For 15-year-old BreAnna Tuter, navigating the mental health system has been a challenge. Prone to outbursts since she was a child, her family struggled to get a correct diagnosis.
“I would blow up. I would scream. I would kick. I would fight them. I would go off in a rampage,” she says.
It would happen every day.
BreAnna is one of thousands of Kansans who receive mental health services each year. Over the years, she and her family have advocated with state legislators for mental health funding.
According to state data, total funding for mental health services will increase from about $203 million in 2002 to a projected $458 million in 2015.
But mental health providers and advocates say that as services shift from hospitalizations to outpatient therapy as part of mental health reform, state funding hasn’t caught up.
In 2008, when BreAnna was 9, she and her family were able to get help and counseling through the Mental Health Association of South Central Kansas.
Doctors eventually diagnosed her with mild autism. The services were paid through Medicaid – a state and federal health insurance program for the poor and disabled.
“If we didn’t have the extra help, there would be no way we could get her the help that she needs,” Lori Tuter said.
While the state has increased money for those who have Medicaid, providers at Community Mental Health Centers – 27 facilities in Kansas that see about 130,000 people each year – say the funding doesn’t cover the majority of people who come to them for care.
State data show that Medicaid mental health funding has increased from about $81 million in 2002 to an estimated $178 million in 2014.
Meanwhile, state grants to help pay for services for the uninsured and underinsured have dropped from about $31 million in 2007 to about $15 million now.
“We’ve seen a flattening out of funding,” said Colin Thomasset, policy and research analyst at the Association of Community Mental Health Centers of Kansas. “States really been shifting it from grant funded to more focused on Medicaid as a way to leverage federal dollars or maybe as a state policy decision.”
More than 85 percent of the state funding for the centers goes toward about 30 percent of the population they serve, he said.
Additionally, the number of Medicaid recipients receiving mental health care increased from about 28,600 in 2002 to about 42,600 in 2012, the most recent year available.
“We serve people regardless of their ability to pay,” said Marilyn Cook, executive director of Comcare, Sedgwick County’s community mental health center. “So while we did everything in our power to get people medical cards that were eligible for them, there were a growing number of people who were not eligible for them.”
Cook says that Medicaid expansion would help the working poor who make too much to qualify for the program.
“We were very hopeful that Medicaid would be expanded in this state but it clearly looks like that’s not going to happen at this point,” Cook said.
In 2013, Comcare provided $3.2 million in uncompensated care to the uninsured and underinsured in Sedgwick County, she said.
Shawn Sullivan, Kansas Department of Aging and Disability Services secretary, said the state will hire a consultant before the end of the year to study spending in each mental health setting and region of the state.
“It will help us determine what part of that funding works, what’s effective and what’s not and the outcomes,” Sullivan said.
“They will also help us track the high risk areas of the state. That will give us a lot better idea of what the funding needs are for the uninsured and for the Medicaid population.”
Nationwide, about one in four adults has a mental disorder, and about one in 17 has a serious mental illness, according to the National Institutes of Health.
With the implementation of the Affordable Care Act, the mental health system in Kansas could expect up to 7,700 new patients, potentially straining the already tight system, according to a recent report from the Kansas Health Institute, a nonprofit organization that studies health and policy issues.
The report found that more than 21.6 percent of Kansas adults between the ages of 18 and 64 said they experienced mental illness in the past year, less than half of those with mental illness have reported receiving treatment and that all but the five most-populated counties in the state do not have enough mental health providers.
The biggest barriers to receiving treatment were cost and a lack of insurance, according to the report.
There is also a significant shortage of mental health providers, including psychiatrists, throughout Kansas and especially in rural areas, providers say.
According to the Kansas Department of Health and Environment, all but five Kansas counties are considered Health Professional Shortage Areas for mental health.
In Wichita, Via Christi Behavioral Health Center, 8901 E. Orme, is the lone inpatient psychiatric provider. People who need inpatient care may have medication issues, may no longer be able to function on their own or may potentially harm themselves or others.
“These are some of the most vulnerable in our community,” said Cindy LaFleur, who oversees post-acute services at Via Christi Health.
“We were one of several providers in the past, until seven or eight years ago. There were upwards of six inpatient providers of behavioral health services in Wichita and now we’re the only ones left in the city. There are a few community providers and outpatient providers in city limits, but as far as inpatient services, we are it.”
The center sees patients 11 years old and up. In its teen unit, there are 14 beds, with the average patient age of 14. Via Christi has about 570 teen discharges a year. For adults, there are 54 beds and the average age is 37 years old. Via Christi has more than 3,000 adult discharges a year.
At Via Christi Hospital St. Joseph, there’s a special unit with 18 beds for the elderly, with the average age at 73. There are about 580 discharges there each year.
A separate psychiatric assessment center at St. Joseph sees about 600 patients each month and about half of them need inpatient services, LaFleur said, and that number has increased over the years as they’ve seen other programs in the community diminish.
Via Christi also serves as an overflow site for state psychiatric hospitals. For the first time, the $290,000 the state pays Via Christi ran out a month and a half before the end of the fiscal year on June 30. LaFleur says that was because more patients were being funneled to inpatient care.
Occupancy at the state’s three mental health hospitals has increased from an average of 500 patients in 2007 to more than 700 this year, according to the governor’s 2015 budget.
“While long term hospitalization is much less frequent, the widespread closure of inpatient mental health facilities at community hospitals along with the difficulty in maintaining continuity of services to outpatients has shifted a much larger population to the state mental health hospitals than was previously projected, leading not only to higher average daily census numbers, but to substantially increased admission rates,” according to the budget.
The state hospitals have also seen an increase in funding from around $58 million in 2002 to $96.7 million this year. Some of that increase is because of the sexual predator treatment program at Larned, medication costs and staff salary increases to reduce turnover.
Via Christi officials say they have seen an increase in the number of patients who pay for care themselves and not with an insurer or state program for behavioral health. Twenty-three percent of the total behavioral health population at Via Christi is self-pay, LaFleur said.
“It’s a good indication there’s a growing need in the community,” she said.
Earlier this year, as a high school freshman, BreAnna was bullied at school. Eventually, she told a counselor she wanted to kill herself, which led to a week at the Via Christi inpatient center.
Things have gotten better since then, BreAnna says.
Her family hopes that she will “become a productive, functioning adult in society and to live a happy and ‘normal’ life,” said Lori Tuter.
“If we didn’t have these services I don’t know what life would be like. I don’t even want to think about what that life would be like,” she said.
BreAnna will be a sophomore this fall. She wants to be a photographer some day. She likes to look at things through different lenses and share what she sees.
“You can try to make people see what you see.”