Bert Nash Mental Health Center hopes to increase the scope of its services as a result of the trend toward privatization.
When the dust settles from the current upheaval in the mental health system, questions of who gets services, who provides them and who pays the bill will have different answers.
At the Bert Nash Mental Health Center, Douglas County's taxpayer-supported community agency, the goal is to seize the opportunities that are created as publicly funded services are delegated to the private sector and managed care puts the squeeze on service providers.
``The system is changing so fast that it's not at all clear six to 12 months down the road to whom you're going to be providing services and in partnership with whom,'' said Sandra Shaw, Bert Nash's chief executive officer.
One of the major forces shaping the role of community mental health providers is the state's effort to get out of the business of providing mental health and social welfare services. As the trend toward privatizing state-funded services continues, Bert Nash will have a chance to bid on contracts to be the local provider.
One such contract begins July 1, when Bert Nash will begin to provide family preservation services with funding from the Kansas Department of Social and Rehabilitation Services. Shaw said that effort will dovetail with a trend toward emphasizing prevention and community education.
``We're going to have to introduce some very strong programs for parent support and for family support to sustain people after an acute crisis that causes us to be involved,'' she said.
As the state relinquishes direct control of the mental health system, communities also may see more services become available at the local level, she said.
``In time, I think we're going to see the effort to build a service system that eliminates the need for anyone to leave the community'' for mental health services, Shaw said. ``That's going to be significantly in response to the state's efforts to privatize services.''
Other services for which Shaw said Bert Nash is likely to compete are foster and group home care for children, crisis stabilization for children and adults, particularly in light of the planned closing of Topeka State Hospital, adult transitional living, and in-home services.
Raymond Higgins, a Kansas University psychology professor, said one of the potential downsides of privatization is that the state is retreating from direct responsibility for providing mental health services. He said it wasn't hard to imagine the state taking it a step further by eliminating funding altogether.
``The goal is to get that out of the state budget,'' said Higgins, who also is director of KU's psychology clinic.
``Everything I see on the political scene is that people are less and less interested in providing the kind of funding to maintain a mental health infrastructure,'' he said.
``I doubt that the communities themselves are going to want to take that over,'' he said.
Bert Nash, with an operating budget of about $3 million, receives about 43 percent of its funding from state, federal and local government sources, including a $440,000 contribution from Douglas County. In addition, the city of Lawrence charges Bert Nash no rent for its space in the south wing of Lawrence Memorial Hospital.
As a sign of things to come, Bert Nash already has embarked on the Lawrence Community Health Plan, a 9-month-old managed care effort in cooperation with Lawrence Memorial Hospital. One of that program's goals will be to promote community wellness.
Among forces pressing for this approach, Shaw said, is an increased emphasis on the cost-effectiveness of services.
``There is simply a growing awareness in the world that we need to be focusing our attention and resources much further upstream,'' Shaw said.
The Lawrence Community Health Plan also is an example of the increased value being placed on the integration of mental health and medical services to provide higher-quality, more cost-effective care, she said.
``Mental health and physical health are inextricably related,'' Shaw said. ``The data is becoming so compelling.''
As it will come into play in the future, Shaw said the concept of service integration also extends beyond the medical community.
``We are eager to have on-site services in the schools so we can work with educators,'' she said.
One of the potential benefits of Bert Nash having a presence in the community at large is a greater acceptability for the concept of mental health services.
``In spite of the fact that we've come a long way, there's still a lot of stigma attached to mental health,'' Shaw said.
She noted that Bert Nash already has begun operating a day treatment program through Lawrence Parks and Recreation to teach children skills for success.