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Mental health centers will serve fewer people

By Dave Ranney | July 23, 2009

The state’s longstanding expectation that community mental health centers serve all comers regardless of their ability to pay has been dropped due to budget cuts.

Instead, state officials have told the centers to focus on a “target population” with the understanding that some people will not be served. Others may be put on a waiting list.

“There will be negative consequences to this, there’s no doubt about it,” said Mike Hammond, executive director at the Association of Community Mental Health Centers of Kansas.

The policy change, which took effect July 1, is spelled out in the Department of Social and Rehabilitation Service’s contracts with the state’s 27 community mental health centers.

The change is driven by recent cuts in state funding to the centers.

“In the last three years — from fiscal year 2007 to fiscal year 2010 — we’ve seen $16 million taken out of the community mental health system,” Hammond said. “You can’t do that and not have an impact on services.”

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FY 2010 SRS contract with community mental health centers

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In the new contract, the target population is defined as:

• Children with a serious emotional disturbance;

• Adults with a severe and persistent mental illness;

• Those at risk of being hospitalized;

• Those who pose a danger to themselves of others;

• Those likely to “experience serious deterioration” if they’re not seen;

• Those whose mental illness put them at risk of being homeless or incarcerated.

The new contract assigns a lower priority to those seeking routine services.

“The folks this will affect are likely to be the guy who’s having trouble at work and needs to talk to someone about it, or the couple that’s having marital problems and wants to see a counselor, or parents who are under a lot of stress and having a hard time with their kids,” said Walt Hill, executive director at the High Plains Mental Health Center in Hays.

“These are the folks who, I’m afraid, will have to wait longer to get in to see a counselor or a psychiatrist,” Hill said. “And when they do get in, it will be less often.”

Hammond discussed the new contracts Wednesday during a meeting of the Kansas Mental Health Coalition.

The change, Hammond told fellow coalition members, is expected to have the most impact on the uninsured.

“Medicaid is considered insurance,” he said, “so, really, who we’re talking about here are the working poor or the self-employed who don’t have insurance.”

Hammond noted that someone who is uninsured and in a crisis situation will be considered part of the target population and will be served.

Rick Shults, director of mental health services at SRS, also met with the coalition. The shift in mission, he said, was solely budget driven and should not be viewed as criticism of — or lack of support for — the mental health centers.

“Nobody is saying people who don’t get services don’t need them,” Shults said. “But at some point in the budget situation we find ourselves in, you have to ask, ‘OK, what can we do with the resources we have?’”

The shift in mission represents a step backward, he said, but it’s still comparable to the level of services offered in many other states.

Mental health advocates criticized the change.

“We had people falling through the cracks before all this happened. Now, there’ll be even more — I don’t see how there can’t be,” said Rick Cagan, executive director for the National Alliance on Mental Illness-Kansas.

“What’s not being said here is that if you’re a 20-something adult who’s experiencing the first onset of psychotic symptoms and you don’t have a history of prior hospitalization, you’re likely going to have to wait until you’re in crisis.”

How the change will affect admissions to the state-run hospitals for the mentally ill remains to be seen.

Shults said SRS is hoping that by including patients who are at risk of hospitalization in the target population, admissions to the hospitals will remain stable.

Others said they thought that hope was unrealistic.

“I don’t see how that’s possible,” Hammond told KHI News Service.

Hammond and Shults agreed that roughly one-half of the first-time admissions to Larned and Osawatomie state hospitals involve patients who had not had prior contact with a community mental health center.

They also noted the hospitals often exceed their licensed capacities.

-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.