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On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service. The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here. Stories and photos may be republished at no cost with proper attribution and a link back to KHI.org.

Rethinking mental health’s role in the rural health care system

Grant helps southwest Kansas facilities build primary care services

By Bryan Thompson | July 24, 2015

Rethinking mental health’s role in the rural health care system
Photo by Bryan Thompson Debbie Bruner, administrator of Minneola District Hospital, says her facility sees patients every day in need of mental health services.

A new partnership in southwest Kansas aims to build mental health services and help strengthen a couple of rural hospitals at the same time.

The nonprofit United Methodist Health Ministry Fund is leading an effort to make the health system work better for people in rural Kansas. The fund’s president, Kim Moore, said the current structure based on small, low-volume hospitals isn’t likely to survive long-term.

“Change is going to happen in rural health care,” Moore said. “And if it isn’t guided by the people in the communities and their friends around the state who love and care for rural Kansas — instead it’s allowed to happen by external factors — the results may be a really poor health care system in much of our rural and frontier areas.”

Moore and his board asked rural health providers for what they called “transformational” ideas. They agreed to fund four projects, including one in Clark County, south of Dodge City.

Clark County is home to two hospitals: one in Ashland, population 853, the other in Minneola, population 742.

“Change is going to happen in rural health care.”

- Kim Moore, president of the United Methodist Health Ministry Fund

At the Minneola Pharmacy, pharmacist Jan Granados doubts she could stay in business without the hospital and its rural health clinic.

“We would not have half the business that we have if we didn’t have the hospital here — the clinic, anyway,” Granados said. “It gets harder and harder as reimbursements get less and less to make any money, and so I think if we lost our customer base, it would be very hard to stay open.”

Like small hospitals all across Kansas, the Minneola District Hospital needs a subsidy from local taxpayers to keep its doors open. The subsidy helps to make up for money the hospital loses on inpatient and emergency room care.

But hospital officials think one way to reduce the need for emergency room care is by providing more complete primary care. So they’re using the United Methodist Health Ministry Fund grant to add a mental health therapist.

Debbie Bruner, who heads the hospital and its rural health clinic, said they see patients who need mental health services  every day.

“A lot of your chronic conditions coexist with some type of a mental health issue that’s going on,” Bruner said. “Especially with your diabetics and your COPDs (chronic obstructive pulmonary disease), where it’s altered their lifestyle, a lot of times you will see depression coincide with that medical condition.”

Now, patients in Minneola have to drive about 40 miles to Greensburg to get mental health services at the Iroquois Center for Human Development. It’s the nonprofit community mental health center that serves Clark and three other counties.

Clinical director Travis Hamrick thinks having a therapist in the Clark County hospitals and health clinics will allow mental health issues to be identified and treated before they get out of hand. And Hamrick agrees with Bruner about the link between chronic diseases, like diabetes, and emotional disorders, like depression.

“For folks with diabetes, it takes a lot of coping skills to be able to manage that disorder,” Hamrick said. “You’ve got to be able to make your doctor’s appointments. You’ve got to be able to check your blood sugar levels. You’ve got to be able to take your medications consistently. Somebody with an emotional disorder or depression, at times they become hopeless or helpless and they just stop taking their medications.”

That can land them in the hospital emergency room over and over, and saddle them with large bills they can’t pay.

At the Ashland Health Center, Medical Director Dan Shuman also is eager to have a therapist on-site. He routinely screens patients for mental health issues and refers them for treatment, but some aren’t willing to travel to Greensburg. It’s not just because of the distance. In a rural setting, friends and neighbors know what vehicle people drive, and Shuman said some patients may be embarrassed to have anyone see their car or truck parked outside the mental health center.

“Part of the benefit of having it integrated into the primary care side is when you show up, you just show up to the clinic,” he said. “You can privately talk to the front desk and tell them who you’re here to see, and once you walk back, nobody knows who you’re seeing.”

That’s the type of practice Shuman had when he worked at a clinic in Molokai, Hawaii.

“It was me and one other doctor, and then the psychologist, and we shared the same four rooms,” he said. “So if I needed something I’d grab him and say, ‘Darrell, I think I need you,’ and he’d come in and see that person immediately, if needed, or set up a time with them.”

The grant to staff the clinics and hospitals in Ashland and Minneola with a mental health professional is only temporary. But the hospitals hope they can show that it helps patients stay healthier and avoid costly emergency room visits. If they can demonstrate that, they might be able to persuade Medicare, Medicaid and private insurers to pay for continued mental health staffing when the grant ends.