Mental health services generally are not provided the same attention, respect or funding as physical health services. Funding poses several challenges to Crosswinds, which provides mental health services to Lyon County and six neighboring counties, which include 17 school districts.
Crosswinds is one of 26 community mental health centers (CMHCs) in Kansas, but few tax dollars support its services. Crosswinds is a private nonprofit agency — not a state-supported service. The state regularly monitors mental health centers to assure that state standards are met, but 70% of the Crosswinds budget is funded by services they provide.
According to Crosswinds Chief Executive Officer Amanda Cunningham, Crosswinds has 190 employees and a balanced budget.
“We’re here to serve a mission for the underserved and those who are severely mentally ill,” Cunningham said.
However, funding has been a challenge. The state of Kansas has failed to adequately fund mental health services generally, and funding of Crosswinds is an example.
“We haven’t had an increase in funding since 2006,” Cunningham reported. “The state made a huge cut in 2006, and we didn’t get an increase until 2019. There was a 17% increase in inflation during those years.”
In 2006, the cuts in community mental health grants were funds intended to cover the cost of providing services to those who are underinsured. It took Kansas until 2019 to get the funding back to the same amount as it was in 2006. This, along with no reimbursement rate increases since 2006, caused great hardships for the CMHCs.
In order to fund their services, Crosswinds has begun fundraising. “We have a development group that works very hard,” Cunningham said. “Most of our budget is spent on our services, but there’s some income from the state to serve the uninsured. Any support from the state is intended for those individuals who can’t pay. As a community health center, we have to provide service no matter what. We have to have emergency services 24/7. We have to provide psychiatric care. The funds we get from the state are supposed to offset some of that. We get some county support as well.”
With underfunding comes the challenge of finding professionals to provide the services to clientele.
“Our focus is, how do we figure out how to pay people better,” she said. “We’ll never be competitive with private practice. It takes a special person to work in a community mental health center. In private practice you choose who you see.”
She noted that mental health service is very stressful.
“We have more people coming in [for services], and it’s hard to watch people sit and wait,” Cuningham said. “We should take in more people, but we can’t. It’s stressful, and our staff are amazing.”
According to Cunningham, Kansas has traditionally been a trend setter with mental health. The mental health reform of 1990 was a major advancement in treatment of individuals with mental illness. It focused on keeping individuals in their communities with services versus sending them to inpatient facilities where they would often live the rest of their lives.
However, the financial crunch since 2006 has resulted in community mental health centers having difficulty being competitive with wages while asking considerably more of their employees to meet the demands required to be licensed as a CMHC. The 2020 Kansas Legislature became the first Legislature to commit to financially supporting CMHCs’ transition to the CCBHC (Certified Community Behavioral Health Clinic) model. This is a national effort to help increase access to everyone, with a focus on serving the community versus the individual. There is focus on access, serving the underserved and integrated care.
With these new standards, the funding model will shift from a fee for service to a cost-based system. The new funding model will allow for CMHCs to be more competitive in pay while providing more effective and efficient services.
But there is much more work to be done. There is a tremendous gap in services for both children and adults who are suffering from very severe episodes of mental illness in Kansas. There are long wait times for all ages when there is a need for inpatient care, and it puts a great strain on community resources (CMHCs, hospitals, emergency rooms, law enforcement officers and jails).
“Due to lack of beds for those that need it, individuals are often not admitted due to too much aggression, physical health problems, etc. Kansas is working on putting more money into the different hospital systems to improve this, but it has been a very long and slow process,” Cunningham said.
Community mental health centers like Crosswinds are providing desperately needed mental health services to Lyon County and surrounding counties. Needed is the community support to encourage Kansas legislators to provide the funding necessary for this vital health service.