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Doing More With Less: Mental Health Centers Experience Strain

Lynelle [L] and Sean [R] Dermigny regularly attend a mental health peer-support group in Olathe, organized by Pathway to Hope.
Photo by Elana Gordon
Lynelle [L] and Sean [R] Dermigny regularly attend a mental health peer-support group in Olathe, organized by Pathway to Hope.

By Elana Gordon

http://stream.publicbroadcasting.net/production/mp3/kcur/local-kcur-973018.mp3

OLATHE, Ks. – About one in four adults has a mental health condition, and in places like Johnson County, Kansas, community mental health centers provide important support to such individuals. But lately, such agencies have been trying to do more with less: a growing number of people are turning to them for care; fewer dollars are coming in to pay for it. KCUR's Elana Gordon has more on how the region is dealing with the strain.

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Olathe resident Lynelle Dermigny knows the personal toll an unmanaged mental illness can have. A former mental health case manager herself, she was diagnosed with bipolar disorder during grad school. She says things can fall downhill fast when she's not getting the right care. That happened about a year and a half ago, when she wound up in the hospital for nearly a week.

"My medicines weren't watched closely enough," says Dermigny. "And I had a reaction to the medicines which caused me to get psychotic. I didn't know what time it was, what day it was or anything like that. So I needed to be completely taken care of."

"To know what she's going through, what she feels, and not be able to do anything about it is just an awful feeling," says Lynelle's husband, Sean Dermigny

Sean also has bipolar disorder. He was diagnosed 15 years ago and discharged from the air-force.

"I was very unmanageable and angry," Sean says. "I would cut on myself and was very suicidal."

Both Sean and Lynelle have turned to Johnson County Mental Health for help at different times in their lives, when they didn't have the financial or emotional resources to support themselves. The place is one of 27 community mental health centers in Kansas, and provides crisis, psychiatric and other treatment services on a sliding scale. Sean first went there ten years ago at the strong urging of his mom.

"She took me over there, and she sat me down. She was determined," Sean says."And within a month I'd gotten in to see a doctor, and from that point on there was hope."

Centers like Johnson County Mental Health serve as sort of front-line entry points for mental health care. The idea, which took shape in the nineties, is that ensuring the availability of services in community settings will help people with mental illnesses live independently, contribute to society, and prevent the use of more costly types of institutional and hospital care.

But today, many centers report that fulfilling this mission is becoming much harder. David Wiebe is director of Johnson County Mental Health:

"We are challenged and required to serve everyone that comes through our front doors," says Wiebe."But we can't do it, I don't think we are doing it right now, most other mental health centers are not doing it."

Wiebe says the agency cared for more than 11,000 people last year, up fifteen percent from three years ago. In addition, more than 600 people a month are now requesting services there for the very first time.

Tanya Hadley, who oversees the center's crisis services and a 24 hour hotline, says the economy has been a big factor.

"We're seeing a lot more people that I don't think we would have seen five years ago," says Hadley. "A lot of people who've lost jobs, who've lost homes. So obviously their stress has gone up, prompting maybe mental health symptoms, some illness that was going undetected before - and maybe they were coping with before because they had better supports."

Public mental Health Centers rely on a combination of federal, state, and local funds - some of it directly through grants, others through Medicaid reimbursements. It varies a lot from state to state. A recent report from the National Alliance on Mental Illness ranked Kansas as one of the top ten for states for its cuts to mental health services since 2009, and according to the Kansas Association of Mental Health Centers, most of the state's public mental health centers report they've since cut some programs, even closed offices. Wait times for services are also getting longer.

"It's always unusual that whenever the need is the greatest, the dollars are the fewest," says Rob Siedlecki.

Siedlecki is director of the Kansas Department of Social Services, which oversees the state's mental health system. He says that despite the current state economic crisis, mental health was mostly spared further funding cuts by the legislature this session, even though several proposals - including the Governor's and the House of Representatives' - would have cut between $7 and $15 million in funding to centers. But Sidelcki says the department is still dealing with some earlier, big across-the-board cuts.

"SRS took a hit of over $40 million this past session," says Siedlecki."$18 million in targeted cuts and over $20 million which we're trying to figure out right now."

Sidelecki says he plans to have those cuts mapped out by Labor Day. He says the previously proposed funding cuts to community mental health centers are off the table, as is closing Rainbow Mental Health, the public psychiatric hospital for this region which leaders have considered closing. Earlier this year, Rainbow had to shut down 14 of its 50 beds, which are often full, after a federal review concluded the place needed more staffing.

Back at Johnson County Mental Health, Wiebe says the closures at Rainbow are only exacerbating the strain in the community, with less treatment options for people in crisis. The county's detention center is seeing more people with mental illnesses coming through its doors, too.

Wiebe, along with leaders of other mental health centers, says say they're relieved the legislature maintained funding for centers this past session. But Wiebe says he's still worried about future support, and how plans to make changes to the state's Medicaid program might affect centers.

Meanwhile, in response to already having lost more than $2 million in state and county support since 2008, and in trying to keep up with current demands for services in Johnson County, Wiebe says staff is putting a priority on caring for people with the most urgent needs, with the most severe illnesses. And while the center won't refuse anyone care, Wiebe says services may not be as intensive for people who aren't experiencing an emergency.

"It really raises question of what's going to happen folks that we don't see, who aren't in immediate crisis, but maybe we'll see in weeks or months, or three years down road when they're in serious crisis," Wiebe says. "And what kind of opportunity was missed there?"

Which brings us back to Lynelle and Sean Dermigny.

Lynelle says Johnson County Mental Health provided critical help for her about two years ago. But she says she often had to wait several weeks to be seen.

"It's really miserable," says Lynelle. "It affects my quality of life. I get sad, scared, and anxious if I'm not able to get in when I need to have an appointment."

Lynelle experienced this around the time she broke down and ended up in the hospital.

Today, however, she says she's in a much better condition. Her disability benefits have since kicked in, and she's able to get more regular care.

Sean, her husband, is also doing well.

"I'm a much happier person, I'm a lot more mellow," Sean says. "I don't remember the last time I got frustrated, let alone angry. I'm no longer depressed or down."

Sean credits his improvement to a combination of things: being on the right medications, regularly attending a peer-support group, and just knowing help is out there, that he and Lynelle aren't alone.

For others, though, now seeking care in the community, mental health centers may be more difficult to rely on.

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