If he had a magic wand, Bill Persinger would turn back the clock to May 2009.
Failing that, however, he would increase resources for crisis care and substance abuse treatment, said Persinger, who is CEO of Valeo Behavioral Health Care in Topeka.
Rep. Will Carpenter, chair of the House Social Services Budget committee, asked Persinger and two other people who testified before the committee on Tuesday afternoon what they would do to fix the state’s mental health system if given a magic wand as a way of narrowing down priorities. The Adult Continuum of Care Committee had produced a report with dozens of recommendations, but confronting them all at once would be impossible given limited resources, Carpenter said.
Persinger said he chose May 2009 because Community Mental Health Centers were relatively well-funded and could see people needing help within a reasonable time. Now, the centers struggle to find providers, and the state as a whole lacks resources to assist people who have mental illnesses with finding transportation, housing and jobs, he said.
“I can find a psychiatrist. I can’t pay for them. They don’t earn back enough in fees,” he said. “The issue isn’t the lack of available people. It’s about finding them and getting them to stay and paying them enough. There are a lot of other, more attractive places to go” than Kansas.
Rick Cagan, executive director of the National Alliance on Mental Illness Kansas, said the state needs to improve its inpatient care. It also should explore peer-run respite facilities, which have been successful in other states, he said. Respite facilities are run by people who also experience mental illness, and can provide a low-stress environment for people who are dealing with a flare-up in their symptoms but who don’t need hospital care.
“I think (respite facilities) would be a wonderful return on investment,” he said. “More public-private partnerships are what we’re shooting for so individuals can be hospitalized, if necessary, closer to home.”
Amy Campbell, director of the Kansas Mental Health Coalition, said the state needs to fund wrap-around services, because they decrease the likelihood a person will end up in jail or the state hospital, and offer incentives for people to go into mental health careers. She suggested the state also should continue investing in short-term crisis facilities like RSI, a small stabilization center operating in the former Rainbow Mental Health Facility in Kansas City, Kansas.
“They don’t have as many repeat customers coming back in crisis” after a stay at RSI, she said. “It’s sort of the low-hanging fruit, something you know that works.”
Campbell objected strongly, however, when Kelly Ludlum, deputy secretary of the Kansas Department for Aging and Disability Services, said the department expects the crisis facilities to eventually become at least partially financially independent. Most people seeking crisis services don’t have Medicaid or private insurance, meaning the facility doesn’t have any way to collect payment for services provided to them, Campbell said.
“If the state is not going to have an ongoing role in the existence of these entities, then just forget it. These are not profit-making facilities,” she said. “I’m not saying the state has to pay all the costs. The state has to help that (type of facility) survive.”
About 200 people attended a rally hosted by mental health advocates earlier in the day. At the rally, KDADS secretary Tim Keck said the Rainbow transition could serve as a model for other communities. He also said the state is working to improve staffing at its two struggling psychiatric hospitals and he expects the one in Osawatomie to be recertified by the federal government soon.
But Keck acknowledged that challenges remain.
“Our current system is stretched beyond its capacity,” Keck said.
Starting toward solutions
Carpenter said he intends for the committee to consider the advocates’ priorities and the other priorities from the Continuum of Care report as soon as its schedule allows. Its task will be to build a consensus that it can promote in a difficult budget year, he said.
“I want to come out of here with a statement from this committee on mental health and where we can head that we can sell to the rest of our legislative friends,” he said.
The state already is spending to treat people in the psychiatric hospitals and to house them in jail, Carpenter said, so the committee needs to come up with a consensus on how the state could save money long-term by investing in other areas of the mental health system. Most people are affected either directly or indirectly by mental health and substance abuse disorders, making it an issue the state needs to address now, he said.
“This problem is there, it’s real and it’s being lived throughout our state,” he said. “I know we don’t have the resources, but we can’t just sit here and throw up our hands and say ‘We don’t have the resources.’”
Cagan said he wasn’t under any illusions the issues could be fixed quickly. The state needs a 10-year plan to begin reshaping its mental health system, he said, and may need to look even further into the future.
“It’s a huge amount of gaps in our system. We can’t do them all at once. But we need a plan,” he said.
Persinger said he sees one clear advantage in trying to improve mental health care in Kansas now: people who weren’t interested before are paying attention.
“For one of the first times in my career, people want to talk about mental health other than when it affects their family,” he said.
Checkoff could fund mental health programs
The Senate Assessment and Taxation committee heard about one option to raise more funds for mental health programs on Tuesday, though it almost certainly would fall far short of what would be needed for system-wide changes.
Senate Bill 447 would allow people to donate money while filing their state tax return to a fund for grants to raise awareness and reduce stigma related to mental illness and substance abuse. The Department of Revenue would deposit money into a specific fund, which the Kansas Department for Aging and Disability Services could use to fund the grants.
Kansas currently allows people to choose from several funds on their tax return, including Meals on Wheels, habitat preservation for threatened species and breast cancer research.
Kelly Ludlum, deputy secretary of the Kansas Department for Aging and Disability Services, said donated funds would be used for grants. The department would have to see how much money was donated and what proposals from community groups would maximize those funds before deciding how to distribute it, she said.
“Generally, prevention offers more bang for the buck,” she said.
One particular area of need is suicide prevention, Ludlum said. KDADS currently doesn’t fund any programs focused on the signs a person is contemplating suicide or how to get help. In 2014, 454 people in Kansas died by suicide, making it the 10th-leading cause of death overall and the second-leading cause of death for people aged 15 to 24.
Colin Thomasset, associate director for the Association of Community Mental Health Centers of Kansas, said the association supports the bill, but would like to see it cover grants for treatment.
“We feel that this might be an oversight in the bill, as allowable programs involve awareness, prevention and stigma reduction – all very worthy aspects that can use more money,” he said. “However, it is also important to note that investing in community-based mental health services directly lowers healthcare costs.”
Campbell agreed that treatment should be added to the list of possible uses of the grant funds. Implementing the checkoff would be a positive step, she said, but it won’t solve the state mental health system’s problems on its own.
“The legislature should commit to close gaps in the continuum of care, and this could be a starting place,” she said. “447 won’t solve all of our problems in the mental health system, but it would be one more tool in the toolbox.”
Megan Hart is a reporter for KHI News Service in Topeka, a partner in the Heartland Health Monitor team. You can reach her on Twitter @meganhartMC