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Rural Psychological Units, Facing Regulation Pressures, Choose To Close


The only inpatient psychological unit in northern Wyoming has closed its doors. One reason the PineRidge Inpatient Behavioral Health Unit had to shut down was because it couldn't comply with new federal regulations aimed at patient safety. And other small rural psych units are facing similar pressures. Wyoming Public Radio's Kamila Kudelska has been looking into this.

KAMILA KUDELSKA, BYLINE: Kris Sturgeon lives in Lander. She suffers from major depression and multiple personality disorder. The day I meet her, she's not doing so well.

KRIS STURGEON: I am in one of my major depressions right now.

KUDELSKA: Because of the recent closure of PineRidge, she can't get the critical care that she needs.

STURGEON: I mean, thank God I am not suicidal, but I also know that I can become suicidal very rapidly.

KUDELSKA: For Sturgeon, the eight- to 13-bed unit with psychiatric staff to help the mentally ill was a safety net. She's been there more than two dozen times in the last few decades. She knew she could be helped quickly. But now, the closest inpatient psych unit is 2 1/2 hours away at the Wyoming Behavioral Institute, or WBI, in Casper.

STURGEON: The last thing I heard was WBI is full, so it's not an option anyway.

KUDELSKA: PineRidge's parent company, SageWest Health Care, explained in a statement that the new regulations from the Centers for Medicare and Medicaid Services, or CMS, were one of the main reasons for the closure. Those new regulations directed all facilities to be clear of anything a patient could use to commit suicide. CMS wouldn't comment for this story. Mark Covall is with the National Association for Behavioral Healthcare.

MARK COVALL: CMS put in place a directive basically saying that all inpatient facilities needed to be ligature-free.

KUDELSKA: Ligature-free - as in, anything that could be tied or bound. He says the problem with the CMS directive is there is no clear guidance for people who inspect these facilities, known as surveyors.

COVALL: Every single psychiatric hospital, inpatient psych setting works incredibly diligently to make sure that it's the safest environment possible. However, surveyors are demanding very high-cost solutions with low value.

KUDELSKA: So one surveyor may say the hospital is in compliance, while another may say it needs to update its facilities. These updates can be very costly and are required to be completed within a short period of time. Nationwide, the cost to clear out those ligatures from psych facilities in one year was around $800 million, according to the Behavioral Healthcare Association. Covall says there needs to be a balance.

COVALL: This idea of a narrow view of just ligature as being the most critical part of this can actually reduce the facility's ability to provide the care that's really necessary.

KUDELSKA: In the past year, at least three other inpatient psych units closed in Ohio, Missouri and California. They all cited ligature regulations as a reason. This is creating more shortage in an already small population of inpatient beds, says John Snook. He's with the Treatment Advocacy Center, a national organization that works to increase access to inpatient psychological care.

JOHN SNOOK: And when they don't have the beds they need, they just end up in a system that can't say no or jails or homeless shelters.

KUDELSKA: The burden of these federal regulations is putting more pressure on an already fragile mental health care system.

For NPR News, I'm Kamila Kudelska in Cody, Wyo. Transcript provided by NPR, Copyright NPR.

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