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July 28, 2011
TOPEKA A top official at the Kansas Department of Social of Rehabilitation Services said he will be asking the state's district court judges to refrain from sending people to the state hospitals for the mentally ill when the hospitals are full.
“We want to go to judges and plead with them and tell them that when you make (commitment) decisions, please consider capacity issues,” said Pedro Moreno, deputy secretary for disability and behavioral health services at SRS.
Moreno's comments were made Wednesday at a meeting of the Mental Health Coalition of Kansas.
The state hospitals, he said, should not be required to take more patients than budgets allow.
“They need to figure out a way how not to break the bank,” Moreno said, referring to the judges and to the state’s community mental health centers.
“The judges cannot just say, ‘You just take 10 people,’ and the (state hospital) superintendents say, ‘There is no money,’” he said. “We all need to work together.”
The state's three hospitals for the mentally ill – Larned State Hospital, Osawatomie State Hospital, and Rainbow Mental Health Facility in Kansas City - have frequently been full beyond capacity in recent years.
Larned State Hospital has been over capacity four out of every five days for at least the past two years, according to SRS reports.
Osawatomie State Hospital has been over capacity one out of every three days.
About half of the three hospitals’ admissions result from referral by a community mental health center; the other half are court-ordered because a judge has determined the individuals are a threat to themselves or others.
"Everybody is frustrated"
Moreno said he hoped to be able to relieve some of the pressures on the mental health system through increased efficiencies but, he said, “it is impossible to take care of everyone.”
All state hospital admissions are limited to people with severe and persistent mental illnesses who are considered a danger to themselves or others.
“We are not very happy with all this economic crisis," Moreno told the assembled mental health advocates. "We are as concerned as you are about this lack of resources. It is not a very exciting time for anybody in America or in the world. To have our country for the first time in our history approaching default on all its obligations is an embarrassment, I think , to all of us as Americans. We are not very happy with what’s going on. Unfortunately, we have to talk about money. We wish we could talk about many other things, but there are budget cuts as you know, the economic crisis doesn’t let up, gas prices are still up, unemployment is still up. There is so much frustration around the country.
Moreno said SRS officials were well aware of the resulting problems.
“Everybody is frustrated," he said, "and when there is no money there is sometimes an increase of substance abuse issues, maybe an increase in mental health issues. It’s kind of a vicious circle.
“For us to have to deal with this situation is a very difficult task and every day we are conscious of your own battles, the consumers, the people that need help," Moreno said. "I just read in the paper that there are 75,000 veterans in America that are homeless – people that went to war for us.”
What will the judges do?
Whether Moreno’s overture to the judges succeeds remains to be seen.
Calls from KHI News Service seeking comment from various district judges were not immediately returned.
Marilyn Harp, executive director of Kansas Legal Services, an agency that provides legal aid to those facing incarceration or commitment, said this:
“The criterion for deciding whether someone needs hospital care is whether they are at risk of harming themselves or other people. To put a judge in the situation of having made that decision and then not providing the treatment necessary for that person to get better and for keeping the community safe is a disaster waiting to happen. This country has too often seen the horrible results of people who’ve slipped through the cracks because no one was aware of the manifestations of their illness and of the harm posed to themselves and to others."
A recent example of Harp's point that drew much national attention was the January mass shooting in Arizona that left six dead and Congresswoman Gabrielle Giffords seriously wounded. The accused gunman, Jared Lee Loughner, is being held in a federal prison in Missouri after mental health experts determined he was schizophrenic and not psychologically fit for trial.
Mike Hammond, executive director at the Association of Community Mental Health Centers of Kansas, said he doubted that the SRS appeal to judges would make much difference.
“We have been sounding the alarm on this issue for the last five years, at least,” Hammond said. “What’s happened is we’re having more and more people turning to the public mental health system for help while at the same time the resources to support this increase have been declining, especially when you’re talking about the uninsured. I doubt that the judges will be a position to do anything. Their concern is with the case in front of them, it’s not with whether SRS has the money.”
Johnson County Community Mental Health Center Executive Director David Wiebe said overcrowding at the hospitals is sure to lead to more mentally ill people ending up in jail.
“What was left unspoken in today’s conversation was the question: If the state hospital is your safety net and it’s not there, what’s your fallback?” Wiebe said. “The answer in many instances is jail. I mean, these are crises, they are emergency situations – if you have to have a safe place, jail may very well be your only option.”
As if to underscore the problem, even as Moreno was talking with the group traffic was at a standstill on nearby Interstate 70 where state troopers were trying to dislodge a man from his recreational vehicle. The Michigan driver of the RV was stopped for driving erratically. The standoff ensued after the man warned the officer that he was armed and would commit suicide. According to Michigan police officials, the man had no known criminal warrants. The standoff ended at about 3:30 p.m. on Wednesday after tear gas was fired into the vehicle and the man surrendered.
"Breaking the bank"
Earlier this month, SRS stopped sending overflow patients from Larned State Hospital to the inpatient unit at Prairie View, a community mental health center in Newton.
Prairie View officials said they were told that SRS had run out of money.
Dr. Roy Menninger, whose father, uncle and grandfather founded the Menninger Clinic in 1925, asked Moreno if he thought suspending referrals to Prairie View would add to the overcrowding at Larned State Hospital.
Moreno said the hospital would be looking for ways to “help people that need help” without “breaking the bank.”
Without prompting, Moreno said the federal government cannot force the hospitals to spend money they don’t have. He specifically cited the Centers for Medicare and Medicaid Services and the U.S. Department of Justice.
“We need to figure out how to use existing resources in the most effective way,” Moreno said, noting that SRS had recently hired a director of hospital coordination.
He said that every day, SRS executives read “incident reports” involving adults and children either in state custody or receiving state-funded services. The reports, he said, “remind ourselves that people are suffering and need help.”
Moreno said SRS would be asking businesses and state government to consider hiring more people with disabilities.
Responding to a question, he also said the agency’s upcoming efforts to promote fatherhood would be “introduced organically,” would not involve “big money,” and could lead to long-absent fathers calling their children to apologize for not being involved in their lives or to express their love.
“I grew up without a father,” Moreno said. “It made a negative impact on me to this day.”