Cuts hurt crisis provider

“It’s been affecting everyone,” said Bob Chase of recent state budget cuts.
Chase, executive director of the Southeast Kansas Mental Health Center, noted that “already, as a result of the governor’s cuts, we’ve had to take $300,000 out of our budget as of Jan. 1.”
The agency works on a calendar year.
Chase said the cuts were difficult.
“We’d already passed our budget in November, and we took 3 percent out then. We eliminated any pay increases. We had already taken out $100,000 — then things got worse with the next state budget projection.”
The agency also laid off three support service employees before Christmas, left one such position unfilled, and will not replace one of four contracted psychiatrists who recently left to pursue other career options, Chase said.
“It’s going to be a huge impact,” Chase said of the psychiatric service cut. “That’s a critical service.”
Last year, 757 screenings were required for mental health clients.
“That’s the highest we’ve ever had,” noted Doug Wright, Director of Crisis Services, “but it’s going up every year.”
The number is rising “because there’s more anxiety and stress for individuals and families,” Chase said. “Our ability to cope is impacted” by the current economic crisis, he noted.

SEKMHC SERVES 3,000 clients in Neosho, Linn, Allen, Anderson, Bourbon and Woodson counties. There are seven offices under the umbrella organization.
“Half of our psychiatry is done in Humboldt,” Chase said. “Pittsburg’s Psychiatric Unit is closed. Coffeyville Medical Center is closed.” With the recent loss, Chase said, “new clients won’t be able to be seen.”
Not all services are structured.
“We also do 24/7 emergency services for the six counties,” Chase said. Such service can be critical. “Sometimes we have three crises going at once. This past weekend,” he said, “there were seven crisis assessments.”
Chase said the shortage of psychiatric care “creates more emergencies. If individuals can’t get timely intervention,” their situation is more likely to escalate, resulting in law enforcement involvement or placement at the state mental hospital in Osawatomie.
Another breech to the safety net is in lag time for services. If courts are involved, as they are in cases of involuntary placement to the state hospital, that client must, by law, be given a court hearing within 48 hours of intake, Chase said. But, “they’re cutting the courts, too.”
“We have an unfunded mandate that we have to serve (clients) in a timely fashion, regardless of ability to pay.”
Yet, he noted, “there are no hospitals that will take anybody for free, so (clients are) sent to the state” hospital.
“We’ve been asked (by Greg Valentine, the superintendent of the hospital) not to send people to Osawatomie because they’re over their census — but they have to take them,” Chase explained. The state hospital has 176 beds. As of Sunday, they had 200 patients, Clinical Director John Helton said.
If clients have been picked up by law enforcement due to a crisis situation, “We’ve been asked to keep them in jail, but they should be in the hospital,” Chase continued. As it is, “most of them are released back into the community for outpatient therapy,” he said.
It’s frustrating, Chase admitted.
“The system starts to break down at some point.”

THE MENTAL HEALTH center’s clients are a reflection of society.
About 150 children are served in an after school program; a summer program that runs four days a week, five hours a day, serves 200 children.
Children make up 34 percent of the agency’s clients. Almost 50 percent are not able to be in the workforce, due to age or disabilities; 28 percent are unemployed workers.
Slightly more women than men are served and clients tend to mirror societal norms for married/divorced/etc.
In additon, the agency receives about 30 crisis hot line calls routed through the Iola office each day, said Ernest Adams, crisis coordinator. To help deal with the heavy, and sometimes unpredictable, caseload, “everyone who’s a therapist is also trained as an emergency clinician,” Chase said. About 20 therapists and 30 case managers — 22 of whom work with children — serve the agency. There are three chemical abuse counselors. Three psychiatrists and one advanced registered nurse practitioner are contracted by the agency. They live in the Kansas City area and must be paid for their drive time, Chase noted.
“There are very few psychiatrists who live in southeast Kansas,” he said. “I have to pay them for driving, or you don’t get them.”
Altogether, the annual budget supports 91 full time equivalent and 55 part time (including summer) employees for the six counties.
Alan Hauser, Chief Financial Officer for SEKMHC said the total annual mental health budget for the six county area runs a little over $7 million. Any reduction is felt.
When the state recently cut Medicaid reimbursements by 10 percent, it had a greater impact than numbers alone can tell, Chase noted. “Our Medicaid revenue is probably 60 percent of our budget,” Chase said.
“Medicaid is a fee for service for the poor and disabled population,” Hauser explained. It is a federal payment administered by the state.
“Of the money we get paid, 30 percent is state money and 70 percent is federal,” he noted. The cut resulted in reduced payments to the state from the federal government as the balance swung to 27 percent state reimbursement and 63 percent federal, he said.
“So the federal government actually saves more money by the 10 percent cut than the state does,” Hauser noted.
“It’s money we’re paying salaries with,” Chase said. “When this happened, we cut positions.”
In addition Hauser noted, “they also cut our grant money $80,000.”
The cuts are especially stinging as Kansas law mandates that “every county musty have a mental health center,” Chase noted. “They may have their own or combine with other counties to save on costs,” he explained.
Throughout the state, 26 mental health centers serve about 70,000 clients in the 105 counties.
Nathan Fawson, director of children’s services, said the agency may face yet more cuts.
It is uncertain what will happen to a $175 Family Centered Sysytem of Care grant the six county area relies on. “It’s one of the potential cuts that may or may not come to pass,” Fossen noted, as the legislature continues deliberations to meet the state’s budget crisis.
“If people are concerned about these thngs, they should contact their legislators — NOW,” Chase empahasizsed. “That’s the only thing they listen to.”
Despite the cuts, Chase said, “we will meet our standards for emergency services. We have done amazing things here for a rural mental health system.”