State cuts to mental health services coming at a price

A little more than four months ago, a Prairie Village policeman shot and killed a 47-year-old woman who a split second earlier had thrown a butcher knife at him.

Prairie Village Police Chief Wes Jordan said Susan Stuckey was mentally ill, noting that officers had been called to her apartment eight times that month.

She was barricaded in her apartment when police arrived and they spent two hours trying to calm her, Jordan said. They entered after she threatened to kill herself by setting the apartment ablaze.

?The officer did everything he could to protect her,? Jordan said. ?This has been tough on him. It?s been tough on us. I can only imagine what her family is going through.?

The shooting coincided with legislators approving deep cuts in the state-funded grants that community mental health centers use to underwrite services for people like Stuckey.

?I?m not going to say the cuts contributed to the incident, but I?m not going to say they didn?t contribute to it, either,? Jordan said. ?The people at the mental health center here are doing everything they can with the resources they have to work with, but I have to say these kinds of incidents are not infrequent. In fact, they?re becoming rather frequent.?

Mental health crisis workers were not on the scene when Stuckey was killed.

Johnson County Mental Health Center Executive Director David Wiebe declined comment on the shooting, citing confidentiality concerns.

Growing gap

?What I can say is that we?re seeing more and more people coming in our front door, requesting services while at the same time we have fewer and fewer of the resources needed to provide those services,? Wiebe said.

?Our state grants have been cut $1.7 million over the last two years. To make ends meet, we?re holding 30 positions vacant and yet last year we averaged 600 intakes – new patients – a month. This year, we?re averaging 660.?

Directors at the state?s 27 community mental health centers say the gap between needs and services is sure to widen in the coming months.

?You can?t take $20.2 million out of a service delivery system ? I don?t care what the system is ? and not expect to have a reduction in services,? said Robbin Cole, who runs Pawnee Mental Health Services, a 10-county program based in Manhattan.

What happened in Prairie Village with Stuckey, she said, could just as easily happen to someone in Manhattan.

?Mental health services should be like an ambulance, or the fire department, or law enforcement ? when there?s a crisis, they?re supposed to be there,? Cole said. ?But for that to happen there has to be adequate funding and right now for mental health services that funding isn?t there.?

In the last three years, the state-funded grants that centers use to cover the costs of serving the uninsured have been cut by 65 percent.

?We went from $31 million in 2007 to $10.8 million in 2010,? said Mike Hammond, executive director at the Association of Community Mental Health Centers of Kansas.

The cuts were driven by persistent declines in state revenues.

More fees, fewer services

Though each center?s caseload varies, surveys have shown that almost two-thirds of the centers? 125,000 patients are uninsured; 30 percent are eligible for Medicaid or Medicare; 5 percent have insurance.

To balance their budgets, centers are charging for services that were once free or near-free, eliminating or limiting access to non-essential services, or both.

?We?ve had to do both,? said Walt Hill, executive director at the High Plains Mental Health Center in Hays. ?We?ve raised our fees and we?re asking that people pay before the services are provided. If they don?t, they?ll be seen but they?ll have to pay upfront before they?re seen again.

?We really didn?t have much choice in the matter,? he said. ?Our state aid is down $1.2 million from what it was a year ago, and in the last 18 months we?ve reduced our staff by 20 percent.?

The restrictions, Hill said, do not apply to people in crisis situations, those with a serious and persistent mental illness or children with serious emotional disabilities.

Center officials also have frozen salaries, denied cost-of-living raises, cut vacations by six days a year, and stopped contributing to workers? retirement plans.

Whether the new pay-in-advance requirement will be enough to offset the center?s losses, Hill said, remains to be seen.

Some people, he said, may be able to pay more, but many will not. ?Two-thirds of the people we see are in families living on less than $24,000 a year,? he said.

?That?s when somebody goes to jail.?

High Plains Mental Health Center?s catchment area includes 20 counties in northwest Kansas.

?I spent this spring meeting with the county commissions in all 20 counties,? Hill said. ?I was very direct with them. I said we won?t be able to do as much as we have in the past and there will people who won?t be getting the services they need.?

Ellis County Sheriff Ed Harbin said he has noticed in recent months that the mental health center?s crisis workers aren?t as responsive as they once were.

?If you wait long enough they?ll get there,? he said, ?but sometimes you can?t wait and that?s when somebody goes to jail.?

Harbin said he didn?t fault the mental health center.

?They do what they can. They go overboard, in fact,? he said. ?But they don?t have enough staff. The funding isn?t there.?

In Wichita, managers at the Salvation Army?s 18-bed emergency shelter for the homeless have seen an increase in residents who are mentally ill.

?I don?t have the second quarter numbers yet but in the first quarter of this year, 24 percent of the people at the shelter needed a mental health assessment,? said Jami Scott, the shelter?s operations manager. ?That?s huge.?

Taking longer

A year ago, she said, Comcare, the mental health center in Sedgwick County, needed about a week to complete an assessment. Now, three- and four-week waits are not unusual.

?That?s for the initial assessment,? Scott said. ?If you need a med check to see somebody about getting started on medication it?ll be another month to get in to see somebody. That?s how backed up they are.?

Comcare Executive Director Marilyn Cook said the longer waits are a consequence of more people ? most of them uninsured – seeking services.

?The problem is more people coming in needing services but without a payer source. They?re uninsured,? she said. ?At the same time, we?ve lost 50 percent of our grant money in the last three years.?

Cook said Comcare has not raised its fees; instead it has cut or eliminated non-essential services, imposed a hiring freeze on all positions that do not generate revenue and cut subcontractor rates.

?We?re not turning people away due to an inability to pay,? she said, ?but we?ve certainly increased our reliance on services that have a payer source.?

Cook confirmed some people ? new patients, especially ? might have to wait eight weeks to see someone who can prescribe medications.

?If you?re in crisis, you?ll be seen right away,? she said. ?But if you?re a new patient and you?re not in crisis, then, yes, it might be eight weeks. I?m being honest.?

The long waits, she said, were due to the center having to cut back on services.

Comcare?s long waits are not unique.

?Everything is taking longer,? said Rick Cagan, executive director at National Alliance on Mental Illness-Kansas. ?I?m hearing that more and more from our constituents. What used to take one, two or three weeks is taking six, seven or eight weeks now.

?Eight weeks is a long time,? he said. ?You may not be in crisis, but in eight weeks you can decompensate substantially.?

Patrol officers filling in

Jess Howe oversees the mental health unit within the Kansas Department of Corrections? parole office in Wichita.

In the past year, he said, he?s seen a steady decline in case management services for parolees who are mentally ill.

?It used to be there. You could count it,? Howe said, ?But there?s no guarantee anymore. It?s there if you?re on Medicaid or you?re on disability. But the guys we?re dealing with aren?t on Medicaid. They?re not disabled. They?re just sick and they?re coming out of prison.?

Howe said he and his co-workers have had to take on the case management chores once handled by Comcare.

?If we waited for them, it?d take forever,? he said. ?We don?t have that option.?

Howe said he doesn?t blame Comcare. ?They do really good work,? he said, ?but the money?s not there.?

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