Topeka ? In the wake of the mass shooting in Connecticut, Kansas leaders say they want to examine the state of mental health services. Advocates will tell them that services are strained.

“It has increased the dialogue,” said David Johnson, chief executive officer of Bert Nash Community Mental Health Center in Lawrence, about the elementary school massacre.

“People are calling me, angry and upset and asking what they can do,” Johnson said.

Adam Lanza, the 20-year-old who shot and killed 20 children and six adults at Sandy Hook Elementary School before killing himself, has been described as someone who had mental issues.

Although the cause of his outburst is not yet known, other recent mass shooters have had psychiatric problems.

“When I look at the stories of the other shooters, these are people for whom their mental health problem was recognized, but they fell through the cracks,” Johnson said. “All we have done over the last five years is turn those cracks into canyons.”

During state budget belt-tightening in Kansas, several mental health programs have been reduced repeatedly.

The state’s mental health grant to community mental health centers was cut by nearly $20 million between 2008 and last year, according to the Kansas Mental Health Coalition. MediKan, which covered adults with disabilities who do not qualify for Medicaid but are eligible for services under the state’s General Assistance program, has been defunded, the coalition said.

A $4.5 million appropriation for a program that serves families who have children with serious mental health issues is in jeopardy because the state is expected to get much less in its annual funding from a legal settlement with tobacco companies, according to mental health officials.

In addition, the state’s mental health care hospitals have been beset with budget problems.

The decisions in Topeka and Washington, D.C., trickle down to Lawrence.

“We are unable to provide a broad array of services that people need to have wrapped around them until they become a crisis situation,” said Amy Campbell, coordinator of the Kansas Mental Health Coalition.

Twenty-five positions have been eliminated at Bert Nash. There have been furloughs and wage freezes.

“The staff has borne a pretty heavy burden,” Johnson said.

To make up for the funding cuts, Johnson has increased fundraising efforts and relied more on group therapy than personal sessions.

A program that placed licensed clinicians in every school in Lawrence has been scaled back to just the high schools and two of the three junior highs.

“When we lost the elementary schools, we lost prevention,” he said.

There are 17 million Americans who have a serious mental illness, and only one-third get treated, Johnson said.

“The median age of the first onset of all mental health problems is 14, and the younger you are, the less likely you are to get treatment. There is no doubt that people aren’t getting the care that they should,” he said.

Campbell said that at the state level the name of the game is to just try not to sustain any more cuts.

“We fight to preserve what is there, rather than talking about what is really needed to have a strong mental health system,” she said. “If all you are doing is struggling to use the budget that you have to actually serve the people who come to your doors, then you are not doing any outreach. We often find families turned away because their problem wasn’t serious enough, not a crisis, so they don’t come back and ask again when the situation gets worse.”