Those who care for the Kansas mentally ill are in a panic about what to do with patients now that two of the three state hospitals are near or at capacity.
"This is a crisis for people who are in crisis," said Dave Johnson, executive director at Bert Nash Community Mental Health Center, referring to people with mental illnesses that render them a danger to themselves and others.
No one seems to know why admissions to Osawatomie State Hospital, which serves Douglas County and eastern Kansas, have increased 15 percent a year for the past four years.
"There's not one single factor; it's probably an array of factors," said hospital superintendent Don Jordan.
A recent surge in admissions prompted the state Department of Social and Rehabilitation Services to warn judges in 46 counties in eastern Kansas that the hospital and Rainbow Mental Health Facility in Kansas City, Kan., would not be able to accept new referrals.
'It created panic'
The warning caused a stir among the state's community mental health centers, including Lawrence's Bert Nash.
"It created panic," said Ron Denney, executive director at Four County Mental Health Center in Independence, Kan. "I had judges calling me all day, wanting to know what we were going to do."
Since the Aug. 12 warning, several patients at Osawatomie State Hospital and Rainbow have been discharged, making room for additional admissions.
"We're at 163 (patients) today," Jordan said Friday, noting the hospital can handle up to 190 patients. "I think the most we got to was 183 or 184."
Contrary to the warning, the hospital did not turn away court-ordered referrals.
But Jordan and others say there's nothing to stop admissions from reaching capacity this week, next month or next year.
"That's so true," said Janice Storey, director of children and family services at Bert Nash. "Approaching capacity at Osawatomie used to be seen as sort of a blip on the screen; it happened, but the numbers would go back down. Now, those blips are more the norm."
Last month, Bert Nash had 19 patients at Osawatomie State Hospital. No county had more. For example:
Sedgwick County had 19; Shawnee County, 18; Johnson County, 7; and Wyandotte County, 8.
Sedgwick, Shawnee, Johnson and Wyandotte counties all have access to in-county hospitals with in-patient psychiatric units.
But Bert Nash lost access to such a program in May when Lawrence Memorial Hospital closed its 15-bed unit. Topeka State Hospital closed in 1997, taking at least 160 beds out of the state's system. The closing was part of a reform meant to encourage greater use of community services.
It is unclear whether that explains why Douglas County, population 103,000, has as many patients at Osawatomie as Sedgwick County, population 463,000.
"It's probably a factor, but it's not the only factor," Storey said. "This is something we ask ourselves every day. It could be any number of things or combinations of things. But I can assure you it's not because we're over-referring. Everybody from here is very high-risk, very high-need."
Looking for the cause
Storey and others said the increase in state-hospital referrals was in keeping with community mental health centers seeing ever-increasing numbers of people who are seriously mentally ill.
"Ten years ago, we identified about 50 people with severe and persistent mental illness. Today, we're at around 350," said Denney, at Four County Mental Health Center. "Where all these people were before, I don't know; that's a good question. But they're here now."
Last week, SRS and the state's community mental health centers agreed to help each other figure out what's causing the increase.
"We need a better understanding," Jordan said. "The fact that we're seeing more admissions on the hospital level, I'm sure, is because the CMHs (community mental health centers) are seeing more people on the local level. That's what we have to get at."
Until then, the centers are expected to work with private hospitals to find alternatives to Osawatomie State Hospital.
"That's not much of a Plan B," said Karen Ford Manza, executive director at National Alliance for the Mentally Ill in Kansas. "Essentially, that means creating a waiting list. That's not a legitimate answer. We need access to more in-patient beds."