The face of mental health treatment will likely change in Emporia and the surrounding counties in the wake of funding cuts and level funding when demand for services has increased.
The Mental Health Center of East Central Kansas faces many challenges between funding cuts and an effort to expand services despite those cuts. Despite years of frozen county funds, the mental health center has expanded services during the past five years. The center has spent several years reducing expenses and diverting money into services, said Bill Persinger, executive director of the mental health center.
History and funding sources
The Mental Health Center of East Central Kansas is one of 27 centers like it in the state. The center was founded on March 12, 1960, and is operating in its 51st year. The center now serves Chase, Coffey, Greenwood, Lyon, Morris, Osage, and Wabaunsee counties.
Persinger said most mental health centers in Kansas operate as a non-profit and several depend on county funding as a critical part of their income.
The Mental Health Center of East Central Kansas receives $525,000 or about six percent of total budget a year from the seven counties in a roughly $9 million budget. Persinger said even though the amount is relatively small compared to the total budget, the money is cornerstone to what the mental health center stands for.
“Even if it’s $1, we’re still accountable to our local people,” he said. “We’re also accountable to the state and federal government.”
Medicaid is a major funding source for the mental health center. About 70 percent of the center’s revenue comes from Medicaid, Persinger said. This past year, when Medicaid was cut 10 percent across the board, it hurt the mental health center to the tune of several hundred thousand dollars — that’s money the mental health center likely will never see again.
Despite cuts, Medicaid still is critical to the budget.
“If it wasn’t for Medicaid and other insurance we’d be sunk,” Persinger said.
There is no mandate requiring counties to fund mental health centers, Persinger said.
“Counties are not required to give them any money,” he said.
Growing need
Admissions to the center have increased by 16 percent since 2006 and 39 percent since 2004, Persinger said.
More emergencies are being handled than ever before, Persinger said. Persinger said during 2010’s Thanksgiving four-day holiday, the crisis staff did 24 face-to-face crisis interventions and took many more phone calls.
“At our peak, we employed five full-time emergency staff, but cut it back to four this past winter,” he said. “And yet, those four staff are now doing the work of what the five used to do.”
The uninsured and the underinsured
A major challenge in the mental health center industry is serving the uninsured or the underinsured, Persinger said. As it is today, minimal fees are charged for those who can’t afford regular fees. If things don’t shift, that price will have to go up.
“We’ve been letting people pay $5, $10, $15 and carry a balance,” Persinger said. “We’re just not going to be able to give out charity care like we used to.”
Persinger said those without insurance or little insurance are the ones most likely to suffer when it comes to mental health services.
“It’s a sad thing that working taxpaying people are going to be the last people to be served,” Persinger said.
‘The plates are shifting’
Persinger said the mental health center has asked for a 50 percent increase in county funding from each of the seven counties. If increases aren’t given and cuts continue, the plates will continue to shift, Persinger said.
“We’re just at the point where we can’t do the same thing,” Persinger said. “The plates have shifted in the crust. State funds have declined so much, county funding has remained level and the pressure has been building and it’s just buckling.
“We will have to decide what type of mental health center we’re going to have,” he said. “We’ve grown tough over the years and you have to get back up to your feet because that’s who you are. But we cannot keep up the way we have been.”
Persinger said any organization has to bring in as much as it puts out.
“We’ve had to toughen up in the last 24 to 26 months,” he said.
The mental health center is seeing more complex patients with less funding, Persinger said.
“We’re trying to figure out a way to say yes to (everyone),” he said. “Still, no one has been turned away, particularly those with severe mental illness.”
The mental health center serves all those who need it — even if they cannot pay. However, several changes have been implemented in response to funding cuts and other funding challenges:
• For the most part, requiring that fees be paid at the time of service versus allowing clients to carry a balance.
• Sending those with delinquent accounts to a collection agency.
• Routing many of uninsured clients who struggle to pay even the reduced fees to graduate intern staff.
• Reduced substance abuse treatment staff down to about three counselors from six.
• Closed two residential care facilities. No residents were displaced or abandoned. Instead, individuals were placed in apartments and given one-on-one treatment.
• Reduced the number of prescribed staff.
• Reduced clinic-based counseling slots at main office and branch offices.
• Eliminated a parenting class.
• Eliminated evaluation services for domestic batterers.
• Dropped a substance abuse intervention program in Emporia schools.
• Eliminated through attrition the position of executive assistant.
In spite of cuts, the center has:
• Expanded full-time school-based mental health programs from two in 2006 to five at present.
• Has not laid off any full-time employees to date. As people resign or retire, most are not replaced.
• Increased specialty services to children with serious emotional disturbances, including increased support to their families.
• Maintained their part in the state’s only Fetal Alcohol Clinic.
• Reduced or maintained the degree to which they use state psychiatric facilities.
• Responded to natural disasters in Kansas and elsewhere.
• Re-organized prevention services from a program that was losing money to one that now breaks even.
• Continued to supply needy patients with free psychiatric medication.
• Continued community outreach and education activities.
• Maintained services to court, legal and law enforcement agencies.
• Maintained transportation services so that needy people can access services.
• Started a consumer advisory panel to obtain feedback from adult consumers with severe mental illness.
• Started a parent support group.
• Enhanced supported employment program, which is designed to try to help the mentally ill find meaningful work.
No major changes to children’s programs
The children’s programs at the mental health center likely won’t change, Persinger said, adding that 93 percent of people 17 and under have third-party insurance, which allows the other 7 percent who don’t to be able to be seen.
“It looks like we can keep up the child guidance part of what we do,” Persinger said. “Because children need to be a priority.”
New goals
The mental health center board of directors met for a retreat in June to brainstorm new goals and objectives for the center. The goals and objectives will be designed to carry the center through the next two to three years. The board should reach a consensus on the goals and objectives by mid-fall.