After more than two decades leading the Southeast Kansas Mental Health Center, Robert Chase will retire as its executive director at the end of this month.
Established in the 1960s — following on from a nation-wide movement away from the mass institutionalization of the mentally ill and toward a more responsive, community-based approach — the center has grown to include six counties in this rural corner of Kansas and, according to Chase, today performs more than 1,200 mental health screenings per year.
According to his colleagues at SEKMHC, including associate director Nathan Fawson, Chase’s reputation within the network of mental health facilities depends on an efficient management style and the consistent measure of empathy he brings to his interactions with both clients and staff.
Chase has also been a strong advocate of viewing mental health in the context of any number of physical illnesses.
“I don’t buy into the stigma. I talk about mental health like it’s diabetes. It’s a health problem. It’s holistic. It’s as complicated as cancer or anything else.”
However, with the increasing pressure being placed on the state’s mental health system, the 72-year-old’s role as a vocal advocate for community-based mental health and for the largely muted voices of the population it serves, has become more pronounced.
Top of mind at the moment for Chase, and for the majority of his colleagues in the field, are the challenges facing Osawatomie State Hospital, which last year reduced its capacity from 206 beds to 146 to comply with demands from the federal government; the current refusal by state lawmakers to extend Medicaid; the continued stigma which attaches to mental illness; and the mostly indigestible recommendations coming out of Topeka that the already strapped mental health system continue to try to accomplish more with less.
IN 1990, Kansas lawmakers passed the Mental Health Reform Act, which promised to adequately fund the state’s community treatment facilities.
“That was a huge transition for Kansas,” remembers Chase, who took over at SEKMHC not long after, in 1994. “It put in place community-based services, so people didn’t have to languish in hospitals. They could get services in the community, preferably early.
“The purpose of the state hospital, meanwhile, was to provide treatment for those who had no insurance and for involuntary commitments — those who were a danger to themselves or others and needed immediate access.”
Chase served for 15 years on the citizens’ advisory board for Osawatomie, whose precarious fate in the now-gaunt network of state hospitals — which today includes only Osawatomie and Larned — is a “huge issue.”
“I know the people who work at Osawatomie. That hospital is not limited by the quality of the people there. It’s limited by the fact that somebody’s not funding them appropriately or paying sufficient wages to get the correct number of nurses and staff.
“This past year, since they’ve gone into the moratorium, has been devastating. There are people in the community suffering because they can’t get adequate, immediate treatment. It puts pressure on law enforcement because, if someone who is a danger to themselves or others is unable to get a bed at the state hospital, and if they’re without insurance, then they come under protective custody.”
Chase views the inadequate attention to the needs of the mentally ill evinced by the state — especially the decision to not extend Medicaid — as not only a failure of policy, but a humanitarian lapse as well.
“To me, really, it’s a moral question. I don’t understand how a so-called Christian community can tolerate consciously withholding insurance from people who desperately need it and who suffer in its absence, who die early, who develop acute symptoms as a result of the lack of equal medical care.
“I can appreciate that there is only so much money when you’re using public funds,” said Chase, a self-declared Republican, who moved into mental health from a career in management in the aviation industry, and who frequently cites efficiency as the vital ingredient in running a succesful organization. “But the purpose of public funds is to be sure that your commitment to your citizens is there, is real. If you want to look at it on a cost-basis, is it saving money to ignore people who desperately need services and become acute in their need or who create an emergency that would never have occurred if they’d had preventive treatment?
“If you’re planning a budget, you can’t constantly be operating out of a crisis, and right now I think Kansas is in daily crisis mode. … It just seems to me that [state officials] are trying to take reality and adjust it to their political ideals, rather than be pragmatic about what we have to do and can do and should do in the spirit of cooperation.
“It’s incredible in today’s world that the governor and legislature don’t extend Medicaid. Why? We are our brother’s keeper. Is it right, for example, that we keep our children from preventative care?
“How do we justify looking in the mirror in the morning and saying ‘I’m not extending Medicaid to these hundreds of thousands of people.’ Especially when we could give them insurance, maybe save their lives. Isn’t it better for society to have people productive and well than to keep them sick?”
AMONG its many functions, SEKMHC provides clients with outpatient therapy, psychiatric services and crisis intervention. The center offers alcohol and drug counseling, too. And provides a comprehensive after-school program that serves between 150 to 200 children year-round. The center also recently instituted Health Homes, a program that coordinates the mental, dental and medical services for the state’s mentally ill Medicaid recipients. Barely a year old, that program, which Chase says is extremely effective, was recently proposed for elimination by an efficiency study commissioned by the legislature.
“The truth, though,” explained Chase, “is that we have one of the best qualified staffs in the state. We have really good therapists, who are diligent and highly productive; they overextend themselves to meet the needs of our clients. I guess my best skill has been choosing the right people and facilitating an environment where everyone is working together in a coordinated way to accomplish their goals and their priorities. Of course, it’s very difficult when your budget collapses around you.”
