Today, mental health remains one of the primary concerns of Wyoming law enforcement officials, Thompson said. He estimates nearly 50% of all SCSO cases involve some mental health aspect. When Thompson began his career in law enforcement in 1998, that wasn’t the case.
While Title 25 holds can be imposed following an individual’s deterioration at the Sheridan County Detention Center or through the Sheridan Veterans Affair Health Care System, Title 25 proceedings often begin with a call for service for officers at the Sheridan County Sheriff’s Office and Sheridan Police Department.
At SPD, calls regarding mental health come in about 18 times per week, according to data from 2021, SPD Capt. Tom Ringley said.
Callers requested welfare checks on friends, family members or neighbors; they reported suicidal subjects. These titles indicate to SPD officers mental health may be a factor in the interaction, Ringley said, but do not always result in Title 25 holds.
At SCSO, the calls have no distinct pattern, Thompson said. Sometimes, reports of a bad driver or domestic incident can result in a Title 25 hold — a 72-hour involuntary commitment — just as easily as a welfare check.
Officers make the decision to “title” a subject — or impose an involuntary hold — based on their training and observations at the scene, Thompson said. They ask themselves: Is this person a danger to himself or others, and will he be able to adequately care for himself if I leave?
Neither SCSO nor SPD initiates Title 25 holds without exhausting other acceptable options such as offering folks a ride to the hospital or offering a mental health resource pamphlet, Ringley and Thompson agreed.
Of the more than 11,000 calls for service SPD responded to in 2021, 934 were incidents related to mental health, Ringley said. Approximately 6% of these mental-health-related calls resulted in a Title 25 hold. The department averaged 55 to 60 Title 25 holds per year between 2017 and 2021, or more than one “titling” per week.
“We see the hospital as a last resort,” Ringley said.
At SCSO, Title 25 holds occur less frequently because the city offers a concentrated populace of nearly 20,000 residents plus visitors, Thompson said. People are more spread out in the sheriff’s office’s 2,500-square-mile jurisdiction.
According to data from the past three years, SCSO averaged about 12 Title 25 holds per year — one per month — with 15 holds in 2019, 14 in 2020 and eight in 2021. As with SPD, this is significantly lower than the number of calls SCSO receives regarding suicidal subjects or suicide attempts.
“If we can work a case without involving the criminal justice system and the parties involved are happy with the outcome, then everyone benefits from that,” Thompson said.
If involuntary commitment is deemed necessary, officers transport the subject to Sheridan Memorial Hospital.
If the titled person has already taken steps to harm himself, Ringley said SPD officers will handcuff him and transport him in the back seat of a police car. If the individual is compliant, he is often transported to the hospital in an ambulance or placed in the back of a police car unhandcuffed.
“Being suicidal is not a crime. Therefore, we have no desire to treat [involuntarily committed] people like criminals, although sometimes the restraints are necessary,” Ringley said.
Upon arrival at the hospital, the law enforcement officer will fill out paperwork related to the Title 25 hold, Ringley said. Officers write down what they observed about the patient, what inferences they made and how they came to the decision to hold the individual. Then, the officer will wait at the hospital to ensure the patient and hospital staff feel safe.
SPD officers and SCSO deputies have been willing to stay at the hospital as long as necessary for emergency room staff to feel comfortable, SMH Emergency Department Medical Director Dr. Luke Goddard said.
Occasionally, a titled person will be held at the Sheridan County Detention Center, Thompson said. SCSO starts by transporting involuntarily committed people to the hospital, so that medical observation and treatment can begin as soon as possible, the sheriff said. But there are occasions when titled people pose an extreme safety risk to hospital staff and must be held in jail.
In his five years as sheriff, Thompson estimated only three titled people have had to be held involuntarily at the county jail.
A third of those involved in Title 25 proceedings initiated by SPD have future contact with the department, either through another titling or a criminal case, Ringley explained. SCSO, too, repetitively interacts with many of the same people in the process.
Some point to this level of repeat involuntary holds as an indication law enforcement shouldn’t be involved in emergency mental health care at all.
The Black Lives Matter movement’s calls to defund police departments across the U.S. included specific requests to fund community mental health services as an alternative to police departments and highlighted several recent cases across the U.S. and Canada in which police responses to mental health crises resulted in violence against Black residents.
Ringley, though, said law enforcement should be involved in this system to ensure the safety of those experiencing mental health crises and agencies responding.
“What’s first and foremost over everything is safety…” Ringley said. “Even if there was a mental health agency in Sheridan that had the means to respond to every mental health call, we would still be there first. We would not expect anyone to go into a place that hasn’t been made safe.”
The major problem faced by this system is the lack of mental health treatment options available in Wyoming, Thompson said. Because the state lacks the mental health infrastructure — from counselors and psychiatrists to brick-and-mortar mental health facilities — to absorb those in crisis, agencies all over the state are scrambling and struggling to offer patients care.
“[This problem] is going to continue to get worse until we have some serious changes in Wyoming,” Thompson said.