EVANSTON — The Wyoming State Hospital serves all 23 counties in Wyoming and has two main programs: Title 25 civil patients and Title 7 forensic patients. All of its patients are court-ordered to be at the hospital, although some are there longer than others. Individual communities in the state also have programs in place to help some of the patients before they are sent to the State Hospital.

Hospital administrator Richard Dunkley said forensic patients (usually there for competency evaluations for the court system) typically stay for less time or come in with restorable situations. 

The hospital has undergone some program changes; Paul Mullenax, the hospital’s business manager, said that some years ago the legislature allowed the State Hospital to do outpatient evaluations. Before that point, anyone who needed a competency evaluation would have to come to the hospital, but now more flexibility is allowed in that decision. 

The hospital also has its own transportation system that goes throughout the state to pick up patients or return them to their communities. Not all qualifying patients come to Evanston immediately, though; there are some hospitals elsewhere that can take patients in the interim while they go on a waiting list. 

“We really don’t take walk-ins here,” Dunkley said. “They’re court-ordered. We deal very closely with most of the counties in the state, and it’s exciting for us to see them take charge through the gatekeeper program.” 

That gatekeeper program has been piloted in Casper since last year and gives mental health centers the power to decide whether a patient can be cared for in the community. Dunkley said it has worked well and reduced some of the admissions to the State Hospital. 

One of the difficulties is that 17 of Wyoming’s counties are rural, which limits care for people struggling with mental health issues such as those that the hospital addresses. However, with the gatekeeper program and plans to develop community services, the hope is that more patients will not require the full removal the state hospital provides. 

Rep. Lloyd Larsen (HD-54), chairman of the Health Facilities task force, agreed, saying that how patients are treated before they have to go to the State Hospital makes all the difference. That issue also encompasses the hospital’s full beds and long waiting lists — and he said it’s something that the remodel can’t fix.

“What we have to do is find a way to divert these folks that have challenging issues in their life, to get them help — hopefully before they require attention at the State Hospital,” Larsen said. 

He then added that another piece of the puzzle is how to give people the support they need to remain stable after they have received the immediate help they need; again, that goes back to the community — and often, that can mean a greater need for good counseling rather than just medical solutions. 

“What we need to do is be able to have in place treatment and resources that allow these folks to … not have to go to the State Hospital as much,” he said. 

That is a challenge in small communities, including ones with fewer than 1,000 people, where there are fewer resources. There are still regional options, though, and telehealth is making it easier to reach good care even from a small community. Larsen said other states are making the same steps, since rural communities aren’t limited to Wyoming. 

Historical concerns

Since there is so much empty property between the old campus to the north and the new area, none of the old buildings will be torn down. Instead, the remodel committee is inviting the community to get involved in the future of Evanston’s history and historical buildings, which will be vacated. 

The buildings didn’t always make up a State Hospital; the campus has been many things over the decades, including a women’s prison. 

“Initially the intent was to tear down ... the old historic stuff,” Larsen said. “We’ve elected to sit on that for awhile in the event that there’s a group or individuals that want to do something with those buildings.” 

The state doesn’t have the funds to preserve and maintain the historic buildings, as its focus is making sure the Wyoming State Hospital serves the direct and immediate needs of its patients, but anyone who wants to keep the historic part of the hospital alive will have the chance to give input on it. 

Mullenax also said that the state hospital is working with Evanston City Clerk Amy Grenfell and Main Street Wyoming, and there will be a brainstorming session in August for people to look at the buildings and see what they could be used for. 

“There’s been a lot of interest from the community in doing something with these buildings,” Mullenax said. 

Overall, the State Hospital remodel is an exciting prospect for many, and there are high hopes that it will be a positive change not only for the hospital itself but the community and even the statewide approach to mental health.