The Kansas Department for Aging and Disability Services has suspended voluntary admissions to Osawatomie State Hospital, one of the state’s two inpatient facilities for people with serious mental illnesses.
The decision, according to a memo sent to the state’s 26 community mental health centers late Tuesday afternoon, was driven by “ongoing and critical census challenges” at the state hospital. The memo also outlined procedures for handling patients who are involuntarily admitted.
In recent months, the 206-bed hospital has admitted record and near-record numbers of patients, causing dozens of patients to be triple-bunked in rooms meant for two.
Last month, federal health officials announced that surveyors sent to the hospital in October had found that its services were “not … sufficient to meet the needs of its patients.”
KDADS officials were warned that if the hospital’s deficiencies were not corrected, it would not be paid for Medicare services provided to patients admitted after Dec. 8.
KDADS filed a correction plan with the Centers for Medicare and Medicaid Services regional office in Kansas City in mid-November. Neither the survey nor the correction plan has been released to the public.
Federal surveyors returned to the hospital Monday.
“They are re-surveying the problem spots and determining (whether) we’ve addressed them and that situation has been rectified,” KDADS spokesperson Angela de Rocha said Wednesday.
De Rocha said the surveyors were aware of the department’s decision to suspend voluntary admissions.
The decision, she said, is allowed by state statute.
It’s not yet known how many would-be patients will be denied admission.
“It shouldn’t be a significant number,” de Rocha said. “It’s not going to have a significant impact on our census challenges, but at this point every little bit helps.”
According to the memo, would-be patients will be denied admission “if their sole diagnosis is anti-social personality syndrome, substance use disorder, or an organic mental disorder such as trauma or dementia.”
Strain on system
Community mental health centers will not be allowed to send patients to the hospital until an on-duty physician has reviewed their records and agreed to admit them.
The new policy will be in effect for as long as the hospital’s census exceeds 185 patients.
Typically, patients who are involuntarily admitted to the hospital have been involved in altercations with police and have been deemed a danger to themselves or others.
Kyle Kessler, executive director at the Association of Community Mental Health Centers (CMHCs) of Kansas, called the change in policy “a real concern,” adding that neither he nor his members were consulted about its potential impact on patients or the centers.
“This is a decision that the state made and that we didn’t have any input into,” Kessler said. “But the CMHCs will continue to do everything they can to treat people in their home communities.”
Between 2007 and 2012, state-funded support for a grant program that the centers use to offset the costs of treating the uninsured has dropped from $31 million a year to $10.9 million.
Underfunding 'crisis'
The state’s mental health advocates have long argued that community-based services for the mentally ill are significantly underfunded. And the decision to suspend voluntary admissions at Osawatomie, they say, will only make a bad situation worse.
“This just underlines the crisis that we have in mental health care in the state of Kansas,” said Rick Cagan, executive director of the National Alliance on Mental Illness-Kansas. “There are solutions out there that have been talked about for years, but for whatever reason we, as a state, keep putting off the decision for making the appropriate investment in our mental health system. And then we keep closing our options for people who’ve gotten to a point where they really need inpatient treatment.”
Expecting the community mental health centers to take on volunteer-admission patients who, prior to Tuesday, would have been admitted to the hospital is unrealistic, Cagan said.
“Do we think community mental health centers ought to be doing a better job? Yes, we do,” Cagan said. “Do we think they have the resources they need to provide more robust services? No, we don’t.”
Keith Tully, chair of the board of directors of the Elizabeth Layton Center for mental health services in Paola, agreed.
“If the hospital isn’t going to admit people who need to be there and who’ve agreed to go there, then it’s going to put more pressure on us, more pressure on law enforcement, and more stress on families that are having to cope with someone who, say, has depression or is suicidal,” Tully said. “We’re in a crisis situation, and now what we hear is how the Legislature is going to have to cut spending. What’s happening, I think, is irresponsible.”
Greg Hennen, executive director at the Four County Mental Health Center in Independence, said the directive will leave the centers in southeast Kansas with few good options after several hospitals in the region have closed their inpatient mental health units.
He said the closure of inpatient psychiatric treatment centers in Bartlesville, Okla., and, in recent years, in Pittsburg, Kan., and Coffeyville, Kan., have left community mental health centers with no place to send patients who need more intensive care.
“We’ve lost 47 private beds over the last five or six years,” Hennen said.
Hennen said when his center could refer patients to area hospitals, Osawatomie was a “last resort.” But with those inpatient beds no longer available, he said, the state hospital had become “our only resource.”
Asked about the impact of the state directive, he said: “It’s going to be chaos for a while.”
Commenting on the requirement that community mental health centers get prior approval from state psychiatrists before referring “involuntary patients,” Hennen said: “The jails will start to get full.”
