Community Mental Health Centers
In 1963, President John F. Kennedy signed the Community Mental Health Act, which led to the establishment of Community Mental Health Centers (CMHCs) across the nation. The Kansas Mental Health Reform Act of 1990 initiated the state’s transition from institutional to community-based mental health care. The Act deemed that Kansas residents in need of mental health services should receive the least restrictive treatment and the most appropriate community-based care through coordination among CMHCs and state hospitals.
After 1990, CMHCs served as the primary points of entry into the mental health system. As more patients used community-based services, the need for state hospital beds declined. The Kansas Department for Aging and Disability Services (KDADS) still oversees the larger State-owned mental health institutions: Larned State Hospital (LSH) and Osawatomie State Hospital (OSH).
Today, Kansas has 26 CMHCs that primarily serve adults with severe and persistent mental illness, severely emotionally disturbed children and adolescents, and other individuals at risk of requiring institutional care. Anyone experiencing a mental health crisis but who lacks a mental health illness diagnosis can seek treatment at a CMHC. According to KDADS, CMHCs offer “comprehensive mental health rehabilitation services, such as psychosocial rehabilitation, community psychiatric support and treatment, peer support, case management, and attendant care.”
Impact of COVID-19. As a result of the 2020 COVID-19 pandemic, CMHCs shifted to telehealth options for nearly all of their services. As the year went on, CMHCs reopened in-person service delivery but maintained telehealth services. According to the Association of CMHCs of Kansas, Inc., symptoms of anxiety disorder and depressive disorder increased during the first few months of the pandemic in the United States compared to 2019.
State Hospitals and Regional Care
Since 2015, LSH and OSH have been the only State-owned mental health institutions. LSH and OSH generally serve Kansans who require longer-term inpatient acute care. The Care and Treatment Act for Mentally Ill Persons (KSA 59-2945 et seq.) provides definitions and guidance for admission to the state hospitals.
In April 2015, the Secretary for Aging and Disability Services imposed a moratorium on voluntary admissions to OSH, as the hospital lacked sufficient space for involuntary, long-term patients. The census for involuntary patients was capped at 146. In 2018, OSH increased its capacity to 166 patients.
In January 2020, KDADS presented its plan to lift the OSH moratorium to the House Committee on Social Services Budget. The agency’s plan includes increasing regional beds within the community. According to KDADS’ plan, “Adding this capacity regionally will help serve patients closer to their home communities.” The agency’s goal is for regional beds to supplement OSH capacity with shorter stays in community facilities, limiting the number of patients sent to state hospitals. One of the long-term goals for KDADS is to fund more community-based and crisis outpatient services to reduce the need for institutional and other inpatient services.
The proposed moratorium plan was included in the Governor’s Budget Recommendation for fiscal year (FY) 2021. The plan included adding an additional 15 to 20 KDADS-contracted regional beds. Currently, KDADS pays for six beds among three of those centers: Freedom Behavioral Hospital of Topeka, Prairie View in Hillsboro, and Cottonwood Springs in Olathe. The plan also proposed an increase in OSH beds from 174 to 182, an increase in crisis stabilization beds from 100 to 125, and adding 30 crisis intervention center beds for a net system increase from 46 to 76 beds.
KDADS anticipates the additional bed capacity at OSH will allow the hospital to begin a Census Management Initiative pilot. The goal of this program is to determine how many adults with severe mental illness are screened as needing treatment but who are on the waiting list for inpatient hospital care. KDADS plans to use the expanded system capacity of both state hospitals and CMHCs to supply each patient with the most appropriate care.
Community Inpatient and Structured Care
Community Inpatient Care and Structured Care Environments are the two levels directly below the State Hospitals on the adult continuum of care. Structured Care Environments include crisis stabilization services, Nursing Facilities for Mental Health, Residential Care Facilities, sobering beds, and social detox beds. Community Inpatient Care includes crisis intervention, community inpatient psychiatric beds, medical detox beds, and substance use disorder treatment.
In 2017, the Kansas Legislature enacted the Crisis Intervention Act, which allows adults to stay in crisis intervention centers for up to 72 hours for emergency evaluation and treatment. The Act also requires a center to file an affidavit with the district court within 48 hours of admission if the patient meets the criteria to be retained. The center must discharge the patient if they no longer meet the criteria or if 72 hours has passed since admission. For more information on the Crisis Intervention Act and associated issues, see article H-4 Mental Health and the Criminal Justice System.
KDADS proposes expanding services at RSI, Inc. in Wyandotte County to designate it as a crisis intervention center. If RSI were to meet those service requirements, it could admit involuntary patients, decreasing the need for beds at OSH. This shift to community intervention services aligns with KDADS’s broader goal of connecting patients to nearby treatment options in appropriate settings.
Kansas currently has five established crisis stabilization centers located in Kansas City, Topeka, Wichita, Salina, and Manhattan. These centers provide patients short-term mental health crisis care of 48 hours or less before they can transition to community-based care. Crisis stabilization is not traditionally provided in hospitals, but it can be an alternative to psychiatric hospitalization.
Mental Health Treatment for Youth
Youth have access to several mental health treatment options throughout the state. Options include psychiatric residential treatment facilities (PRTFs), the Medicaid Home and Community Based Services waiver for Serious Emotional Disturbance, and Professional Resource Family Care. Each option is detailed in more depth below.
PRTFs. These facilities provide comprehensive mental health inpatient treatment for youth who cannot otherwise be served safely and effectively in a less-restrictive environment. They generally provide services for longer-term stays. There are currently eight PRTFs in Kansas.
The Children’s Continuum of Care Task Force noted in its 2017 report that PRTFs had gradually shifted from treating chronic mental health illnesses to crisis stabilization. Additionally, from 2011 to 2017, there was a 65 percent decrease in the number of PRTF beds across the state, from 780 to 272. As a result, PRTF waiting lists have expanded. The Task Force recommended that PRTFs return to their original treatment model with a focus on chronic illnesses, rather than acute and crisis care. The 2020 Legislature added funding for 8 PRTF beds in Hays.
Medicaid Home and Community Based Services Serious Emotional Disturbance Waiver. The Serious Emotional Disturbance (SED) waiver is designed to assist adolescents who have been diagnosed with a mental health condition to avoid psychiatric hospitalization. Children with a serious emotional disturbance, who are financially eligible, and who meet admission criteria for a state mental health hospital are eligible for the SED waiver.
Services and supports under the SED Waiver may include attendant care, independent living and skills building, short-term respite care, parent support and training, professional resource family care, and wraparound facilitation.
Professional Resource Family Care. This service provides short-term and intensive supportive resources for the patient and their family.
In October 2015, the Centers for Medicare and Medicaid Services (CMS) ruled that Kansas was in violation of the federal Mental Health Parity and Addiction Equity Act because a third party (the CMHCs), rather than the Managed Care Organizations (MCOs), granted prior authorization for PRTF services in order for a provider to receive Medicaid reimbursement. After the ruling, the MCOs gained authorization privileges.
Child Welfare System Task Force
House Sub. for SB 126 (2017) directed the Secretary for Children and Families to study the child welfare system. The Child Welfare System Task Force was directed to convene working groups to study the general administration of child welfare by the Kansas Department for Children and Families. The Task Force made several recommendations related to mental health among Kansas youth:
- First, the State “shall require access to high-quality and consistent medical and behavioral health care for youth in foster care through the Medicaid state plan” by MCO oversight;
- Second, the State “should provide young adults age 18-21 with the option to seamlessly re-enter the child welfare system and ensure continuity in medical behavioral health and support services for youth who have exited the custody of DCF”; and
- Third, the State “should fully fund, strengthen, and expand safety net and early childhood programs through public services (DCF, mental health, substance abuse, and education) and community-based partner programs, and reduce barriers for families needing to access concrete supports.”
Kansas Legislation Related to Youth
2016 SB 367 and the Establishment of the Juvenile Justice Oversight Committee
The Juvenile Justice Oversight Committee (JJOC) was established in 2016. Pursuant to KSA 75-52,161, the Committee recommends to the governor and legislature the reinvestment of funds that result from the reduction in the number of youth placed in out-of-home placements. Among the evidence-based programs funded through reinvestment include several aimed at mental health, including the Massachusetts Youth Screening Instrument to identify mental health needs and mental health training for staff who work with youth. The Kansas Department of Corrections administers the programs.
2019 HB 2290 and Suicide Prevention
In 2019, the Legislature passed HB 2290, which required the Office of the Attorney General to appoint a Kansas youth Suicide Prevention Coordinator and additional support staff to identify, create, coordinate, and support youth suicide awareness and prevention efforts throughout the state. The coordinator was empowered to develop web resources to facilitate communication with youth to promote safety and well-being, develop interagency strategies to help mental health stakeholders, coordinate efforts to prevent and address youth suicide, and disseminate information on suicide reduction, among other duties. Funding for the position was not included in the Governor’s FY 2020 and FY 2021 budget recommendation. The 2020 Legislature added the position in FY 2020 and FY 2021 and directed the agency to use existing special revenue funds to fund the position.
In 2018, President Trump signed into law the Family First Prevention Services Act, which encourages the maintenance of families to preempt a child’s entrance into the foster care system. The Act allows for federal reimbursement for mental health services, substance use treatment, and in-home parenting skills training.
Funding of Mental Health Services
Medicaid provides the largest source of state funding for community-based mental health services. CMHCs use certified Medicaid match funds to provide services for children with a Serious Emotional Disturbance, children referred to CMHCs by Children and Family Service contractors, and all other children and adults who are Medicaid eligible. Medicaid covers Targeted Case Management, Comprehensive Medication Services, Personal Care Services, Pre-admission Screens, Activity Therapy, Group and Individual Psychotherapy, Training and Educational Services, Crisis Intervention, Community Transition, and Respite Care. CMHCs also receive county funding through mill levies (up to two mills for mental health services) and other taxes.
Federal law generally prohibits states from using Medicaid funds for services provided to non-elderly adults in “institutions for mental disease” (IMDs). IMDs are any inpatient or residential facility of more than 16 beds that specializes in psychiatric care. However, the federal government provides mechanisms for states to finance certain IMD services. In 2018, CMS approved Kansas’ application to waive the 15-day monthly maximum on substance use disorder treatment for IMD utilization. This waiver also allows the State to expand screening, brief intervention, and referral to treatment services as mitigation practices.
Crisis stabilization services are generally funded through lottery vending machine revenue. However, given this relatively new source of revenue, several of the crisis stabilization centers receive individual funds for their operations. These include centers in Wichita, Topeka, and Salina. RSI in Kansas City receives its own established fund.
During the 2020 Legislative Session, the Legislature passed the 2020 appropriations bill (2020 SB 66).
Included in the 2020 appropriations were the following items related to mental health:
- $1.5 million from the State General Fund (SGF) and $500,000 from the State Institutions Building Fund to open a 14-bed unit at OSH in spring 2021;
- $5.3 million, all from the State Institutions Building Fund, to remodel the OSH Biddle Building to allow KDADS to apply to CMS for federal reimbursement certification for 30 beds;
- $5.0 million, all from the SGF, to add the regional inpatient beds outlined above;
- $4.0 million, all from the SGF, to create 8 acute care psychiatric beds for youth in Hays;
- $2.0 million, all from the SGF, to increase grant funding for CMHCs;
- $1.0 million, all from the SGF, to create a PRTF pilot program at Ember Hope in Newton; and
- $750,00, all from the SGF, to establish a separate SGF account for funding the Douglas County Community Crisis Center.
Due to estimated shortfalls in state revenue caused by the COVID-19 pandemic, the Governor announced her allotment plan on June 25, 2020. Her allotment plan included several of the following mental health-related items:
- $2.5 million of the $5.0 million for regional beds;
- $2.0 million for additional CMHC grant funding;
- $1.0 million for the Ember Hope pilot program; and
- $750,000 to create a separate SGF account for funding the Douglas County Community Crisis Center.
- 2018 Mental Health Task Force Report.
- According to the National Alliance on Mental Illness, a “mental health crisis is any situation in which a person’s behavior puts them at risk of hurting themselves or others and/or prevents them from being able to care for themselves or function effectively in the community.”
- See the 2019 Report of the Kansas Mental Health Taskforce for the Adult and Children’s Continuum of Behavioral Health Care.
Connor Stangler, Research Analyst
Matthew Moore, Fiscal Analyst