‘System Has Been Stretched To The Absolute Limit’: Former Osawatomie Superintendent
Steve Feinstein was superintendent of Osawatomie State Hospital from 1994 to 1998. He has a Ph.D. in psychology and got involved in mental health issues when he was hired to run a state mental hospital in eastern Oregon. Although he’s retired now, the Louisburg, Kansas, resident continues to pay close attention to what’s going on at Osawatomie, one of two state-run hospitals for the severely mentally ill. In a recent interview, he spoke to us about the Kansas hospital’s slew of recent troubles.
Tell me what Osawatomie State Hospital was like in the early 1990s.
Osawatomie State Hospital at that time was a pretty good place to go if you had serious mental illnesses. Though we were short-staffed at some point, we had the luxury of having a culture that was alive and allowed us to carry on a tradition at the hospital that had been one of the best in the country for a very long time.
Over the last year, this same hospital has been cited for all sorts of problems and deficiencies. In December 2014, voluntary admissions were suspended after federal health authorities said that its services were not sufficient to meet the needs of patients. And more recently, it lost its Medicare payments to the tune of about $1 million a month because it was out of compliance with health and safety standards. How did things come to such a pass?
It really isn't surprising. The state agency had been warned for better than a decade that we were moving into a position where we were way under-resourced at the state hospital, that we simply did not have enough staff, that they weren't paying attention to maintaining the culture of service and treatment at the hospital, that there was a focus on managing the front door and the back door of the hospital just to maintain census. But the perspective of delivering clinical care somehow got lost in the process. The mental health community had warned the hospital time after time that they were placing staff in a dangerous situation because they were understaffed.
How long ago were these warnings issued?
Well, personally, I gave testimony at the Legislature going back as far as 2001. And the story really hasn't changed that much in all of this time. There have been patches put on problems, crisis fixes. That's been the history of the state hospital. The real issue, the bottom line about why do we have this hospital, how many beds do we need, what kind of services should we be delivering, what should our staff look like – those problems really were never addressed.
Should Kansas be investing more in its mental health system?
You know, the promise of mental health reform that began back around 1990 was that we were going to have a lot of money moving into the community because we were closing down beds at the state hospital. It would free up dollars. And for a brief period of time that money was there. But over time, the commitment of providing sufficient to appropriately run the hospital has dwindled away.
On that same note, even as resources haven't kept up with need, Kansas has fewer for-profit and nonprofit hospitals treating mental illness than it did in the past. That means state hospitals and community health centers have had to pick up the slack. Can they do that?
It depends on what you mean by "picking up the slack." If a person needs in-patient treatment, the community mental health center for the most part is not able to provide that service. Nor do we have sufficient beds in the community to provide that service. In terms of whether we can ramp up community mental health services to do more, I think the system has been stretched to the absolute limit at this point. We simply can't do more unless we get more money.
If you were back in charge of Osawatomie today, what would be the first order of priority for you?
I think the issue is getting the right number of people, and the right people, on staff, and getting them well-trained, and paying them appropriately, and supporting them appropriately, and working very closely with the community mental health centers to develop a seamless system. But understand that fixing that problem is especially difficult when you don't have a total commitment to making your state hospital a center of excellence that attracts the best people to serve the very most disturbed people.
Dan Margolies, editor of the Heartland Health Monitor team, is based at KCUR. You can reach him on Twitter @DanMargolies.