Pressure grows on mental health system

“[T]he concern I have is what happens when we get to that point where [Osawatomie State Hospital] isn’t taking ‘involuntaries’…. It’s going to be 3 o’clock in the morning, and your deputy is going to be dealing with someone who has no place to go but can’t be left on the street.”
— Sandy Horton, head of the Kansas Sheriffs’ Association

A week ago Friday, in the late afternoon, Allen County Sheriff Bryan Murphy was called to the home of a middle-aged individual whose behavior and speech held the promise of some danger, either to themselves or to members of the community.
Murphy recognized the individual, and had a passing knowledge of the person’s mental health picture. “We hadn’t dealt with them for probably two years — because they stayed on their meds. For whatever reason, this day, they were off them.”
After some discussion, the person agreed to submit to a screening by one of the crisis specialists at Southeast Kansas Mental Health Center in Iola.
The screener returned a swift verdict: The individual required involuntary commitment to Osawatomie State Hospital, one of only two remaining inpatient psychiatric hospitals in the state.
Unfortunately, late last month, in a move that has worried law enforcement and mental health professionals across the state since its prospect was rumored four months ago, the Kansas Department for Aging and Disability Services froze admissions to the hospital after the patient population reached its new maximum capacity of 146.
Osawatomie reduced the number of psychiatric beds last spring — down from 206 — when the hospital began a building renovation projectdemanded by federal inspectors.
And so, turned away from Osawatomie, Murphy, along with SEKMHC’s director of crisis services, Doug Wright, spent the next six hours trying in vain to locate a treatment facility for the individual in custody.
“So you have somebody who needs committed,” explained Wright. “They are a danger to themselves or others — they may be suicidal or homicidal — and now Osawatomie says, ‘Sorry, we’re full — we’ll let you know when we have an opening.’”
Anticipating the fallout likely to arise from the sudden deletion of 60 beds, the Legislature recently gave KDADS the authority to spend up to $3.45 million to cover the cost of treating patients affected by the moratorium at psychiatric units operated by private hospitals  — of which there are only a handful of this variety in the state, and none in southeast Kansas.
Even then it isn’t a perfect salve, since state law allows these hospitals to decline involuntary admissions.
“Plus,” explained Wright, “one of the difficulties with the idea that private hospitals or private facilities could fill this gap is that anybody that’s private has to do one thing, which is make money. So where do you put the person who’s mentally ill, unemployed, has no insurance? Those places aren’t going to want to take them, because they want to keep their doors open. So there’s always going to be a need for a state-funded facility.”
Lacking better options, Murphy and Wright continued down the list, calling each of the hospitals in turn — KU Med, in Kansas City, for example, Stormont-Vail, in Topeka.
No luck.
“It got to the point where I actually made contact with my deputies,” explained Murphy. “I said, ‘Guys, it’s going to be a long weekend.’ And at that point I began making arrangements to go out to Super 8 and have my deputies sit on this person 24/7, until we could figure something out.
“We couldn’t release them. We took them under police protective custody not only for this person’s safety but for other parties that were involved. … But the person hadn’t committed a crime, and so we can’t house them in jail. Statute specifically says we cannot use a detention facility to hold people that are going to be sent to a mental health facility.”
As Friday night bled into Saturday morning, a temporary solution was finally achieved when the individual in custody was persuaded to check themselves into a psych unit on a voluntary basis — at which point one of the previously contacted hospitals produced an open bed.
 “The sheriff and I were on the phone till midnight,” recalled Wright, “trying to figure out what else we could do. Now, that’s just the type of guy Sheriff Murphy is and that’s the type of agency we want to be. But there’s going to come a time when he and I can talk until six in the morning and it’s not going to help.
“We have a system set up to say here’s what we’re going to do,” said Wright. “But it’s a broken system.”

IN 1866, the Kansas Insane Asylum (which would in time become Osawatomie State Hospital) admitted the state’s first mental patient. Its goal, in common with similar institutions of the day, was to centralize the care of the mentally ill, and, to some extent, conceal their appearance from polite society. 
A century later, however, a national movement toward deinstitutionalization was afoot. With the proliferation of antipsychotic medication, proponents argued, it was now cheaper and more humane to care for the mentally ill where they lived.
In 1963, President Kennedy passed the Community Mental Health Centers Act, which strove to replace the by-then overgrown asylums with a more responsive network of behavioral health centers.
A goal of the mental health center movement then, as now, was to point would-be patients toward resources in the community and away from state-run hospitals, like Osawatomie.
Toward this end, SEKMHC — which serves a six-county area — performs roughly 850 individual screenings per year. Of those, about 40 percent are hospitalized.
And yet, as the number of evaluations is on the rise, state funding for mental health centers has dipped steadily since 2008.
In 1990, Kansas lawmakers passed the Mental Health Reform Act, which promised to adequately fund the state’s community resources. Instead, according to the Kansas Mental Health Coalition, in the last six years, the state “has slashed its Mental Health Reform grants by 50 percent…relegating many individuals in crisis to emergency rooms and jails.”
“Still,” explained Wright, “we’re finding ways to keep 60 percent of our people in the community…by providing them with emergency psychiatric appointments, case management appointments, attendant care, whatever we can to keep them safe in the community — we’ll do that first.
“But there are going to be those people, who, even if we did all of that, we can’t keep them or those around them safe. There is a limit to what we can do in the community. I think we have to accept as a society that there will always be a need for a certain number of inpatient beds. And I think with the reduction [at Osawatomie], that number is too low to meet the need.”

GIVEN THE scarcity of treatment facilities in southeast Kansas, the news this month that Applewood Rehabilitation, Inc. — a 45-bed nursing facility in Chanute — has chosen to close its doors, delivers an added sting to the region’s mental health system.
According to a report by KHI News Service, Applewood, which cares for individuals with severe and persistent mental illness — and often serves as a transition point for patients leaving Osawatomie — recently received word from the state that its reimbursement would suffer a cut of about $7,000 a month.
The mental health nursing facility, one of 11 of its kind in the state, and the only in southeast Kansas, made the determination that it could no longer afford to operate, and is now in the process of finding new community-based facilities for residents ranging in age from 24 to 77.
“We just got tired of seeing our expenses go up and our reimbursement go down,” said Mary Harding, one of the facility’s four co-owners.
Of the many discharged from Applewood, some will find placement in another, similar nursing facility (the next closest is in Paola). But many of these facilities, too, are at maximum capacity.
“Some may go to a regular nursing home,” said Wright. “But for a lot of those people who go from a [mental health nursing facility] to a regular nursing home, they don’t get the mental health care they once had. So inevitably a lot of these people will not fare well, and will get sent back to Osawatomie State Hospital, which, again, is itself currently full.
“It’s a vicious cycle.”

“THIS moratorium is truly dumping the issue back in our laps,” said Sheriff Murphy. “When people get into those situations where we have to intervene, and we have to take someone into protective custody, there’s something that went drastically wrong in their life. These people truly need help and assistance, and the state has tied our hands.
“It is our duty to make sure our people are taken care of. That’s why we have mental health centers. That’s why we have state hospitals. Those hospitals are obligated to the care and treatment of the citizens in the state. If we can’t help those citizens in their time of need, what are we doing?”
And while the overwhelming majority of individuals with mental illness are non-violent, there are some — often the candidates for Osawatomie — whose illness expresses itself violently. Murphy recalled responding recently to one individual whose delusional speech was punctuated by his firing a gun into the air.
“This is a problem waiting for a place to happen,” reflected the sheriff. “Somebody is going to get hurt. And I just don’t think our legislators are seeing that it’s an issue. So often some tragedy has to happen before something gets fixed. Why?”