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(This post was written by Caitie Hilton last month...sorry for the delay in posting it.)

Recently I attended Mental Health Advocacy Day at the Capitol and had a chance to learn about the current issues facing the mental health system in Kansas as well as speak to my representatives and senators.

When Governor Brownback came into office in January, he came up with a list of programs whose funding he thought should be cut. The mental health system is one of those programs, and it is now facing huge funding cuts, on top of the massive cuts they have endured over the last three years.

Governor Brownback’s plan includes:

1. Cutting $10.2 million from State Aid to Community Mental Health Centers. Across the state of Kansas, these centers serve nearly 18,000 people and of that number, 3% of them have no insurance at all. If this funding is cut, these people will be turned away.

2. Cut the Family Centered Systems of Care program, which provides children with severe mental illnesses and their families with services such as psychiatric medications, therapy, rehab services, support to family and parent support. Almost 850 kids and families benefit from this program in any given month.

3. Cutting $500,000 in salaries and wages at the State Hospitals.

4. Close 14 beds at Rainbow Mental Health Facility

Along with these plans, he is rejecting the following plans:

1. Funding $3.4 million to the staff at the 30-bed unit at Osawatomie State Hospital to address the accelerating growth in admissions.

2. Support funding for private hospital beds. Many urban areas have numerous psychiatric hospitals to serve people who need inpatient resources. In rural areas, however, people often suffer the greatest hardship because of the distance to state hospital.

3. Support extending the statutory exemption from preferred drug list for sensitive mental health medications provided by the Medicaid and MediKan programs.

4. Restore cuts to addiction treatment programs.

5. Support flexible funding streams that support children and families, including coordination of care.

I would like to address each item of Governor Brownback’s funding cuts individually, starting with cutting funds to Community Mental Health centers (CMHC) and the Family Centered Systems of Care.

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Because of the poor economy, the CMHCs have seen an increase in the number of clients they are seeing.

According to the Kansas Mental Health Coalition, one-third of Kansans with mental illnesses or substance abuse disorders (or both) who are under the federal poverty line are uninsured. In addition, 34% are underinsured and have unmet mental health needs but encountered cost of treatment as a barrier to seeking treatment.

For these people, State grants fund services for the uninsured and underinsured who don’t qualify for Medicaid and don’t have the resources to pay for their mental health treatment.

Without treatment and care, it is highly likely that they will end up in contact with law enforcement, hospital emergency rooms or State Psychiatric Hospitals (which are the most costly levels of care).

Individuals who can be treated in the community have been shown to have an improved quality of life and faster recovery at a significantly lower cost. For this reason, treatment at a community level is part of a cost-effective budget.

The current costs for community and non-community treatment are:

• $22/day to treat a Medicaid patient with a SPMI (severe and persistent mental illness) diagnosis at a CMHC.

• $10/day average to treat a non-SPMI Medicaid consumer at a CMHC

• $428/day at a State Psychiatric Hospital

• $257/day at a Psychiatric Residential Treatment Facility

• $80/day incarcerated at Larned Correctional Mental Health Facility

Governor Brownback’s proposed funding cuts will include eliminating State Aid funding, which has been allocated at $10.2 million since the 1980’s, and funding to the Family Centered System of Care, funded at $5 million. In total, his proposed budget cuts will eliminate at least $20 million to some of the most vulnerable Kansans at the same time increasing the need for far more expensive treatment options.

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The next item on Brownback’s proposed cuts list is inpatient psychiatric hospitals. Currently, SRS operates three State Hospitals: Osawatomie (OSH), Larned State Hospital (LSH) and Rainbow Mental Health Facility (RMHF).

These hospitals are facing stagnant budgets, crumbling and condemned buildings and an increase in patients. Because of this, a change has been made in the utilization philosophy. They have gone from being able to provide long-term residential treatment to being restricted to providing short-term acute care services.

Currently, the average stay for an adult at one of these hospitals is 5 days. At the same time, inpatient admissions have continued to increase, as has the need for more beds.

All three hospitals regularly operate over census. OSH operates over census one out of every three days a week, and LSH operates over census more than four of five days.

From this past July – December, OSH was over census 34% of the time and LSH was over census 83% of the time. In May and July of 2010, the State Psychiatric Hospitals had to refuse voluntary inpatient admissions because they had no available beds. Yet a mere $3.1 million increase in funding would accommodate the growing number in admissions.

Instead, 14 beds out of the 50 at the Rainbow Mental Health Facility have been cut to save $812,000 in staffing costs. (RMHF serves clients from Johnson and Wyandotte counties.)

So…at a time when we are already facing a severe shortage of psychiatric care beds in Kansas, Gov. Brownback wants to eliminate even more of them!

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Another point I feel that I should mention is preserving open access to Mental Health Prescriptions. Kansas is noted for having one of the best state statutes related to medication for mental health conditions in the country.

Passed in 2002, KS 39-7, 121 b. exempts mental health prescription drugs from prior authorization or a preferred drug list.

This is important because preferred drug lists are specifically designed to reduce the use of certain drugs, no matter how effective, by limiting which drugs can be prescribed to patients without preapproval from the insurance company or, if a drug is not on the list, by setting up administrative steps that patients and/or doctors must take to (hopefully) get approval for the drug that actually works best.

These preferred drug lists are primarily based on the cost of the medication (because older or generic drugs are much cheaper), so the state expects to get savings from better pricing from the manufacturers. As a result, the new, more expensive drugs are far more likely to be restricted.

Unfortunately, these newer restricted drugs are also usually the drugs that are more effective, better tolerated and have fewer side effects, which leads to decreased medication non-compliance and improved results.

Effective medication is a large element of mental health recovery. Effective medication helps control symptoms, makes the illness manageable, and increases daily functioning and quality of life.

For this reason, continuity of effective medication is key to maintaining recovery. And this continuity is accomplished by preserving open access.

It results in a 65% decrease in inpatient costs, a 55% decrease in emergency room costs and an overall savings of $116 per patient, per month. It allows children with mental illnesses to stay in their homes and schools, and allow adults to stay in their community, get jobs, acquire independent living and contribute to their community.

Studies about open access (along with the experience of other states) have repeatedly shown that full access to the complete range of medications used to treat mental health conditions saves money, both in Medicaid and State General Funds.

Other data across numerous states has shown that restricting the access to these medications drives up costs exponentially. For example, when California forced patients with mental illnesses to switch to cheaper medication, it cost the state $6-8,000 per person more because of increased hospitalization.

The Kansas Coalition for Mental Health has figured up the numbers, which clearly show that preserving open access will save our state money.

For example, one week of hospitalization would cost $15,554 for a patient who required inpatient hospitalization because of symptoms caused by a lack of access to an antipsychotic drug not on the preferred drug list.

However, maintaining that person on a newer antipsychotic medication for one year would cost only $15,000!

In addition, patients who discontinue medication and end up in jail or prison cost roughly $23,000 a year per patient.

The institutional costs avoided by medication therapy are about $73,000 per year per patient.

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Since 2008, there has been a $20 million reduction in Mental Health Reform grants. That is a 65% reduction in these funds. If Governor Brownback’s proposed cuts are approved, they will be cut even more.

No other state programs have taken a 65% cut. And these new proposed cuts would actually zero out some highly effective programs, such as a children’s program that provides treatment to the children of families that don’t qualify for Medicaid but can’t afford health insurance.

We as a state simply can’t afford to do this!

After all, mental illness affects people of all ages from all walks of life. Indeed, 1 in 4 Kansans will have a mental illness at some point in their lives.

I repeat…1 in 4 Kansas will have a mental illness at some point in their lives!!

We’re not talking something that affects someone else. Something you’ll never have to deal with. We’re talking about an illness that either you or a family member or a friend will have.

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Recovery from a mental illness is vital to living a productive life.

For those of us who have mental illnesses, continued access to Community Mental Health Centers, psychiatric hospitals (when needed) and open access to medication are necessary for recovery.

For those of you or your loved ones who will develop a mental illness, they will be equally necessary.

Governor Brownback’s proposed cuts to mental health services will not save the state money. Not in either the short or the long term.

If people cannot afford services at their CMHC and do not have access to the medications that help them manage their symptoms, they are likely not going to be able to be functioning members of society.

Repeated hospitalizations and contact with law enforcement that leads to incarceration will increase dramatically. The lack of ability to function will lead to people not being able to hold jobs. All of this is going to lead to both a decreased quality of life for people with a treatable illness and increased costs to the taxpayer.

The numbers clearly show that cutting mental health funding will not save the state money, but will, instead, increase what the state…and taxpayers…end up paying per year.

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Not surprisingly, Governor Brownback did not accept our invitation to make an appearance at the Mental Health Advocacy Day.

If Governor Brownback is so willing to make such drastic cuts, I feel he owes an explanation to the people directly affected. Lieutenant Governor Jeff Coyler did attend and wanted to pass on a message from Governor Brownback: “Governor Brownback wants to ensure that all Kansans are treated humanely and equally.”

I had to bite my tongue.

These proposed cuts will not treat the mentally ill humanely or equally. As I wrote previously, no other program has suffered having their funds cut by 65%.

Since Governor Brownback is so eager to cut funding for the state mental health system (and so unwilling to speak to those directly affected), I have one request for you: please, please, PLEASE write or e-mail or call your Representatives and Senators and ask them to not cut mental health funding.

Mental illnesses are life-threatening illnesses. People die from them every day. Cutting mental health funding is a disaster waiting to happen. An unnecessary, expensive disaster.

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The Recovery and Hope Network (RAHN) is a small yet wildly successful local nonprofit serving people with severe and persistent mental illness in Douglas County. Written by members and staff of RAHN (it’s pronounced “rain”), the purpose of this blog – Flying Over The Cuckoo’s Nest – is to educate people about mental illness and the possibility of recovery, to reduce fear and stigma, and to reach out to those in need and their families and friends, neighbors and coworkers.

1009 New Hampshire, Suites C & D
Lawrence, KS 66044

Tel: 785-856-1222
Email: info@recoveryandhope.org
Website: http://recoveryandhope.org
Facebook: http://www.facebook.com/pages/Recovery-and-Hope-Network-RAHN/114529948569741
Blog:: http://www2.ljworld.com/weblogs/flying-over-the-cuckoos-nest/ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~