By CRISTINA JANNEY
Hays Post
Mental health officials discussed the restructuring of mental health services in the state, as well as the challenges of funding and workforce, during a High Plains Mental Health Center-sponsored town hall meeting in Hays on Tuesday night.
"To realize the importance of a network that is so tightly bound by the values involving timely access to high-quality mental health care, I think, is one of the cornerstones of our statewide system," said Kyle Kessler, executive director of the Kansas Association of Mental Health Centers.
Kansas has moved away from a community mental health center model to Certified Community Behavioral Health Clinics.
Under the community mental health center model, all of the centers functioned differently and independently of each other.
The Behavioral Health Clinic has set standards for the clinics and changed the way those clinics are funded.
In the 1990s, Kansas set about to move people who needed treatment for mental illness from inpatient hospitals to community outpatient treatment.
Kansas had more than 3,000 psychiatric inpatient beds, and many community and private hospitals also had psychiatric wings.
"It kept people from being in psychiatric hospitals for months and sometimes years at a time," Kessler said, "but in that process, Kansas overcorrected."
As inpatient beds were decreased and hospitals closed, funding was supposed to follow those in need of care to community services.
Over time, policy priorities changed, Kessler said.
Funding for mental health treatment was cut repeatedly by the state. In 2015 and 2016, $30 million, equal to 10% of state mental health funding, was cut.
"We saw substantial eroding of funding that was supposed to follow people back to the communities," Kessler said.
And then even more hospital beds were cut.
Additional beds were cut at Ossawatomie State Hospital, and Topeka State Hospital, which had about 1,000 beds, was closed. The Rainbow mental health facility in Kansas City, which had 80 to 100 beds, closed.
"As recently as a month and a half ago, we had a waiting list of 30, and those were people who were deemed to be a danger to themselves or others by the courts and local authorities," Kessler said.
The state established a Crisis Intervention Center model, which allowed people to be treated locally for short-term acute stays.
The goal was to help people without them having to go to state hospitals or engage with law enforcement or courts or end up incarcerated, Kessler said.
A new state hospital is set to open in Wichita in 2027, which should take some pressure off Larned and Osawatomie, he said.
"I think we are going to a good place as it relates to capacity," Kessler said.
He said mental health advocates decided that if the system was going to receive renewed funding and grow, it should be rebuilt in a way that made the most sense to Kansas and was designed by Kansans.
Michelle Ponce, associate director of the Kansas Association of Mental Health Centers, further explained the Certified Community Behavioral Health Clinics, stating they expand the services provided to their communities and alter the way the clinics are funded.
Mental health clinics have historically operated under a fee-for-service basis. Those fees for services have remained static since 2008, Ponce said. However, the costs of providing those services did not.
The new model is meant to reimburse clinics at the true cost of providing services.
"Through the process, they are getting paid a lot more for individuals who have Medicaid," Ponce said.
All community health centers and all Certified Community Behavioral Health Clinics are required to serve anyone who walks through their doors who needs their services, regardless of their ability to pay.
The Kansas Department of Aging and Disability Services, in its research, found that a 40% investment in the mental health system saw a 75% increase in access.
Ponce said the system is meant to be a whole, integrated health model.
"It could be an individual who is being seen for a mental illness, but they're also really struggling because maybe they have diabetes," Ponce said, "and they are having a hard time managing the symptoms of their diabetes.
"That is not something historically mental health centers would be in the business of treating. Now they are responsible for helping that individual meet those needs."
That could be through their own staff or reaching out to the local health department. It is care coordination, which is more than a referral, Ponce said.
The care coordination also involves ensuring individuals have housing, employment and food.
"It's about ensuring all of those needs are met, not simply looking through the lens of meeting their mental health needs, but really their whole-person needs," Ponce said.
The Behavioral Health Clinics have nine criteria they must meet. Ponce highlighted crisis services and outreach to veterans, which she said has been a population that has been difficult to reach.
High Plains Mental Health Center has a mobile crisis team. They are required to contact someone in crisis within two hours. Because of the geographic challenges in rural Kansas, case managers may take an iPad to a person or the emergency room to connect a person with a therapist remotely.
The other component of crisis response is crisis stabilization units or crisis intervention centers. The difference is that crisis intervention centers can admit involuntary patients.
High Plains Mental Health Center is remodeling the third floor of the Hadley Center as a crisis intervention center. The facility is set to open in March.
Kessler spoke about the high cost of the mental health workforce shortage in Kansas. State hospitals, especially Larned State Hospital, are using a high percentage of contract nurses.
Five years ago, the cost of contract nurses was $5 million. Now it is more than $45 million.
"That's not sustainable," he said.
The Kansas Behavioral Health Center of Excellence was created to increase recruitment and retention of nursing faculty and students.
Before 2021, Kansas was bordered on all four sides by states that had implemented the Behavioral Health Clinics model or expanded Medicaid, allowing them to pay staff more.
In 2021, the Kansas mental health system had a 25% employee vacancy rate across the system.
"It is really hard to meet the needs of your community with a 25% staffing vacancy rate," Ponce said.
She said the Behavioral Health Clinic model has been a game-changer for the workforce.
The state has seen the following increases since 2021:
• 60% more child case managers
• 43% more adult case managers
• 75% more licensed professional counselors
• 40% more licensed clinical social workers
• 80% more licensed practical nurses
• 50% more advanced practice registered nurses
However, Ponce said the system still needs to recruit more people to work in the system.