Mentally ill see fewer choices for treatment in Kansas

More people in Douglas County involuntarily committed to state hospital each year

About once a week, often in the middle of the night, Kent Hayes gets a call that his services are needed.

“I get calls from the Salvation Army. They say, ‘So-and-so is out on the front stoop. He’s threatening to kill somebody.’ I pick ‘so-and-so’ up, and we go to the hospital. They’re really in the middle of a psychotic break,” said Hayes, the homeless outreach specialist for Bert Nash Community Mental Health Center. “You get them to the hospital, and the person who comes over to do the screening, they don’t have any choice but to involuntarily commit them to the state hospital.”

It’s a process that’s becoming more common each year in Douglas County, court records show. The number of so-called “involuntary commitments” for mentally ill adults more than doubled in recent years in District Court, from 49 in 2000 to 113 in 2005.

The total for 2006 is likely to be higher; as of mid-September, 103 cases had been filed.

Dist. Atty. Charles Branson, whose office handles the cases, sees it as a reflection of changes in the state and local mental health systems, including the closing of Topeka State Hospital in the late 1990s. Statewide numbers show mental health commitment filings up 26 percent in the last three years, even as the state’s overall court caseload dropped by about 6 percent.

“I think, to some degree, this has been something that’s been building up over time,” Branson said. “Here locally, we’ve had LMH close their mental health wing. : That was a resource we had here in the community that is now no longer there.”

‘The magic key’

A typical mental health commitment goes like this: Somehow, a patient is identified as being in a mental health crisis, often after being taken to the hospital or being arrested and booked into jail. The person is evaluated by a screener from Bert Nash to determine whether he or she should be involuntarily committed.

“Essentially, the criteria is that they have to be a danger to themselves or others and incapable of making a health care decision for themselves,” Branson said.

The requirement for hospitalization is pretty cut-and-dried, Hayes said.

“Basically, the only way you can get in the hospital anymore is if you threaten to kill yourself or someone else,” he said. “That’s the magic key.”

The person is then taken to Osawatomie State Hospital for stabilization. Within 48 hours, the person must come back to appear before a judge in Douglas County, who decides if the person should continue to be held.

If the person is sent back to Osawatomie, the stay often isn’t long, both Hayes and Branson said.

“You’re talking three days, four days even,” Hayes said. “I haven’t seen many people there for longer than a week.”

According to figures from the Kansas Department of Social and Rehabilitation Services, the average stay at Osawatomie was 40 days in 2004, 31 days in 2005 and 29 days in 2006, but that figure is for the hospital’s total population, including voluntary commitments.

More structure needed?

Mental health court cases are confidential, so it’s hard to say exactly who’s being committed in Douglas County. Branson said some of them are repeat cases.

Hayes thinks many of the people committed have severe and persistent mental illness and need a more structured environment than Kansas’ system can now offer. After being released from the hospital, they go back to the streets.

“When they forget to take their medication, or sell their medication for a bottle of booze or whatever, two weeks later they get into trouble again,” he said. “You’re talking about people that used to have a structured environment, either in a group home or a hospital-type setting. You’re talking about a lot of chronically mentally ill people that we don’t take care of anymore. It’s a primitive system.”

Still, Kyle Kessler, deputy secretary of SRS, said some advocates despise the concept of mental health hospitals and institutional settings. He said SRS constantly is monitoring the system and looking for ways to improve it.

“I think that there are dedicated providers, not just in Douglas County but throughout the state, who do the best job they can to help that population,” he said. “It’s certainly one of our highest priorities.”