As the Wyoming Legislature considers a bill that would keep insurance companies from upcharging patients with a history of mental illness and substance abuse, Teton County is making strides in filling holes in local health care.
Over the course of 2018 three women moved to the community to provide services: licensed clinical social worker Lindsay Long and psychiatrist Kathleen Logan, who are both part of St. John’s Physician Practices, and psychiatrist Cheryl Collins, who is in private practice.
Long, the behavioral health program coordinator at St. John’s Medical Center, was hired in March to develop a mental health focus in the hospital’s outpatient clinics. The addition of two new psychiatrists, she said, has been huge.
“I have more people to call and refer to,” Long said. “It’s nice to be able to say, ‘Hey, we could get you in within a week or two,’ instead of ‘You have to wait six weeks.’”
Mental health isn’t a “somewhere else” problem. While Jackson is a “smaller place, it’s just like every place else,” Logan said.
“None of us are immune to depression, anxiety — all of those types of things,” she said. “Our ability to cope with it at some point, for whatever reason, may be diminished … it’s something we’re all vulnerable to. So no matter how strong we see ourselves, life circumstances and genetics and the whole combination can get us down.”
Collins moved to Jackson in November from Washington, D.C., where she had her own adult, child and adolescent psychotherapy and psychiatrist practice for 15 years.
“I’m a one-woman show,” Collins said. “I always have been.”
She and her husband had talked about moving here for a while.
“We’d been coming here and we were always sad when we left,” Collins said. “Walking back into the office in D.C., I thought, ‘I got to get outside more.’ Being outside there is different than getting outside here.”
But while she’s appreciated the access to nature, she’s also taken note of the independent- minded nature of Wyoming folks — and the misconception that scenery can solve everything.
“What we carry around in our inner world is the same, no matter what the external world is like,” Collins said. “Sometimes because it is so beautiful here people maybe feel like they shouldn’t be sad or something.”
Collins does both medication management and psychotherapy, a combination she said works well for her patients.
“You get to know the person so much better when you’re doing therapy and seeing them more frequently,” she said. “You can tease out more what’s biological and what’s psychological if you know the person better.”
Logan, who said she’s “first and foremost a physician,” works for St. John’s Medical Center, specializing in child and adolescent psychiatry. Before joining St. John’s she was on staff at the Mayo Clinic for 34 years.
“I’ve spent my entire career, which is excessively lengthy, dealing only with children,” she said. “So I know kids, I know kids very well. You need both child psychiatrists and adult psychiatrists, and I think coming in here as a child psychiatrist I have something to provide that was perhaps not present here before.”
She conducts comprehensive assessments, diagnoses patients and writes scripts if medication is needed. Patients go elsewhere for counseling.
Although Logan started working in Jackson in September, she’d been doing project work with the hospital since early 2018 with the goal of assessing the need for children’s mental health services.
“That was the segue into starting this,” Logan said. “If I hadn’t done that I probably wouldn’t be doing this.”
She found the system of therapists, providers who specialize in medication management and actual psychiatrists to be “extremely confusing.”
“Even coming in here, knowing the mental health field, trying to pinpoint what kind of therapist does what — it’s hard,” Logan said. “There’s a lot out there.”
More work to be done
There are steps health care providers here could take to continue solidifying mental health offerings in the valley. Chief communication officer Karen Connelly said St. John’s aims to “identify the gaps and find resources to address them.”
Long splits her time between Urgent Care and Family Practice and Wilson Medical and Internal Medicine, connecting patients to resources and offering psychotherapy.
“A lot of time [for] patients that’s their gateway to talking about mental health,” she said. “They feel safe with their provider or doctor. So this is a way for us to capture people who might not otherwise seek mental health help in other areas.”
According to Current Psychiatry Reports, a peer-reviewed medical journal, 50 percent of people who come into provider’s offices with suicidal ideation will die by suicide within a month.
“Being in not only a rural community but a mountain town where historically the rate of suicide has increased quite a bit, we want to make sure we’re really supporting people who come to the provider’s office,” Long said.
In Long’s case, addressing gaps might include making sure a social worker is in each outpatient clinic every day of the week so more patients have a plan and don’t end up at the emergency room in crisis.
“As I’m at one clinic one day a week, we’re barely scratching the surface,” Long said.
“I get referrals and I follow up, but the likelihood of that person answering the phone is probably a lot less versus if I were just to be in the room with them, building rapport instantly ... and having that therapeutic relationship,” she said.
Having formerly taught psychotherapy at George Washington University, Collins would like to offer continuing education for local mental health care providers.
“I’m hoping to pick up teaching in some form here, too,” she said. “I’m hoping to develop those things.”
For Logan, plugging holes means working on relationships with C-V Ranch, Red Top Meadows and the Van Vleck House as well as attempting to recruit a psychiatrist or better yet, two, who can take her place for the long term.
Such an addition would require an increasingly robust system to reassure doctors their patients are supported.
“People are really invested in having the best outcome for their patients,” Logan said. “So if they’re working in a place where they can’t have that, they’re not going to stay.”
It also means coming up with a better way to help patients in crisis who show up to the emergency room and don’t have the money to seek treatment elsewhere. Best-case scenario, she said, would be a small adult and child unit in Jackson,
“The wealthy can get on a plane and you can go wherever [they] want and can get in to some place,” she said. “I’m looking at the people who don’t have those resources.”