Grading the States 2006: Kansas - Narrative
Kansas looks good, but the glow is superficial.
The state has strategic plans, reports, updates, and information on its Web site that buzz words like "recovery," "self-determination," and "wellness" in all the right places. Good intentions exist, but rhetoric often doesn't match reality.
The Department of Social and Rehabilitation Services (SRS) directs mental health care in the state, and there are indications that SRS has embraced the vision of President Bush's New Freedom Commission and the need for system transformation. It has created a five-year strategic plan and invested in data collection mechanisms - along with other initiatives. While the planning process was remarkably open, consumers and families feel that SRS has been inflexible, and has a history of asking for their input and then ignoring it. The result is a plan with little consumer and family ownership or support.
The state has piloted evidence-based practices (EBPs) such as supported employment and integrated dual diagnosis treatment. Partnerships with Dartmouth College and the University of Kansas have helped guide these programs. It remains to be seen whether these pilots will be the precursor of statewide implementation. However, as these practices spread, they must be closely monitored to ensure that they meet the evidence-based standards.
What is strange is that Kansas has no Assertive Community Treatment (ACT) programs - one of the oldest and most effective EBPs, and one that is critical to any comprehensive mental health system.
SRS has shown very little interest in ACT, investing instead in a less intensive case management model, called Strengths, developed in partnership with the University of Kansas School of Social Welfare. Although the program provides standardized training for case management and has some research to support its effectiveness, it is not a substitute for ACT, especially for individuals needing highly intensive services. Other states, such as Oklahoma, have had success in using ACT and Strengths together, providing a powerful and flexible combination that meets the needs of highly vulnerable individuals.
Advocates report that the availability, quality, and timeliness of crisis services are inconsistent from one Community Mental Health Center (CMHC) to another and have been described as "inadequate." There is a need for increased numbers of clinically trained staff at CMHCs to ensure that consumers receive a higher quality treatment.
Access to acute inpatient treatment is also a problem. State hospitals are frequently at or above their capacity. NAMI Kansas supports the position of the Association of Community Mental Health Centers (ACMHC) of Kansas to create a system of regional, state-operated inpatient facilities to supplement the state's three mental hospitals. This proposal would help increase the state's capacity while at the same time providing services close to a consumer's home community. However, it is worth noting that even with state hospitals stretched beyond capacity, there has been a significant reduction in the use of seclusion and restraints.
Kansas is behind the curve in the decriminalization of mental illnesses. The state has looked into training for jail diversion, but there seems to be no sense of urgency, in spite of the costs of treatment that otherwise are shifted onto the criminal justice system. NAMI Kansas is working to establish a Memphis Model Crisis Intervention Team (CIT) with police in the greater Kansas City area, which may help spur interest statewide.
SRS has demonstrated some creativity in addressing the needs of people in rural areas (25 percent of the state's population) and the state's growing multicultural diversity. Limited block grant funds have been used to fund pilot projects at CMHCs for culturally competent initiatives. Infrastructure for telemedicine exists in most CMHCs and the state psychiatric hospitals, but it is underutilized and inconsistent, potentially because of concerns around privacy and lack of training for consumers and providers using this service.
Finally, it is worth noting the state's goal of involving consumers in services, particularly through 20 Consumer Run Organizations (CROs) that receive state funding. CROs serve as the go-to network for the state in policy and service planning and also provide self-help and peer support programs across the state. But consumers say the system could be better, with greater emphasis on education and recovery and increased incorporation of their concerns into the planning process for the mental health system.
Kansas is not the only state in which such complaints have been raised, but it is part of a troubling theme.
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