During the twenty-three years I took care of patients at the Menninger Clinic (1972-1995) I learned several lessons that apply to the Kansas Neurological Institute.

First, the treatment plan for every patient needs to be customized to meet the unique needs of the patient. A one size treatment plan such as "all patients should be treated in the community" does not work.

Second, there is a continuum of care in health care. Primary care refers to the day to day care of the patient in the office by the patient's main doctor. Secondary care refers to the physician "specialist" who acts as a consultant to the primary care physician and patient. Tertiary care is provided by physicians and other healthcare providers in a setting that is highly specialized and geared to treat complex and long-standing medical conditions. Some patients in our community need the ongoing care that can only be provided in a tertiary care setting such as Menninger, KNI, or Topeka State Hospital.

Parents, family members, and health care professionals who take care of patients sometimes experience "compassion fatigue." At KNI a familiar but refreshed set of caregivers comes on board every eight hours. These refreshed caregivers are in a position to offer the intensive care and support required by the patient during any eight hour shift.

Caregivers in institutions counter compassion fatigue by working only eight hour shifts, having ample vacation leave and time away from work, participating in continuing education workshops, discussing their positive and negative feelings toward their client in staff meetings and supervision, and identifying with the overall caring mission and purpose of the institution.

The closure of Topeka State Hospital, the Menninger Clinic in Topeka, and the potential closure of KNI reflects society's misunderstanding of the important role that these institutions play in the health care system. For the sake of the KNI patients and their families, please keep KNI open.

—Ira Stamm, Ph.D. Topeka