Legislature’s confounding cuts to mental health and substance abuse treatment budgets will harm some of the state’s most vulnerable residents — and drive up costs to the state — for years to come.

Access to behavioral health assistance was already scarce in Wyoming. Then the pandemic ramped up need while erecting additional barriers. Is this really the time for lawmakers to swing their hatchet?

What’s perhaps even more unconscionable than the timing is that legislators ignored available funding options that made the cuts unnecessary. Meanwhile, a new law aimed at prioritizing who can get state-funded treatment will almost certainly shut out many who depend on the services today.

Lawmakers reduced state funds for mental health and substance abuse treatment at Wyoming’s community behavioral health centers by $15 million, a 17% cut for the next two years that went into effect July 1.

What services have been affected? Outpatient mental health treatment, which allows people to stay in their homes and receive help, has been reduced by more than 80,000 hours. Outpatient substance abuse treatment has been cut by more than 15,000 hours.

Forty beds have been eliminated from residential mental health treatment centers, and 39 beds at residential substance abuse facilities.

In an April article on the National Institute of Mental Health’s website, Director Joshua Gordon assessed the impacts of COVID-19. Wyoming legislators should pay attention.

“As is often the case, unfortunately, the most vulnerable among us are feeling the mental health effects most intensely,” Gordon wrote. Factors include job loss, housing instability, food insecurity, poor health and loss of family and friends.

“From all that we know, it is clear these impacts will outlive the pandemic itself,” he added.

In November, Gov. Mark Gordon [no relation to the NIMH chief] made $5 million in federal CARES Act funds available to behavioral health providers to help address pandemic-related needs.

But the governor’s use of these emergency federal funds came two weeks after he recommended — and the Legislature later approved — the $15 million biennium budget cut. So while the CARES Act funds were welcome, there is still a gaping $10 million hole in the Department of Health’s mental health services budget.

Wyoming’s budget decisions about treating the mentally ill often don’t make sense. In 2014, lawmakers cut $8 million from services when the state had a projected $238 million surplus and money was shoved into savings accounts instead of helping residents.

In 2016, the Legislature eliminated all substance abuse treatment programs at the state’s prisons, despite experts’ warnings that it would increase recidivism and drive up costs. Both problems emerged, and lawmakers reappropriated the funds the next year.

Legislators are so eager to cut treatment programs that they fail to consider the long-term impacts. The most effective treatment occurs when there is early intervention with patients. If they are uninsured and/or treatment funds have been slashed, there is a greater risk of homelessness and incarceration. 

At 23%, Wyoming has the highest percentage of adults with a mental illness who are uninsured, according to Mental Health America. The figure is more than double the national average.

The organization also says Wyoming ranks 45th in the U.S. in access to mental health care.

The most infuriating aspect of Wyoming’s cuts to behavioral health services is that the state has the money to fully fund them. Lawmakers always find ways to create or continue programs they want, if it’s for a constituency they deem worthy.

Did the masses cry out for a $1.2 million litigation fund so Wyoming can sue other states that want to stop using its coal? Of course not. Could behavioral health centers put that money to better use? You bet they could.

A few legislators, bless ‘em, are telling residents the truth: The budget “crisis” that mandates harmful cuts isn’t actually real. Wyoming has more than $21 billion in eight separate trust accounts, soaring returns on investment funds and millions of dollars socked into various savings accounts every year.

“We’re a wealthy state and we have to manage it properly. And we need to be frugal along the way, but we don’t want to be cheap, and we don’t want to be cruel,” Rep. Jerry Obermueller (R-Casper) explained on the House floor in March.

Obermueller, a retired accountant, said Wyoming has added $1.5 billion to its balance sheet over the past five years. It’s happened while many legislators keep crying about how broke the state is and how certain budgets must be cut.

Another Casper Republican, Rep. Steve Harshman, criticized the way the state is doing business. 

“Are we going to cut today’s folks, today’s seniors, the disabled, so we can save more money for the future?” he asked. “Wyoming is not a poor state. We’ve been richly blessed, and we’ve got challenges.

“We can overcome them,” Harshman said. “And with steps that aren’t very dramatic, frankly.”

Here’s one step that Harshman, a former Speaker of the House, recommends: Expand Medicaid. It would allow the state to treat low-income adults with mental and physical illnesses who don’t qualify now for either Medicaid or Affordable Care Act health insurance subsidies. 

I’m sick of listening to conservative legislators say we must find a “Wyoming solution” to the state’s healthcare problems, when one of the primary answers — providing health insurance to people who desperately need it — has been rejected every year since 2013.

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How about passing a state personal or corporate income tax, or higher sales or property taxes, with a portion of the new revenue used to improve the health of Wyoming’s needy residents? 

In addition to slashing funds, the Legislature this year passed House Bill 38-Community behavioral health-priority populations. The measure had strong support: the House approved it by a vote of 37-22, and in the Senate, 20-10.

Under the bill, the Department of Health will develop policies to determine who Wyoming gives priority access to state-funded mental health and substance abuse treatment.

The plan is still being developed by the department, legislators and other stakeholders. Some advocate for a system that gives highest priority to inmates leaving prison, adults with acute or severe mental illness and at-risk families.

Those in two lower-priority tiers would have to meet arbitrary income qualifications to even receive treatment. Others would just go without services when the money runs out.

I’m not suggesting this initial list doesn’t include worthy priority populations. But behavioral health centers currently treat anyone who seeks help. People who cannot pay aren’t turned away; it’s one of the shining principles of how Wyoming provides care now. We don’t need to change it.

Andi Summerville, executive director of the Wyoming Association of Mental Health and Substance Abuse Centers, told WyoFile the new system under HB 38 could potentially slash general access to treatment by half. That’s unacceptable.

“In most places, we don’t have an answer on where those people should go,” she said. 

The Equality State has money available to provide necessary treatment to all who need it, and if legislators decide those funds can’t be touched, they can raise tax revenues. Delaying treatment that Wyoming can afford and should provide is both cruel and ultimately more expensive than early intervention.