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Mental health system ‘crumbling,’ advocates say

By Dave Ranney | December 22, 2006

By Dave Ranney
KHI News Service

TOPEKA, Jan. 10 The state"s hospitals for the mentally ill are full, leaving former and prospective patients in jails or on the streets, confused or uncertain where to find help.

All but a handful of the state"s private hospitals have closed their in-patient psychiatric units.

Community mental health centers say they can"t do much more than they"re doing now. Their budgets are tapped out.

"It"s like the system is crumbling around us," said Susan Bumsted, director of community services at Breakthrough, a street-level program for the mentally ill in Wichita.

"I hate saying it, but we"re at the point now where the jails are offering some of the best community-based crisis care," she said. "They"re doing what the rest of us can"t."

This is unacceptable, say advocates for the mentally ill.

"Every year, it"s the same thing. We talk about this impending crisis and how bad it is, and then nothing happens," said Amy Campbell, a spokeswoman for the Kansas Mental Health Coalition.

This year might be different. The interim Legislative Budget Committee has proposed:
* Re-opening a 30-bed unit at Osawatomie State Hospital;
* Paying private hospitals to re-open some of their psychiatric-unit beds;
* Figuring out how the state hospitals can better meet the needs of the state.

It also wants to know why so many more people are in need of so many more services.

Annual admissions to Osawatomie State Hospital, for example, reached 1,856 in Fiscal Year 2006 a 32 percent increase since Fiscal Year 2004.

Between July and November 2006, the hospital recorded 754 admissions, putting it on course for 1,809 admissions by June 30, 2007.

"That looks like there"s been a leveling off," Campbell said. "But what"s really happening is that two or three years ago, you could get somebody in. Now, they just say, "No, we"re not taking anybody, you have to wait." It"s not the same."

Data show that roughly half of the state-hospital admissions are "first presenters," a term referring to people who are new to the system.

"These are people who don"t have a medical home, they"re not seeing anyone, they haven"t been to a community mental health center," Campbell said.

"This is going on all over the country," she said. "It"s not just in Kansas."

The trend should not come as a surprise.

"Step back and look," Campbell said. "First, we slash the number of state-hospital beds, then the private beds all but disappear, in part, because insurance doesn"t cover in-patient anymore. And then add in the fact that people are just sicker than in the past they"re showing up that way, very seriously ill. It"s not like you can divert them to community care. They"re beyond that already."

Campbell said she and other mental health advocates will press lawmakers for more in-patient beds and a thorough review of the state hospitals" mission and how it"s changed.

"The hospitals used to be about stabilization, getting better," said Breakthrough"s Bumsted. "Now, it"s all crisis management, getting in and out in a week."

State-hospital patients, Bumsted said, often end up back in their communities without the services they need.

Lawmakers voted to close Topeka State Hospital in 1996 after realizing that patients could be better served in their communities.

For a while, they were. But the state"s community mental health centers now say their resources haven"t kept pace with demand.

"The pendulum has swung too far," Dr. Roy Menninger said during a recent meeting of the mental health coalition.

Menninger, whose father, uncle and grandfather founded the famous Menninger Clinic in 1925, is chairman of the coalition.

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.