The state's mental hospitals are too full

Ban on voluntary admissions now in place

0 | SRS, Hospitals, Mental Health

Jim Mosbacher of Breakthrough House in Topeka.

Jim Mosbacher of Breakthrough House in Topeka.

— The Kansas Department of Social and Rehabilitation Services has suspended voluntary admissions to the state’s three hospitals for the mentally ill.

All three facilities are full beyond licensed capacities, officials said.

“This is as bad as it’s ever been, which is why we took the action we did,” said Ray Dalton, SRS deputy secretary of disability and behavioral health services.

It’s become increasingly common for Larned State Hospital, Osawatomie State Hospital, and Rainbow Mental Health Facility in Kansas City to have four or five too many patients. Last week, however, each had at least nine too many.

In recent years, SRS has been able to avoid suspending admissions by shifting referrals; patients who ordinarily would have been sent to one hospital were sent to another.

That’s not an option when all three hospitals are over census.

“We’re really limited in what we can do,” Dalton said.

It’s unclear, he said, what caused the spike in admissions.

“I’ve talked to the superintendents and they say there doesn’t seem to be one particular thing they can pin it on,” Dalton said. “Usually, when there’s a spike like this we can get them through the crisis and back out into the community, but this time the acuity level seems to be higher than what it’s been in the past.”

The hospitals’ capacities:

• Larned State Hospital – 76 beds.

• Osawatomie State Hospital – 176 beds.

• Rainbow Mental Health Facility – 50 beds.

The hospitals continue to accept people ordered to the facilities by the courts or escorted by police. Voluntary admissions involve adults who realize they’re ill and in harm’s way.

Admissions are reserved for adults with serious and persistent mental illnesses who are considered a danger to themselves or others.

The suspension took effect May 19. Since then, no one has sought voluntary admission.

In recent years, around 30 percent of admissions to Larned and Osawatomie state hospitals have been voluntary. At Rainbow, half the admissions have been voluntary.

Voluntary admissions require a referral by one of the state’s 27 community mental health centers. When the hospitals are full, the community centers are expected to find placement alternatives for people who otherwise would be admitted.

Predictable problem

Mike Hammond, executive director of the Association of Community Mental Health Centers of Kansas (ACMHCK), said the suspension couldn’t have come at a worse time, noting that center budgets have been cut $30 million in the last three years, including a 10 percent reduction in Medicaid reimbursements that became effective Jan. 1.

“No one can say they didn’t see this coming,” Hammond said. “You can’t take $30 million out of the system and not expect something like this. The system is under tremendous strain.”

The cuts have caused centers to lay off workers and limit access to services. It’s inevitable, Hammond said, that as more would-be patients receive fewer services, a percentage will “decompensate to a point of being in crisis” and warrant hospitalization.

“We’ve said all along that if we don’t serve these people in the community, it’s not like they’re going to just go away,” Hammond said. “They’re going to show up in the emergency room, in jail or, in this case, the state hospital.”

Hammond said center directors were upset over having their budgets cut and then being told they must find – and pay for – care for patients who need to be hospitalized but are considered voluntary admissions because they haven’t committed crimes. Those who commit crimes likely are eligible for involuntary admission,

“It’s frustrating,” he said. “I can’t tell you how many times we’ve told policy makers this was going to happen and yet, time after time, we were ignored.”

Hammond said the association and other advocacy groups were exploring the possibility of filing a lawsuit, accusing the state of violating a disabled person’s right to crisis services.

“We met with our attorney today,” Hammond said Friday, “and, basically, he said we don’t have a case until we can prove actual harm (to a would-be patient), which at this point we can’t do because we’ve made sure that anyone who’s voluntary isn’t being referred to one of the hospitals. But that can’t go on for much longer.”

Rocky Nichols, executive director at the Disability Rights Center of Kansas, said his group also was considering a lawsuit.

“I’d say we’re looking at our options,” Nichols said. “We were shocked when we got the memo that said no more voluntary admissions. That’s pretty drastic.”

Center attorneys, he said, are reviewing federal laws meant to ensure access to crisis services for people with disabilities.

“What the state is saying is that even if you’re in crisis and, say, on the brink of homelessness, you’re not to be admitted if you’re voluntary. That option is taken off the table,” he said. “That seems pretty extreme. This is going to hurt people and I wouldn’t be surprised if somebody dies.”

Raising the cry

The Disability Rights Center, ACMHCK, the Kansas Mental Health Coalition, and the National Alliance on Mental Illness-Kansas plan to issue a press release Wednesday, calling attention to the system’s troubles. Their representatives are scheduled to meet with members of Gov. Mark Parkinson’s staff on Thursday.

“We understand the position that SRS is in,” said Rick Cagan, executive director at NAMI-Kansas, “but restricting state hospital admissions really limits the tools the system has to help people who are at the point of crisis.”

In recent years, advocates and SRS have urged legislators to underwrite additional beds in psychiatric units in a handful of public hospitals across the state.

They’ve also asked legislators to set aside $3.1 million to staff a newly remodeled 30-bed unit at Osawatomie State Hospital that sits vacant because SRS can’t afford workers to man it.

Both initiatives have been unsuccessful.

Earlier this year, SRS Secretary Don Jordan warned members of the Senate Ways and Means Committee that all three hospitals were “operating at the bare minimum staffing.”

Later, $1.6 million was cut from the hospitals’ budgets.

Delusional, suicidal

Keith Rickard, who runs the community mental health center in Leavenworth, said that when someone is referred to one of the state hospitals they are usually delusional, suicidal, or experiencing “significant mood swings” or severe depression.

“What’s most distressful about this is to have someone who’s in crisis, who’s an appropriate referral for inpatient services and who realizes they’re suicidal and is willing to be hospitalized and they’re denied admission,” Rickard said. “When that happens, all we can do is come up with a safety plan, try to get them in to see a psychiatrist and work with family members as much as we can. We do what we can, but it’s a very troubling situation. They would be so much better off and so much safer at one of the state hospitals.”

Jim Mosbacher is director at Breakthrough House, a street-level program for seriously mentally ill people in Topeka. He said he wasn’t surprised by the SRS memo.

“We’ve seen this coming for a long time,” he said “In a way, it’s kind of unavoidable. There’s a percentage of people who just don’t benefit from case management and who can’t function in the residential placements that are available. They need to be somewhere where somebody can work with them all day long. We see a lot of them go to the state hospital, get past the crisis stage, get out for a few days and then the crisis – whatever it may be – returns and the cycle repeats itself.”