By Dave Ranney

KHI News Service

July 24, 2008



TOPEKA State officials are soliciting public comment on a series of proposals for overhauling the state"s mental health system.

The proposals are outlined in three "Hospital and Home" reports available online at www.medicaidtraining.org , which includes a form for reader feedback.

"The emphasis here is to truly identify things we can do and to hold us accountable," said Rick Shults, acting director of mental health services at the state Department of Social and Rehabilitation Services.

The reports focus on access, assessment and crisis management.

Legislators last year directed SRS to redefine the role of the state"s three hospitals for the mentally ill. SRS, in turn, broadened the project to include community based services as well.

The recommendations have been available to the public since June.

"These are living documents," Shults said. "We want feedback, we want to move forward."

Lawmakers last reformed the state"s mental health system in 1990.

In recent years, the state hospitals in Osawatomie, Kansas City and Larned have routinely been over capacity, private hospitals have closed many of their psychiatric units, county jails have become dumping grounds for the mentally ill , and community mental health centers say they"re running out of money.



Among the recommendations:

* Review the treatment efforts in the nation"s 10 best inpatient psychiatric hospitals and apply them to the state hospitals.

* Encourage the University of Kansas Medical School to use the state hospitals in Osawatomie and Larned as teaching hospitals.

* Encourage private hospitals to provide inpatient psychiatric services in their catchment areas.

* Design and support housing, transportation and work programs for the mentally ill.

* Redefine the role of nursing home-like facilities for the mentally ill.

* Find alternatives to transporting "persons in crisis" in police cars while bound in restraints.

* Take steps to ensure that all programs for the mentally ill have board members who are living with a mental illness.

* Start a Court Appointed Mental Health Special Advocate program for helping the mentally ill deal with the judicial system.

* Develop alternatives to incarceration.

* Give mentally ill adults and parents of mentally children the opportunity to choose between service providers.

Shults reviewed the recommendations during a meeting Wednesday with the Kansas Mental Health Coalition.

The coalition"s chairman, Dr. Roy Menninger, objected to the recommendations, saying they focused too much on the "big picture," not enough on the role of the state hospitals.

Stephen Feinstein, a former superintendent at Osawatomie State Hospital, agreed.

"The general theme of the reports seems to be "let"s take a very careful look at what"s going at the "front door" and at the "back door" getting people in and getting them out," he said. "But there doesn"t seem to be much attention paid to what"s going on in between. It"s like we"ve gone back to the old bed-management days as opposed to leading the way."

Feinstein serves on the board of the National Alliance on Mental Illness.

Menninger is a former president and CEO of the Menninger psychiatric clinic which moved from Topeka to Houston in 2003.

Shults defended the reports.

"Services provided to people with a mental illness are part of a system," he said. "What happens in one part of the system affects another part of the system. So to be effective, we have to take a systemic view, and that view includes inpatient services, which includes the state hospitals."

-Dave Ranney is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. He can be reached at dranney@khi.org or at 785-233-5443, ext. 128.