By CRISTINA JANNEY
Hays Post
Local officials expressed frustration with issues of lack of communication, lack of transportation and lack of beds that have led to long waiting periods for adults and juveniles needing inpatient psychiatric care in western Kansas.
High Plains Mental Health sponsored a meeting with the Scott Brunner, deputy director of the Kansas Department of Aging and Disability Services; Andy Brown, commissioner for Behavioral Health Services at KDADS; Bobby Eklofe, president KVC Hospitals; and K.C. Johnson, president of HealthSource, Thursday in Hays.
About 70 audience members joined in the discussion, including members of law enforcement, mental health providers, emergency care and hospital staff, and educators.
RELATED STORY: Patients in crisis wait up to a week for admittance to Larned State Hospital
Citing the need for infection control and difficulty with staffing, Larned State Hospital has not operated at full capacity since 2020. They have 74 beds available at this time.
Walt Hill, director of High Plains Mental Health Center, said in February the waitlist for the state hospital was up to 35 people and the average wait was 67 hours.
Brunner said the waitlist was down to 19 people for the month of May.
In addition to taking children from Kansas, KVC is also taking calls from Missouri, Iowa, Nebraska, Colorado and Oklahoma.
Nationwide crisis for child psychiatric care
Brown said the nation is in crisis in terms of children's psychiatric care. There is more demand for care and children presenting with more severe needs, he said.
The latest state budget included more funding for youth residential treatment facilities to help with staffing issues, Brown said.
Eklofe said KVC may have a licensed capacity, but the actual capacity may vary depending on staffing. Eklofe said KVC lost staff during the pandemic and is trying to recruit them to come back.
Hospitals struggle to find staff
He said KVC has seen about a 20 percent turnover rate in the last couple of years and has struggled to fill all of the positions.
It is not just the number of staff needed, it's also the specialty staff that is needed, he said.
Beyond staffing, Eklofe said KVC also looks at the safety of children when deciding how to prioritize admissions. A child who is sitting in an office may take priority over a child that is waiting in a hospital room or emergency department for safety reasons.
Area hospital staff expressed frustration about waits and the screening process for juveniles. One worker said a youth was at her facility for 10 days and had to be screened multiple times because of the long wait.
Brunner said the state hospital draws as many employees it can from Larned and the surrounding area but struggled to find enough qualified employees even before the pandemic.
The hospital is working with contract agencies to bring nurses to the facility.
Brunner said he did not have specific numbers on the number of staffing vacancies at the Larned currently.
"Our primary focus is to keep our staff and our patients safe," he said.
The hospital keeps workers over for extra hours or extra shifts or calls workers back to work to meet the needs of the hospitals.
"It's a constant, dynamic, moving thing every single day," he said.
The severity of the patients' illnesses and their need for one-on-one or two-on-one staffing can also alter the number of staff members needed.
Patients wait in ERs, local hospitals without medication<br>
HealthSource works with most of the state's community mental health centers to do screenings to determine if people need to be admitted to psychiatric hospitals.
Those screenings are done through telemedicine. The average response time for these telemedicine screenings is an hour and 41 minutes. However, people have had to wait as long as seven hours.
It also works with the state to manage the state's mental hospital waiting lists. Twenty-one percent of more than 400 screenings in the High Plains Mental Health catchment area met the criteria for involuntary commitment to a state hospital.
Over the last six months, HealthSource has handled 1,200 calls to its crisis line. The average wait is 17 minutes, but Johnson admitted often waits are longer. Johnson said the agency is constantly working with staffing to cut those wait times.
Fifty-nine percent of their calls were from people who were suicidal. Nineteen percent of the calls were from people experiencing violent thoughts.
Johnson said the agency works with community providers like High Plains Mental Health to try to keep people out of the hospital when possible.
HealthSource also administers the State Institue Alternative plan, which pays private hospitals to care for people with acute mental illnesses.
Johnson said HealthSource is looking at investing in a system that would allow law enforcement or hospital officials to see the progress HealthSource is making to place someone.
Audience members, including Ellis County Sheriff Scott Braun said there is confusion as to whether all patients admitted to a state hospital needed to be medically cleared.
Braun said he was being told they did, so they were all being taken to HaysMed for that clearance. This is taking time away from ER and hospital staff.
Johnson said not all patients need to be medically cleared.
Some ER physicians are reluctant to prescribe any psychiatric medication to patients who have come in off the street. This results in patients waiting days in a local hospital for admittance to a psychiatric hospital without any treatment.
"It's like having a broken leg and not getting it set," one ER staff member said.
Change in statute considered for out-of-state patients
Thomas County Undersheriff Eric Smith said as a result of Interstate 70 going through his county, law enforcement deals with many individuals who Have mental health issues who are not from the local area and have no plan to stay in Kansas after they are released from the hospital.
He said there is confusion on who should be responsible for those patients.
Brunner said the statute doesn't give officials a clear path for those patients. He said state officials are aware of the problem and hope to propose legislation to deal with the issue.
Officials express concerns about potentially suicidal, violent individuals being released into community
Lt. Tim Greenwood of the Hays Police Department, as well as other members of the audience, said they were concerned about the screening process. He said he felt the screeners were only talking to patients and not to law enforcement officers who may have spent hours with a patient.
He was concerned some patients are being released into the community with safety plans who have been violent or suicidal.
"We don't ever want to do things that would ever put people in danger," Johnson said. "We might have criteria that this person doesn't meet certain expectations, but this is still really scary. What are the things we can do? You can get a second opinion."
Hill said High Plains Mental Health is the only community mental health center in the state that has an automatic secondary review of screenings for inpatient psychiatric admissions.
Johnson said he will work with his team to ensure law enforcement officers and medical professionals have opportunities to report their observations to screeners.
"It's not about us, it's about patient safety," he said.
Secure transportation
Finding secure transportation to get patients from rural hospitals to state psychiatric hospitals has also been a challenge.
Sometimes law enforcement will transport patients. However, that may depend on the willingness of the agency to do so and their available staffing.
Transporting someone with a mental illness handcuffed in the back of a police car may be traumatic for the person with the illness, Hill said.
HaysMed has trained staff to complete these transports. Some suggested expanding such a service to other areas of the state.
Hill said high liability insurance may be a barrier for agencies to provide this type of service.