Decades ago, travelers entering Topeka would have seen an unexpected motto beckoning them as they pulled into town.
“Welcome to Topeka, Kansas, the psychiatric capital of the world.”
The city’s credible claim to that title was in large part predicated on the presence of the world-renowned Menninger Clinic, whose iconic clock tower loomed in the background of the sign.
Karl Menninger’s eponymous institution was a heavyweight in the behavioral health world, bringing top-flight researchers and practitioners to Kansas, although the facility eventually left for Houston in the 2000s.
In 2021, community health centers in Kansas are seeing a marked uptick in interest due to strain brought on by the COVID-19 pandemic and improving attitudes toward mental health more broadly.
That could increase further next year, when the 988 crisis line rolls out, with a goal of making mental health support as easy to access as other core services.
But these forces come after years of funding and staffing challenges. Now, providers are looking to new models as a way to ensure the sustainability of their services going forward.
“We have had the history as a state of being a national leader,” said Kyle Kessler, executive director of the Association of Community Mental Health Centers. “And so for us to get the infrastructure back in terms of our workforce and our priorities in behavioral health and helping healthcare overall, we can be a national leader again.”
Demand for mental health services on the rise — even pre-pandemic
It is no secret that the COVID-19 pandemic has prompted widespread concern about mental health, with anxiety and depression increasing during the last year due to lockdowns and uncertainty about the virus and the economy.
Even before the pandemic, community mental health centers saw a 10% increase in patients since 2016.
Throughout much of 2020, those numbers actually dropped off for some groups, with residents confined to their homes. For providers who deal primarily with children and young adults, schools weren’t in session to refer individuals in need of care.
But that trend is beginning to change.
For Family Service and Guidance Center in Topeka, director Brenda Mills noted that the previous high-water mark for calls to their crisis services line was 89. Recently, that number was over 120.
Karen Smothers, director of clinical operations for FSGC, noted that young people who previously had a difficult time in a school environment actually were helped by the pandemic, as they had less of a need to socialize and engage with their peers.
Students who needed the most support were those who felt isolated without their usual social and school environments when the switch was made to remote learning.
Now, with a return to physical classes, albeit with disorienting mitigation efforts, both groups of youths are feeling adrift and in need of support.
“When classes resumed, I think it’s just maybe a clash of everything going on between the youth who were feeling really withdrawn before trying now to resume their routine,” Smothers said. “And then in the meantime, the youth who typically would struggle now are being thrown back in the classroom, and are having those same conflicts again.”
Normally, early summer is a quieter time for the clinic, as school ends and families go on vacation. Not this year, however.
“Right now we’re slammed, we’re absolutely bursting at the seams with referrals,” Smothers said.
‘We need to see real commitment’
It is likely that demand will further increase over the next year, with mental health advocates in Kansas well aware of the national rollout of the 988 crisis line.
Lawmakers approved $3 million to help the three crisis lines in Kansas currently operating expand their staff and infrastructure.
But currently 30% of all calls are sent out of state due to high volume, according to Monica Kurtz, vice president for external programming at the Kansas Suicide Prevention Headquarters in Lawrence.
This often comes down to a lack of staffing. More than 100 hours of training are needed to ensure workers, either volunteer or paid, have the tools needed to answer calls from Kansans in distress.
Sending calls out-of-state isn’t ideal, Kurtz said.
“We do pretty strongly believe that Kansans are best served by Kansans,” she said. “We have a better idea of what goes on in our state, and what resources are available for folks.”
But KSPHQ has seen a 50% increase in calls in recent years, and the rollout of 988 could see that number double or even triple as it becomes more established.
The funding, included in the state budget, puts Kansas ahead of other states in getting 988 up and running, Kessler said.
But Kurtz pointed out that a more aggressive funding proposal — which would add a 50 cent-per-line surcharge on Kansans’ cellphone bills — stalled. The extra funds from that bill could have expanded response services, particularly in western Kansas, she noted.
And while legislators can take another whack at the issue next session, Kurtz said she was uneasy with having to ask legislators to maintain funding each year.
“It’s not enough to just say it with your words, we need to see action,” she said. “This is a critical issue, has been a critical issue for the last decade. And we need to see movement on it, we need to see real commitment.”
Staffing challenges hit providers across Kansas
Advocates argue funding hasn’t kept pace for community mental health providers either.
From fiscal year 2007 to fiscal year 2020, funding for community mental health centers fell by 16%, according to the Disability Rights Center of Kansas. That’s despite those facilities serving 30,000 additional patients.
And funding struggles can mean staffing issues, particularly for facilities that compete with other states to attract high-level practitioners.
That includes Four County Mental Health in southeast Kansas, whose offices are mere miles away from the Oklahoma border.
Executive director Greg Hennen said he had an administrator leave to go across the border, where she made more as an entry-level therapist than she did as a more senior worker in Kansas.
“Right now, yeah, Oklahoma kills us,” Hennen said. “Their master’s level therapists are starting out $20,000 higher than we can start ours out at.”
About 1.3 million Kansans live in an area where the U.S. Department of Health & Human Services deems there to be a dearth of mental health workers.
Even when facilities have an adequate number of therapists, finding entry-level workers can be a challenge. Mills noted that she often has to compete against fast food outlets and big box stores.
“It was tough before the pandemic, but it has gotten worse,” she said.
For Hennen, the struggles have meant fewer personnel in area schools. While districts might want counselors around three times a week, the lack of staff might mean someone is there only once a week.
And in Topeka, Smothers said they have had to lean on more telehealth and group therapy sessions, at least for some patients, in an effort to triage care and deliver the required services.
“I don’t know what to expect a month from now or two months from now,” she said. “It feels like uncharted territory.”
Could new model boost mental health treatment?
Mental health advocates are hopeful that a potential solution is in the cards.
In 2014, Congress approved an experimental program for clinics, one designed to increase partnerships between mental health facilities, hospitals and law enforcement, as well as offer 24/7 crisis care and beefed-up substance abuse treatment.
In exchange for using proven, evidence-based strategies to advance those goals, facilities would get a higher Medicaid reimbursement rate — meaning more money to boost their bottom line.
Kansas wasn’t an initial participant in the so-called certified community behavioral health center model, but two of its neighbors, Oklahoma and Missouri, were. The program has since become permanent and has expanded to dozens more states.
That has compounded the challenges for providers in border regions, like Four County Mental Health in southeast Kansas.
But Four County elected to go it alone, obtaining a grant from Washington to begin the process of converting to a CCBHC model — the first provider in Kansas to receive that backing.
“It really has a nice impact not only on the patient, but also on the community in general,” executive director Hennen said of the facility’s early experiment with the program.
The new model means more of an emphasis on integrating behavioral health with other care. After an individual sees a psychiatrist, they can walk across the hall to a primary care physician to address high blood pressure or diabetes.
And while this may mean more money is spent upfront, providers argue there is a cost savings for society as a whole on the back end.
“You may be spending more on behavioral health care, but all of a sudden, you’re saving money on the primary care side, particularly where hospital inpatient hospitalizations and (emergency room visits) are concerned,” Hennen said.
State lawmakers approved more money to help get Kansas facilities formally approved as CCBHCs, allowing them to eventually access the greater funding opportunities that title allows.
Some providers are already laying the groundwork to become CCBHCs. Central Kansas Mental Health Center, for instance, got a $4 million grant to expand their services earlier this year.
Advocates aren’t yet ready to rechristen Topeka as a global behavioral health capital. But they do profess a genuine excitement for the future for Kansas’ mental health system.
For Mills, the director of Family Service and Guidance Center, the growth in mental health awareness has been building for some time.
“It maybe took the pandemic for people to recognize that, though I think some people were getting it before,” she said. “But this has been a long road to try to get this awareness and education out there about how critical the need is for people to be mentally healthy.”
If you or someone you know may be struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255) any time day or night, or chat online.