Select Committee on Mental Health and Substance Abuse Services Minutes

Committee Meeting Information

June 17, 2008

Wyoming State Hospital

Evanston, Wyoming

Committee Members Present

Senator Pat Aullman, Cochairman

Representative Keith Gingery, Cochairman

Senator Ken Decaria

Senator Wayne Johnson

Representative Jerry Iekel

Representative Jane Warren

Committee Members Absent

Senator Bob Fecht

Senator Rae Lynn Job

Senator Ray Peterson

Representative Patrick Goggles

Representative Tim Hallinan

Representative Jack Landon

Legislative Service Office Staff

John H. Rivera, Senior Staff Attorney

Joy N. Hill, Associate Research Analyst

Others Present at Meeting

Please refer to Appendix 1 to review the Committee Sign-in Sheet
for a list of other individuals who attended the meeting.

Executive Summary

The Committee met for one day at the Wyoming State Hospital. The Committee heard testimony: from the State Hospital on forensic evaluations and proposed changes to the statutory provisions related thereto; on the status of regional mental health and substance abuse programs that have been created or funded as a result of bills sponsored by the Committee; and, on the SAGE initiative. The Committee also gave preliminary consideration to proposed draft legislation relating to how the Workers' Compensation Program addresses mental injuries .

The Committee will tentatively meet again in Casper on July 31 and August 1, 2008 to consider proposed draft legislation and to discuss other matters relating to mental health and substance abuse services.

Call To Order (June 17, 2008)

Chairman Gingery called the meeting to order at 8:20 a.m. The following sections summarize the Committee proceedings by topic. Please refer to Appendix 2 to review the Committee Meeting Agenda.

Criminal Forensics Unit Evaluations, Wyoming State Hospital

Chairman Gingery discussed the nomenclature of criminal forensic evaluations, i.e., W.S. 7-11-303 competency to stand trial and not guilty by reason of mental illness (NGMI). The Legislature passed an amendment to the statute last year that was believed to have fixed the problems created by courts ordering both evaluations at the outset of a criminal proceeding, but the permissive language of the statute may have been too nebulous for the courts.

Chairman Gingery introduced Mr. Robert Stahl, Administrator, Wyoming State Hospital (WSH), to the Committee. Mr. Stahl stated that Ms. Amber Martines, Ms. Robin Cooley-Sessions, Dr. Candace Shields and Dr. Stephen Golding, have developed language for proposed statutory changes (Appendix 3).

Ms. Martines gave a PowerPoint presentation (Appendix 3), explaining the differences between the two evaluations authorized under W.S. 7-11-303. Courts have traditionally ordered both evaluations even though the purposes are different. The competency evaluation is used to determine if the accused is currently able to understand the charges and participate in court proceedings. The NGMI evaluation examines the defendant's mental state at the time of the crime he is alleged to have committed. Statistics haven't changed much since the statutory changes described by Chairman Gingery, with over 80% of court orders still requiring both evaluations to occur at the same time, which is expensive and contributes to the backlog at the WSH. She recommended separating the evaluations into different statutory sections to clarify that the evaluations are for different purposes and should occur at different times during a criminal case.

Dr. Golding provided his background, including acting as a forensic consultant at WSH for about 10 years. He stated the suggested changes would bring Wyoming law into compliance with practice standards and constitutional standards. Once competency has been raised as an issue, other proceedings cannot proceed; therefore, the court should not ask for both competency and NGMI evaluations at the same time. Only after the person has been determined to be competent to stand trial should the defendant then be in a position to assert the NGMI defense, which then opens up the person’s prior medical records to look at his mental state at the time of the criminal act. If determined to be incompetent to stand trial, the criminal trail does not proceed, but the defendant is provided treatment to regain his competence Simultaneous requests for both evaluations allows prosecutors and judges to initiate the NGMI defense, without participation of the defendant. The U.S. Supreme Court has held that only after competency has been determined can a defendant then assert the defenses that may be available to him, including the right to avoid self-incrimination and the right to assert the NGMI defense. Dr. Golding said the only suggested statutory changes from the Wyoming Attorney General (A/G) are to split the statute with respect to the evaluations and related matters. Wyoming has not incorporated the most current language that came from the U.S. Supreme Court in Sell v. U.S., 539 U.S. 166 (2003), which addresses when a person has the right to refuse medication to restore competency and requiring a finding that there has to be a substantial likelihood that the person can be restored to competency with the treatment regime. He believes the Committee should address this issue in the same bill the WSH is recommending. On the other hand, the Committee may not want to address the issue regarding the restriction on the length of treatment that may be permitted to restore a person to competency, addressed by the U.S. Supreme Court, because it is too contentious an issue to address before receiving input from representatives of all interested parties and achieving a consensus.

Chairman Gingery directed staff to draft proposed legislation incorporating the changes proposed by the WSH and the A/G and the changes recommended by Dr. Golding, based on the Sell case. Chairman Gingery will discuss the potential bills with the cochairmen of the Joint Judiciary Interim Committee.

WSH questions:

Karn Building HVAC Problem

Chairman Gingery reminded the Committee that last year, while touring the Karn building where the criminal unit is located, it was an extremely hot building. There was an effort to get an HVAC system built, but the consultant estimated that the cost would be about $3 million which is classified as more than major maintenance. The Department of Administration and Information classifies this as major capital construction (capcon). He asked what can this Committee do to help getting the HVAC system in the building. Mr. Stahl replied that the WSH may need more money and legislative authorization for additional money to cover costs. Senator Decaria said there is no capcon money for this and it would require an exception request to get the money authorized. Senator Johnson advised it would be necessary to move fairly rapidly if the request is to be taken to Governor or to the State Building Commission (SBC). Representative Warren explained the procedure of presenting the request, which would require a very convincing showing that there is an emergency or very high priority for the HVAC system. She added that an endorsement by the SBC might be a more effective approach.

Geropsychiatric Unit

Chairman Gingery explained the background relating to the building of a geropsychiatric unit, either at the WSH or elsewhere in the State.

Senator Decaria said the Committee should move forward on this issue. It needs to be proactive for this population because it is already appearing and the State has no where to treat them on a long-term basis. Senator Aullman advised if the Committee is to proceed on this issue, it needs to get more educated in terms of the need, what the proposed facility could provide and why the geriatric patients can’t be treated in their homes. Senator Johnson asked to be reminded why the facility in Basin can't be used. Chairman Gingery replied the problem in Basin is the inability to get properly trained staff for geriatric patients with mental illness issues. Representative Iekel suggested that a grand plan has to be developed to ensure any proposal fits within that plan.

Mr. Stahl advised that Ms. Carol Day is developing a survey process and recommendations may come for Title 25 and other issues. The waiting list at WSH is down, which is partially due to the opening of 14 beds in Cottonwood Hall and hiring certified nursing assistants who are working 12 hour shifts.

Regionalization Status Reports

Wyoming Association of Mental Health and Substance Abuse Centers (WAMHSAC)

Mr. Mark Russler, WAMHSAC President, stated WAMHSAC is having some difficulty identifying what start up costs for new programs will be approved by the Department of Health (WDH). This is affecting development of group homes and residential facilities, particularly the one in Casper. Start up costs for new facilities have always been negotiated by WDH and the monies are crucial. He advised that other obstacles include staff recruitment and retention. In response to a question from Chairman Gingery, Mr. Russler said there have been some issues surrounding the start up costs for Casper facility that were authorized in legislation enacted last session. Responding to Representative Iekel, Mr. Russler expressed gratitude for the serious boost in salaries that were provided, but the centers are already behind just one year later, making recruitment difficult.

Southeast Region

Dr. David Birney, Director, Peak Wellness Center, distributed Appendix 4, describing the regional services provided in the Southeastern region of the State. The Haven, a residential program, purchased land in the county and is now being sued by some nearby residents who claim that covenants have been violated. Dr. Birney expects a positive resolution to the lawsuit, but noted that the resistance encountered in establishing the group home has been an eye-opening experience. In Laramie, there will soon be a total of 30 supervised apartments for mentally ill clients. Dr. Birney feels the first regional program in the State is progressing well. A continuing problem has been to find ways to obtain funding to purchase or expand buildings for use by clients. Social detoxification services are difficult to provide because it is necessary to have a certain level of occupancy to be workable if a provider is only paid for actual occupancy of a bed. Either the State could purchase a specified number of beds within a region, or pay a rate that is higher than is currently being paid. Better utilization of the respite care program is a goal that is being worked on because participation has not be as extensive as expected. Dr. Birney responded to Chairman Gingery's question by stating that a Goshen County program has a sex offender treatment program, but it requires a very specialized form of treatment and it is hard to staff the program.

Mr. Ron Blake, Director, Carbon County Counseling, presented his portion of the report for the region. The region serves 29.5% of the State's population. The three centers in the region served 4.69% of the 29.5% living within the region. He discussed how the funding appropriated under 06HB91 and 07SF76 was spent in the region. The centers within the region have had some challenges and experiences in trying to implement regionalization. One of the major challenges was that the crisis stabilization funds, which were intended to be for the full biennium, were exhausted in 15 months. The centers are now trying to access other sources of funding to keep the program active.

Central Region

Mr. Mike Huston, Director, Central Wyoming Counseling Center; Ms. Lisa Amos, Director, Alcohol Crisis Center; Mr. Jerry McAdams, Director, Fremont Counseling Services; and, Ms. Peggy Wiley, Director, Solutions for Life, presented on the status of the Central Region.

Mr. Huston distributed Appendix 5, describing expenditures within the region by program.

Ms. Wiley stated regionalization has been very beneficial for Solutions for Life. The program has been able to use all the services available within the region. She has been director for 5 years, and now has 40 employees. The group home operated by her program had a late start and now has a problem because the WDH estimated the program owes the State $58,000 and she says the State owes her about $50,000 in start-up costs. She is working through these issues with the WDH. It is an issue because Solutions for Life needs to open additional crisis centers. All but two clients have been clients returning from the WSH. She is not sure she can continue operating group home without reimbursement of start up costs. Medication management has worked out well. She has been using telepsychiatry for a year so they can access crisis help right away. Her program has already used its entire appropriation for mental health transportation. She would like to expand to Niobrara County. The substance abuse quality of life funding was also used for housing and keeping people in homes. She would like to have a child psychiatrist for her program, more cooperation between WDH and WAMHSAC, and legislative support for crisis stabilization and the growth in needs that is occurring. She has seen some positive change as a result of the legislative changes for provisional licensing. With respect to sex offender programs, she has had issues with insurance companies regarding having a perpetrator program in the facility.

Representative Iekel asked what help is needed for crisis stabilization. Ms. Wiley is hoping that Dr. Birney’s program will have a residential program like the program Mr. Huston is opening in Casper. Mr. Huston advised he has applied for crisis stabilization funding for an 8 bed facility, but has not yet heard if the application has been approved.

Mr. McAdams described his programs in Lander. He has problems with housing for clients and recruitment of staff. His program has a program to treat sex offenders and is not experiencing the same insurance problems that Ms. Wiley is having as a result of her program's inability to afford the insurance premiums. Chairman Gingery added that Pineridge Hospital in Lander also has a sex offender treatment program. Mr. McAdams advised his program has a full time registered nurse (RN), but he has not been successful in recruiting a licensed practical nurse (LPN). Housing is biggest issue in recruiting. The mental health transportation program will get more use as time goes by. He has not used funding for mental health respite care either. The substance abuse quality of life funding is being used for emergency subsistence, health and medical supports and housing.

Ms. Amos added that the substance abuse quality of life funding has been used by her program for transportation and clients have greatly benefited from that. She also makes many referrals to Fremont Counseling Services. She would like to have funding for staff to serve 20 or more social detoxification clients. The crisis center currently is looking at substance abuse transitional housing program in Riverton that could serve the region.

Mr. Huston advised that CWCC is acting as the WAMHSAC agent for the purchase and implementation of the telepsychiatry equipment and services, which should be completed over next three to five months. His program uses transportation funding less than other regions because CWCC has its own vehicles and a more comprehensive transportation system in Casper, using a token system. CWCC hasn’t had much need to spend mental health respite or quality of life funding at this point because he prefers to get those services for free when possible. Representative Iekel asked if regionalization is working. Mr. Huston replied the problem is getting clients to services. The transportation funding that was provided has been a great thing. His sex offender treatment program has been operating for years and is getting people in for that treatment. The Legislature did enact legislation providing start up costs for his new facility, but he is very frustrated. He pared his request down to what he felt was reasonable. He distributed Appendix 6, which shows which startup costs were allowed and disallowed by the WDH. The new residential facility will be opening the first week of August.

Western Region

Mr. David Nees, Director, Pioneer Counseling Services, distributed Appendix 7, a report on activities in the region. He introduced Ms. Linda Acker, Director, Southwest Counseling Center (SWCC), who highlighted what has been accomplished at SWCC. Unlike some other programs, Ms. Acker is required to have the cash in hand before she can buy property because the property her program controls is owned by the Sweetwater Board of County Commissioners. She has a 26 bed facility for females and their children, if necessary, which will accommodate persons with co-occurring conditions. That brings the total capacity of her program to 73 beds and the beds at being used fully. The unemployment rate is 2.3 in Sweetwater County but she has seen a high turn over in residential staff. Recruitment is very difficult. Providing social detoxification services is a challenge in the region, but those patients often also require medical detoxification. Her program is unable do provide that services due to liability issues and the local hospital does not provide medical detoxification either. SWCC is at the maximum number of beds (70 beds) it can accommodate. SWCC has had a sex offender treatment program for 20 years.

Mr. Ed Wigg, Director, Curran-Seeley, said the substance abuse quality of life funding has been a learning process for his staff and clinicians. The funds have been used to take clients to get prescriptions filled and for fuel expenses to get to the Center in Pinedale. The respite funding has also been slow to grow, also because of the public's unwillingness to use the services available, or because of a lack of knowledge about the program.

Ms. Deb Sprague, Jackson Hole Community Counseling Center, described the early intervention program as a prevention program. The program is implemented as part of SAGE. The number of elementary schools in Jackson has doubled in the last year. Now there are 8 kindergarten classes and the program is using thera-play, a best practices technique. The program is also doing observations in the 1^st and 2^nd grades to identify children who need specialized services.

Mr. Nees said the Uinta County program is partnering with the WSH to develop a regional crisis facility consisting of 6 beds. His program has used the opportunity to use grant funding from the state to employ a medical case manager. He has had difficulty in recruitment over the years. Some of his concerns include the western region is fairly large and having services in multiple locations throughout the region is important. More beds for residential patients is needed. Psychiatric recruitment assistance would be helpful, including recruitment and retention programs for new graduates, such as a loan repayment like the State does for other professions. Some funding has been dedicated within the region for psychiatric recruitment. There is an on-going need to keep beds available for substance abuse residential treatment.

Chairman Gingery asked why High Country Counseling is not present at the meeting. Mr. Wigg stated his program has taken over that program's contracts for substance abuse services.

Basin Region

Mr. Mark Russler, Dr. Alice Russler, Mr. Ivan Koderling, Mr. Fred Snelson and Mr. Leo Hammond spoke on behalf of the Basin regional providers.

Dr. Russler, Director, Yellowstone Behavioral Home Center (YBHC), distributed Appendix 8, a folder with numerous documents describing activities by the providers in the region. The providers in the region are attempting to build 10 regional services. All services listed on page 2 of the update report are new services as a result of 07SF76. YBHC has finalized purchase on a 6 bed home last September. Psychiatric services in the region are provided through two psychiatrists from West Park Hospital and two advance practice nurses. She has experienced difficulty in hiring medical support staff, and will continue to recruit. She expects to expend all of the transportation funds provided by the end of June. Respite care is underutilized. For early intervention services, YBHC, Hot Springs Counseling Center and Cloud Peak Counseling Center have full-time therapists. Substance abuse residential and transition services are being provided by Cedar Mountain Center.

Dr. Russler advised the funding for social detoxification services has not been used because no facility is available within the region to provide the service. Chairman Gingery asked what happens to the funding for social detoxification services if it is unused within a region. Dr. Russler said the money would revert to the State. Senator Decaria asked if the money can be uses it to send people out of region to provide the services. Dr. Russler says that option has not been pursued, but it could be possible to send persons needing the service to Lisa Amos' Center in Lander, but the issue would be the transportation funds that would be needed and are already being over utilized. Mr. McDaniel, WDH, believes that money has some flexibility and he will work with the region to see there is a way to use the social detoxification funds to provide the services within or without the region. Mr. Russler, Director, Cloud Peak Counseling Center, said it is difficult to assess the number of people needing the service in the region because the entry point may be in one place and the person referred to a variety of different places for social detoxification services. It is difficult to get a group together to provide the service in one location. If there is no mental health issue, West Park Hospital will not accept social detoxification patients for the $115 per day authorized by the State. There was general discussion of using the empty buildings at the Retirement Center in Basin. Dr. Russler said there may be an urban legend about empty buildings at the Retirement Center. The providers have toured the Center and the buildings are either in use or are being prepared for use in the near future.

Dr. Russler stated the salary increases as a result of the legislative appropriation were quite a success, having facilitated recruitment of therapists. It remains a continuing challenge because of competition from public and private employers in the region. It has been difficult to recruit a qualified RN, mainly due to salary. It may be necessary to hire less experienced RNs and train them on the particular needs of the patients served by the providers.

Dr. Russler reiterated that the mental health respite program has been slow getting off the ground. There have been limited referrals, but she believes it is a good program that should continue. Chairman Gingery asked if money should be set aside for social marketing of the respite program. Dr. Russler replied that it might help, but it may be more important that individuals be willing to step forward if they have used the service. Word of mouth may be a better way to develop the program. Representative Warren commented that presentations at the meeting indicate that continuing existence of the stigma associated with mental illness. She asked what can be done to reduce the ignorance about mental illness. Dr. Russler said social marketing did help when the group home was being opened. Her board of directors of is beginning a campaign to reduce stigma in the area.

In light of the information provided in Appendix 8, Chairman Gingery asked for a copy of each of the other region's plan to see what the cooperation level is among providers within each region.

Northeast Region

Ms. Pam Peldo, Director, WYSTAR and Mr. Mike Purcell, Director, Campbell County Behavioral Health Services (CCBHS), presented on behalf of the region.

Mr. Purcell distributed Appendix 9, describing the regional services provided by the providers within the region. In December, 2007, CCBHS opened the Green House group home. While his program has not used telepsychiatry yet, Campbell County Memorial Hospital is already able to do it. As soon as CCBHS has the equipment it will begin using telepsychiatry. Mr. Purcell does not believe there is a psychiatrist in Crook, Johnson, Sheridan or Weston counties. Campbell County does have a youth psychiatrist available. The respite care program has had very limited use, similar to other centers. The program is in the process of developing and will be very slow to catch on. Mr. Purcell advised that providers for organizations and families who have lived in Gillette for any length of time know what respite care is. Both professionals and volunteers are used to provide respite care. It is difficult to recruit early intervention providers for children with mental health needs. Mr. Purcell added that the funding for salary increases came at a very good time.

Ms. Peldo stated the waiting list for women in need of substance abuse residential services has been reduced as a result of new beds that were authorized and funded. The waiting list for men has remained at about 20 . The greatest need for substance abuse residential services was coming from Campbell County. The residential group homes are set up to accept children of a mother who is in treatment. The language of the appropriation is pretty prescriptive in terms of the number of beds funded by gender. She suggested the language of the funding bill should authorize the total number of beds for the region, without limiting the number of beds by gender. The substance abuse quality of life funding is a new ballgame and providers are still learning the rules. Collaboration has greatly improved services within the region.

Ms. Peggy Nikkel, Director, UPLIFT, stated it is very challenging to develop respite care for children and families. It would be necessary to look at multiple strategies for different communities because the need will likely vary among communities.

Mr. McDaniel said it has been helpful to review the progress of regionalization with the regional providers. Over the last year, the Mental Health and Substance Abuse Services Division and providers have worked through dozens of issues that have been very complicated. While addressing the issue of start up costs, Mr. McDaniel said the question becomes, what are reasonable start up costs. It is not defined in statute. What is needed is a policy that is consistent. Mr. Bob Peck, CFO, WDH, has put a policy in place that helps the WDH determine what is allowable and what is not, using generally accepted accounting principles (GAAP). The WDH is still negotiating with providers in an effort to prevent holding up the opening of new facilities.

Senator Aullman has two questions: Is there something the state can do to help the situation with respect to better utilization of the respite care funds; and, was the funding in 07SF76 for nurses intended mainly for training RNs to go back to school to become psychiatric nursing? Mr. McDaniel replied he thought the money was intended to hire the nurses and for recruitment. With respect to crisis stabilization, the WDH did issue a RFP, and three of the four regions submitted applications. The Northeast did not submit an application. In the next week, the WDH will have a decision on the applications.

Chairman Gingery asked if Attorney General Salzburg could enter as an amicus, or intervene in some other manner, in the lawsuit involving Peak Wellness Center in Laramie County. He believes there appears to be a state interest in that lawsuit. Mr. McDaniel will inquire about that. He is aware of a Supreme Court decision holding that communities may not block these type of homes with covenants and zoning.

SAGE Update

Mr. Mike Kusiek, Albany County SAGE Pilot Project and Ms. Fran Van Houten, Teton County SAGE Pilot Project presented a status report on their projects, describing how the projects work.

In response to a question from Chairman Gingery, Ms. Van Houten said it is less important to look at how many people are actually served in SAGE project. It’s a process not a program and its purpose is to change how providers do their business by coordinating community services under a federal Substance Abuse and Mental Health Administration (SAMHSA) grant. She described how she will act as a facilitator among the family and relevant provider agencies to make sure services are coordinated and each provider is aware of what other providers in the community can, or will, provide in a particular case. When parents know they have a voice and a choice, they are more likely to work toward the success of the program.

Mr. Kusiek advised that the Albany County project uses a similar process with slight differences. Systems of care in Albany have existed on a small scale for 20 years. In Albany county, folks who live there are either there for a long time or transient, so he has to tackle issues in a slightly different manner. He relies upon social marketing, through the media (Laramie Daily Boomerang) and Wyoming National Public Radio, and word of mouth. He uses the state photo voice project as well. He is serving about 30 families. A care coordinator helps the family navigate and learn their rights and to understand that the families can be in charge with what their needs are. The program also helps the agencies understand what the families need and what the agencies need as well.

Chairman Gingery asked how could this program be expanded. Mr. McDaniel replied we should not rely on new money to make it work, but rather educate on how to use the money in the system. The SAMHSA grant is time limited and its intended to establish a process that doesn't rely upon this funding to continue. Ms. Van Houten added that it is not about the money. The issue is system change and getting existing agencies to learn about each other and to work together. Senator Decaria stated that if the goal was system change, that change should be empowering without needing SAGE coordinators to be involved. Ms. Van Houten added that the idea is that once the system gets established, SAGE can fade away. Ms. Mary Flanderka stated she expects an application for a SAGE project in Buffalo. Gillette is interested as well. She is approaching the requests with the idea that they don’t need more money, but rather need to learn from other communities and ultimately use a mixture of existing resources. Chairman Gingery asked if this Committee should do anything to help expand the concept into other communities. Ms. Flanderka replied that it is not necessary at this point. We should wait but keep the issue on the radar screen.

Post-Traumatic Stress – Workers’ Compensation

Senator John Hastert introduced Mr. Abe Wheeler and Dr. Steve Cook, Psychologist. Sen. Hastert explained why he became involved in the issue of post-traumatic stress disorder (PTSD) as it relates to the workers' compensation program. He distributed copies of his proposed draft legislation, 09LSO-0053.W1 (Appendix 10) for the Committee's consideration. Dr. Cook will talk about statutes and how they prohibit mental health treatment. Senator Hastert said his bill failed introduction by one vote last session. He wants this bill to be a place holder for now. The Joint Labor, Health and Social Services Interim Committee is studying workers' compensation statutes at its last meeting and was not able to consider this issue. Due to the mental injury nature of this issue, Senator Hastert wanted to bring the issue to this Committee. In response to a question form Chairman Gingery, Senator Hastert advised that Senator Scott would likely be willing to consider the issue, but he doesn't know if the full Labor Committee would agree. The Labor Committee had about 15 bill draft requests and Senator Hastert is concerned this legislation would get lost in the shuffle.

Mr. Wheeler described the events that led to his PTSD while performing duties as a volunteer fireman.

Mr. Mike Newman, Attorney-at-Law, discussed Mr. Wheeler’s case before the Office of Administrative Hearings, which is currently on appeal. He stated that W.S. 27-14-102(a)(xi)(J) was amended in 1994 because of a fear that work-related stress claims would be filed, as happened in California, and pose a potential risk to the fiscal integrity of the workers' compensation program.

Dr. Cook stated that, based on his experience and work in community and in the Air Force, he was concerned about linking physical issues to mental injuries. Such approach misconstrues the interplay between psychology and physiology. PTSD should not be completely tied to physical injury. PTSD can have a delayed onset, so tying it to timeframe for physical injury is inappropriate.

Chairman Gingery stated this Committee could work this bill for next meeting, but if the Joint Labor, Health and Social Services Interim Committee wants it instead, he would defer to that Committee. During the next legislative session, this bill will go to the Joint Labor, Health and Social Services Interim Committee anyway.

Representative Iekel added that he believes this bill may fit within the topic approved by MC for the Joint Labor, Health and Social Services Interim Committee. One concern he had on the bill was that the bill says what a mental injury isn’t. He believes that "mental injury" should be defined in some positive way, based on the DSM-IV perhaps.

Senator Aullman stated that, as a volunteer EMT, she has experienced some of the same type of stress Mr. Wheeler experienced. She believes the Committee should consider this issue, particularly if the statements are correct that a paid firefighter would have been covered on the program, but volunteers firefighters are not.

Chairman Gingery stated that he believes that some of the language on page 2-lines 14 through 19 should be reinserted. He also believed that the Legislature did authorize funding to help with mental health issues experienced by emergency responders. Mr. McDaniel clarified that the funding was intended for bereavement counseling for surviving family members of emergency responders who die in the line of duty.

Committee Discussion

Chairman Gingery would like the Committee to address the oversight issue. He and Cochairman Aullman will prepare a memo summarizing what the Committee has learned in the last two meetings and submit the memo to the full Committee to consider and revise as necessary at the next meeting. The final product will then be distributed to the Joint Appropriations Interim Committee. He also suggested the Committee should have bills drafted based on the proposed language provided by the WSH earlier in the meeting, including language as recommended by Dr. Golding with respect to the U.S. Supreme Court in Sell v. U.S, supra; Senator Hastert's bill; and, possibly, amendments to Title 25 to address the bill sponsored last session by Representative Warren on costs of emergency detentions and to address a correction needed with respect to the costs of the county of responsibility, based on Fremont County's concern. He would like to address the HVAC needs of the WSH and the needs of geropsychiatric patients by getting more information to be able to educate the Legislature on those needs.

Senator Aullman would like to have an appropriations bill drafted to get the system moving.

Representative Iekel would like to see legislation providing for recruitment enhancements.

Senator Decaria would like to have legislation to clarify that if one region can't provide social detoxification services for its residents, that region's funding for that purpose may be used to pay for the provision of those services in another region that has the services available. He would also like to keep geropsychiatric needs on the table for discussion, even if no bill is drafted this interim.

Senator Johnson wanted to complement the community providers for their efforts in implementing 06HB91 and 07SF76.

PUBLIC COMMENT

Ms. Nikkel requested that the State should provide funding to continue the SAGE initiative since federal funding will end in 2½ years. The State funding could be used to fund case coordinators within the designated regions of the State. She added that the Governor's Planning Council on Mental Health is in favor of enhanced supported housing for persons who are mentally ill, and the continuing support for persons with mental illness and their families.

Ms. Carol Day, WDH, said she can provide the Committee with a report that is based on a study of the needs of geropsychiatric patients in Wyoming.

NEXT MEETING

Chairman Gingery said he and Cochairman Aullman would explore possible meeting dates in August. The probable meeting site will be in Casper so the Committee can tour the new residential facility that Mr. Huston will be opening in that month.

Meeting Adjournment

There being no further business, Chairman Gingery adjourned the meeting at 4:40 p.m.

Respectfully submitted,

Senator Pat Aullman, Cochairman Representative Keith Gingery, Cochairman

Appendix	Appendix Topic	Appendix Description	Appendix Provider
1	Committee Sign-In Sheet	Lists meeting attendees	Legislative Service Office
2	Committee Meeting Agenda	Provides an outline of the topics the Committee planned to address at meeting	Legislative Service Office
3	PowerPoint Presentation with Attached Proposed Statutory Changes	Provides information relating to psychiatric evaluations required under W.S. 7-11-303, and suggested changes to those provisions	Wyoming State Hospital
4	Report of Southeast Region Providers of Mental Health and Substance Abuse Services	Describes how mental health and substance abuse providers in the Southeast region of the State are implementing programs authorized under 06HB91and 07SF76	Peak Wellness Center
5	Report of Central Region Providers of Mental Health and Substance Abuse Services	Describes how mental health and substance abuse providers in the Central region of the State are implementing programs authorized under 06HB91and 07SF76	Central Wyoming Counseling Center
6	Statement of Position on Start-Up Costs for Residential Treatment Facility	Shows what start-up costs were allowed or disallowed for new residential treatment center to be operated by Central Wyoming Counseling Center	Central Wyoming Counseling Center
7	Report of Western Region Providers of Mental Health and Substance Abuse Services	Describes how mental health and substance abuse providers in the Western region of the State are implementing programs authorized under 06HB91and 07SF76	Pioneer Counseling Center
8	Report of Basin Region Providers of Mental Health and Substance Abuse Services	Describes how mental health and substance abuse providers in the Basin region of the State are implementing programs authorized under 06HB91and 07SF76	Yellowstone Behavioral Health Center
9	Report of Northwest Region Providers of Mental Health and Substance Abuse Services	Describes how mental health and substance abuse providers in the Northwest region of the State are implementing programs authorized under 06HB91and 07SF76	Campbell County Behavioral Health Services
10	09LSO-0053.W1, Workers' compensation-mental injury	Provides proposed change to statutory definition of "mental injury" for workers' compensation purposes	Senator John Hastert