Reforms should be considered

Mental health care providers and advocates in Kansas are recommending a series of statewide reforms, and we hope incoming legislators are paying attention.

Wichita’s Via Christi Health says it isn’t equipped to handle its most difficult (violent) patients. A lack of beds at Osawatomie State Hospital has forced mentally ill patients to remain in emergency rooms for days. Providers are still struggling to absorb the 4 percent reduction in Medicaid reimbursements enacted by Gov. Sam Brownback and the Legislature earlier this year.

The Association of Community Mental Health Centers of Kansas has developed a package of reforms called Mental Health 2020, and it includes a list of proposals that would address these problems. Mental Health 2020 calls for more psychiatry residents at the University of Kansas Medical Center, a funding increase for behavioral health clinics that treat uninsured and underinsured patients and the reinstated operation of 200 crisis beds at Osawatomie State Hospital.

According to the executive director of the CMHC association, Kyle Kessler, state funding for community mental health centers has been declining since the onset of the Great Recession, leaving the mentally ill with fewer and fewer options: “If those in need of services do not receive timely treatment, they may have to be served in emergency rooms, state hospitals or jails, all of which are much more expensive than community-based services.”

The issues Kessler mentions - such as mass incarceration of the mentally ill - are in dire need of attention across the country. For example, the Treatment Advocacy Center estimates that there were “356,268 inmates with severe mental illness in prisons and jails” in 2012. At the same time, there were only “35,000 patients with severe mental illness in state psychiatric hospitals.” For the most part, prisons and jails aren’t capable of providing adequate care to people with mental illnesses. This means inmates’ mental health often deteriorates while they’re locked up, which is one of the reasons their rates of recidivism are higher than average.

Moreover, according to a 2007 survey funded by the U.S. Department of Justice and the National Institute of Mental Health, sexual abuse against mentally ill inmates is startlingly pervasive. The survey found that one in 12 mentally ill inmates said they had been sexually assaulted (versus one in 33 inmates without psychological disorders). The situation is far worse for female inmates with mental illnesses, a staggering 25 percent of whom reported being sexually assaulted.

To be clear, this data comes from 12 prisons “in a single mid-Atlantic state prison system,” so it can’t be extrapolated to Kansas. However, almost a quarter of the inmates held by the Shawnee County Department of Corrections have mental illnesses, which means we should be worried about all of the other problems cited above (high recidivism, incomplete care, etc.).

Kansas needs to do all it can to make sure mental health care isn’t being left to our prisons, jails and emergency rooms, and Mental Health 2020 is a great place to start.