Editorial: Crisis situation

Where are people who need inpatient care for serious mental illness supposed to turn when state hospitals turn them away?

State officials have arrived at a plan to stabilize Medicare and Medicaid reimbursement for patients at Osawatomie State Hospital.

Unfortunately, that plan will create even more problems for community mental health centers across the state.

Osawatomie, one of just two remaining state inpatient facilities for people with serious mental illness, was in danger of losing Medicare reimbursement because of overcrowding that stressed both hospital facilities and staff. The hospital is licensed for 206 patients but state officials reported the patient population reached 250 several times in late summer and fall. Faced with the threat the hospital would lose funding from the federal Centers of Medicaid and Medicare Services, state officials decided to take relatively drastic steps to reduce Osawatomie’s patient census.

Earlier this month, the Kansas Department for Aging and Disability Services announced that Osawatomie wouldn’t accept any voluntary admissions until the hospital’s census reached 185 patients. The hospital also implemented policy to “aggressively triage” patients referred for involuntary admission.

The steps at least temporarily solved Osawatomie’s problem, but it created a whole new level of stress for community mental health centers that depend on state hospitals to handle severe mental health cases, mostly people who have been deemed to be a danger to themselves or others. For instance, in the first weekend after Osawatomie instituted the new triage system, eight patients referred by Comcare, Sedgwick County’s mental health agency, were denied involuntary admission to Osawatomie.

Unlike most smaller counties, Sedgwick County at least has some options. According to news reports, Wichita has about 100 beds for psychiatric patients, but that is down from nearly 300 beds about 20 years ago. A spokeswoman for KDADS acknowledged that the availability of private inpatient programs for people with mental illness has declined drastically across the state and that state facilities are having to take up the slack. But what happens to people with serious mental illness when the state also is unable to provide treatment? In too many cases, it’s left to families or local law enforcement to deal with crisis situations.

The state contends that many of these cases can be handled by community mental health centers, but at the same time the state acknowledges the growing need for those services, it has been cutting funding for the community centers.

State officials may not have had any good options to deal with overcrowding at Osawatomie State Hospital, but a triage system that turns away people facing serious and potentially dangerous mental health challenges isn’t an acceptable long-term strategy for the state.