Crisis in Kansas: Sign of the times?

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CMHNetwork is seeing signs of layoffs in mental health centers all across the country. What is troubling is that we are not seeing much in the way of discussion about how to do things differently, i.e., take a systems of care approach to developing a service net that does not rely on a "mental health center" needing to be the sole answer to meeting the needs of those with mental health challenges.

Here is an article from the KHI News Service talking about layoffs in community mental health centers in Kansas. Comment at the end of the article and let us know what you think. How would you address this increasingly frequent problem?

— It isn’t hard to find a Kansas police official upset with the state’s mental health system.

But Brad Schoen, director of the Riley County Police Department, is particularly outspoken.

“Frankly, the social service component of what’s going on in the state’s mental health system is an embarrassment,” Schoen said.

For the past few years, government funding for the state’s 27 community mental health centers has failed to keep pace with the number of people needing services and treatment. The local centers became the cornerstones of the state’s mental health system following reforms in the early 1990s that decreased reliance on the state mental hospitals.

“It started out with ‘We’re going to establish all these mental health centers, there’s going to be all this funding and it’ll all be locally controlled.’” Schoen said. “Well, that lasted until the funding got tight, and they’ve been cutting continuously since then.”

Actually, funding for the system has been up and down since 1991. But for the past five years it has been flat or significantly decreased even as the number of people seeking services has grown.

As a result, say Schoen and many other law enforcement officials, they increasingly end up dealing with mentally ill people who otherwise might not have landed in the criminal justice system.

“We have a guy in jail right now who’s accused of killing a gentleman in the northern part of the county,” Schoen said. “I can tell you his mental health is not good, and in my opinion he’s the kind of person we were told was going to be taken care of by the establishment of all these local mental health centers. Our mental health center is doing everything it can with the resources available. It’s the state that’s not held up its end of the bargain.”

The latest budget problem that the centers face stems from the most recent contract struck between them and the Kansas Department of Social and Rehabilitation Services. Projections used to develop the contract underestimated the Medicaid services the centers provide. That increased the savings the state expected from the contract from 8.5 percent to about 11 percent. But more savings for SRS meant fewer dollars for the centers, prompting at least one to announce layoffs and reduced services.

As state officials continue to look for ways like that to cut budgets, the problems of access to mental health services are increasingly apparent to more people than the police.

Disintegrating support system

One of the legal provisions of the mental health reform of 1991 was that the mental health centers would serve all who needed help. But with budgets tightening even as demand for services has grown, those with less severe or obvious problems often end up waiting longer for care.

“It’s a lot more difficult to get in to see somebody,” said Chris White, a peer specialist who works with the mental health center in Leavenworth. “It’s like they’re always overbooked.”

Barb Andres is executive director at Venture House, a Wichita program sponsored by Episcopal Social Services.

Many of those served by Venture House are homeless or near-homeless and many are mentally ill.

“We have always had people come in who are dealing with a mental illness. That’s not new,” Andres said. “But what is new is we’re starting to have people come in who are actively psychotic. They are very, very ill.

“They were ill before, but what’s happened is that with all the cuts, the support system that used to help them maintain has disintegrated,” she said. “The whole system — it may be housing or being able to get in to talk to someone about getting your meds adjusted — is pulling back. It’s focused a lot more on crisis than it is on helping people maintain.”

The problems with the mental health system described by Schoen, Andres and others have yet to become a top priority of the Kansas Legislature or other state policymakers. A few, however, have expressed concern.

“We’ve heard the governor say he’s not going to hurt the most vulnerable among us,” said Rep. Bob Bethell, an Alden Republican who sits on the Health Policy Oversight Committee. “But we’ve certainly done a number on mental health.

“I don’t see where this is going,” he said. “I see us cutting services on the community level and I see the state hospitals saying they’re full and can’t take any more patients. So what’s happening is a lot of people are getting locked up for the sake of their own safety and for the safety of society at large. That’s not a good solution to the problem.”

As part of the 1991 reform, the mental health centers also were designated the gatekeeper for people needing services, a function which often has put the centers at odds with independent therapists and social workers who have long argued that the mentally ill need easier access to independent providers.

Sky Westerlund is executive director for the Kansas Chapter of the National Association of Social Workers, a group that has called for easing the centers’ control over referrals.

“The community mental health centers have driven the system for the past 20 years, since mental health reform,” Westerlund said. “But with all the cuts that have taken place in recent years, it’s pretty clear to me that SRS is suspicious. It’s wondering if there might be a better way of doing things.”

Westerlund said her group favors changes that would improve services and “open up” the system, but that’s not what she’s heard SRS officials talk about when mental health issues come up.

“The discussion I’m hearing,” she said, “is, ‘OK, we’ve got a damaged system here. How do we rebuild it and not spend as much money?’

“But if you destroy a system, it’s going to cost you more to build a new one,” she said. “This shouldn’t be about reams of paper and getting by with less. It should be about services.”

David Johnson, executive director of Bert Nash Community Mental Health Center in Lawrence, said state budget cuts forced him to lay off 12 workers in the spring.

He said the center expects to end 2012 with a $90,000 deficit.

“This is a long-term issue when it comes to cuts to mental health,” Johnson said. “We’ve had to work real hard to keep from sinking under. No question about that.”

Johnson said his goal is to keep the center open until 2014, when the federal health reform law is slated to extend Medicaid eligibility to an additional 16 million Americans, including thousands in Kansas.

“The light of the end of the tunnel I'm working for is the 2014 expansion of Medicaid under the Affordable Care Act,” Johnson said. “I’m just trying to make sure we're still around when that time comes.”


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