Can mentally ill wait?

Like the mentally ill Kansans they serve, the state hospitals need a lot of attention. Officials can’t just halt admissions and expect people who are in crisis to be OK.

So it was worrisome when the Kansas Department for Aging and Disability Services recently froze involuntary admissions at Osawatomie State Hospital, one of two state-run psychiatric hospitals. The cap follows a moratorium on voluntary admissions.

The new limit of 146 patients, down from the 206 patients the facility is licensed to serve, enables a $3 million renovation urgently needed to respond to federal citations related to overcrowding, deficient care and other problems. The cap was no surprise – the Legislature earmarked funding to help place patients elsewhere.

But the hospitals long have been under stress, challenged by limited funding, short staffing and low pay. The unidentified $50 million in state budget cuts that Gov. Sam Brownback has yet to make is cause for more concern about the system.

And the ripple effects of an admission freeze are reaching far beyond the hospital walls, leading to a waiting list in Sedgwick County and increasing fears statewide that patients who need acute psychiatric care will languish in emergency rooms or land in jails or on the streets.

“This is all about having enough ‘ports in the storm’ for when people are in crisis,” Johnson County Sheriff Frank Denning told the Kansas Health Institute News Service.

KHI also quoted a psychologist with Comcare, Sedgwick County’s community mental health center, who said it had been common in recent months for involuntary-admission patients awaiting approval or denial by state hospitals to spend 24 to 48 hours in Wichita emergency rooms.

That doesn’t sound wise or sustainable. Such delays in placement carry risks for more than the patients.

Unfortunately, Kansans need not imagine the worst-case scenario. A month before the new freeze began, a man who’d been discharged from Osawatomie three days earlier allegedly fatally wounded a fellow resident in a Kiowa County care facility. The father of Brandon Brown, the former patient now charged with second-degree murder, told the Kansas City Star that he believes the Osawatomie hospital released his son prematurely because of state budget problems. (Declining to address the specific case, a KDADS spokeswoman told the Star that processes at both state hospitals are “designed to ensure that individuals who are discharged leave the hospital with appropriate supports.”)

With help from state funding, Comcare recently has been able to serve more critically ill patients closer to home and dramatically reduce its referrals to Osawatomie. But as Comcare executive director Marilyn Cook recently said: “There are really people that need that state hospital level of care.” Can they wait for it?

A KDADS committee has been studying the mental health system; its recommendations are due soon.

The partnerships among state officials, mental health providers, advocates and law enforcement will need to be strong to see the state through the freeze at Osawatomie. And Brownback and GOP legislative leaders – whose just-passed two-year state budget relies on duct tape and prayer as well as a higher sales tax – must closely monitor the hospitals’ operations and funding needs.

For the editorial board, Rhonda Holman

This story was originally published July 4, 2015 at 7:07 PM with the headline "Can mentally ill wait?."