Psychologist Wants to Improve Access to Care to Address Wyoming’s Mental Health Crisis

Expanding Medicaid and granting prescriptive authority to psychologists seen as potential solutions

By Shen Wu Tan

Special to the Wyoming Truth

In 2021, Wyoming hit new highs for drug overdoses and suicides. Health data released in October shows that 108 Wyoming residents died from drug overdoses last year, the highest number reported since 2012. Meanwhile, Wyoming’s suicide rate also reached a record high with 189 suicides—or 32.8 suicides per 100,000 individuals, which is more than double the nationwide rate of 13.5 suicides per 100,000 people.

State officials are paying attention. Gov. Mark Gordon hosted a mental health summit in Casper last month, where legislators, health officials and other stakeholders brainstormed ways to address the state’s ongoing mental health crisis. Legislators also approved one-time COVID-19 relief funds to increase Wyoming’s local suicide prevention call coverage to all day, every day earlier this year. And at its Nov. 21 meeting, the Joint Revenue Committee is set to hear a draft bill that would create a trust fund for the around-the-clock 988 Suicide and Crisis Lifeline. 

Hollis Hackman, legislative chair for the Wyoming Psychological Association and one of the featured speakers at the mental health summit, is working to solve the state’s mental health problems. Hackman, 69, of Sheridan, became a licensed psychologist in 1984 after graduating with a postdoctoral degree in counseling psychology from the University of Nebraska. He took his first job in Casper before moving to Sheridan in 1986. As a U.S Army veteran who served in Colorado and Germany in the early 1970s, Hackman witnessed the effects of exposure to trauma firsthand.  His military experience and his desire to help others spurred him to pursue a career as a psychologist.

Hollis Hackman is the legislative chair for the Wyoming Psychological Association. He believes the state could address its mental health crisis by expanding Medicaid, allowing  interjurisdictional compacts and granting prescriptive authority to psychologists. (Courtesy photo from Hollis Hackman) 

Hackman sat down with the Wyoming Truth to share his perspective on mental health issues in Wyoming and discuss potential solutions. What follows are excerpts from the interview.

How would you assess the mental health crisis in Wyoming? Is it improving, worsening or staying the same?

Hackman: Given that we have the highest suicide rates in the nation, when we have for a couple years now and we’ve been perennially in the top five or so, I would say we’re definitely in a crisis in our state with mental health services.

Have the delivery of services improved over time? That’s hard for me to say. We have ongoing problems in a state, and presently, we are in a tough spot, just looking at our suicide rates if nothing else. But also we unfortunately have folks with serious mental illness in some of our county jail settings and other incarceration sorts of settings where they are likely not getting any sort of treatment other than perhaps some medication and that’s probably pretty limited.

Wyoming lines up in terms of national trends with opioid overdoses …Things have gotten worse as a result of the [COVID-19] pandemic, that’s for sure. Problems with suicide can’t be ignored, and we need to do what we can to get those suicide rates down.

Why are suicide rates in Wyoming so high compared to the national rate and some other states?

Hackman: There are several factors. Access to care would be at the top of the list. We’re a rural, frontier kind of a state, broad expanses. It’s easy to be isolated in this state. Isolation can contribute to problems… And if there’s limited access to care that exacerbates the situation.

People have easy access to guns in our states, so that can also be a complicating factor. Suicides can often reflect an emotional disturbance that can be short-lived, but certainly can be intense when it’s occurring…And if people start to conclude that others are better off without them being around and focus on hopelessness and things of that nature, and they can become impulsive and if they have access to a weapon, which most of us do in Wyoming, there can be a pretty lethal outcome. So, we need to do more in the state to figure out how to provide safety and get distance between lethal means if a person is experiencing mental difficulties.

Any suggestions for that?

Hackman: What they’ve done in other states is made arrangements with sporting goods stores that sell guns to provide for safe storage. If somebody is in a situation [where] they don’t feel as safe as they would like to, there are programs where a person could have their guns stored safely for any period of time through one of the gun stores. We [Wyoming] don’t do it currently, but part of what we’re looking into is how we could do that.

What actions could state legislators take to address Wyoming’s mental health crisis?

Hackman: Well, we have two bills that are pending in the Joint Labor Committee—interjurisdictional compacts …There’s one bill for psychologists, and there’s one for licensed professional counselors. And what those interjurisdictional compacts do, they are an agreement among states to provide a service or to share a service or share a responsibility. In this case, we’re talking about the delivery of mental health services via telehealth means…

But what it means is, if Wyoming would join the psychology interjurisdictional compact…psychologists [who] hold the credentials…could then practice into any of the other compact states with that credential, providing tele-psychological services and vice versa.

We’re also very interested in a prescriptive authority bill for psychologists…If we changed our statutes in Wyoming to allow for psychologists to prescribe . . . then that would increase access to care for folks in the state in terms of medication sorts of interventions.  

I would also mention a third thing. The Wyoming Psychological Association, along with almost all the other providers in the state, has long supported the expansion of Medicaid under the ACA [Affordable Care Act] in this state. And we have yet to do so…Medicaid expansion would provide insurance coverage for the 25,000 or so folks in the state who can’t afford insurance right now and don’t qualify for other insurance under the ACA. 

What’s your take on Wyoming’s approval of one-time COVID-19 relief funds to expand suicide prevention coverage?

Hackman: The ARPA [American Rescue Plan Act] funds are welcome, but they are one-time funds…The 988 number…rolled out last summer, last July. The bill, when it was passed, it authorized all that. It was during the Trump administration and allowed for states to establish some kind of fiscal vehicle to support the ongoing provision of those 988 [Suicide and Lifeline Crisis] services. And what Wyoming elected to do was to use ARPA funds to do that. And that’s great for those two years, but when those ARPA funds go away, which they definitely will, then how is the state going to continue to fund its 988 call centers? 

We hear all the time that we need more resources in the state for mental health. But more mental health services require more resources. And more resources require funding. And the only real source of new funding is Medicaid expansion, because our revenue in our state is all based on severance tax dollars on the exports of coal, gas and oil. And we do have some sales tax revenue. But the rest of our revenue is tied up in extractive kinds of industries, and they have fallen… We need to figure out other ways to cover our health needs in the state and our mental health needs in particular.

Next week, the Joint Revenue Committee will consider a proposal to create a trust fund to continue to fund 24/7 suicide prevention services. Do you support this?  

Hackman: Anything that is more permanent than ARPA dollars is going to be a good thing, generally speaking. So, I imagine I’m going to be supportive of it. I just don’t have the details on it yet.

Any final thoughts on how Wyoming is handling its mental health crisis?

Hackman: I think we’re going in the right direction. But as I mentioned, there are things we can do. There’s legislation we can look at.  

Our problems with mental health in the state aren’t just going to go away. . . they’re probably going to get worse once those extractive industries continue to head in a downward direction…Funding our departments of health, corrections and all that is just going to get to be a more pressing issue for us as we go forward.

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