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SPOTLIGHT
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The time has come for a mental health services change

Published on -11/24/2013, 6:58 AM

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By BRAD SCHOEN

Riley County Police Department

In my 31 years in law enforcement, I have seen many changes in the way our community responds to challenges. Some of these changes have made life better for the people of Kansas. Others? Not so much. Mental health care falls squarely into the "not so much" category. Changes put in place in the 1980s have not worked out as planned. When things don't go according to plan, we need to rethink our approach.

The closing of Topeka State Hospital is a prime example. Built in 1872, the Topeka State Hospital was one of three state-funded institutions serving people with severe mental illness. For the next century, the state of Kansas -- and the nation as a whole -- centralized mental health services in large, government run institutions. In the 1980s, state governments nationwide, and specifically here in Kansas, began closing these psychiatric hospitals, intending to replace them with a community based system of mental health service providers. Offering care at the community level was seen as both more humane and more effective.

Unfortunately, plans to create a comprehensive mental health system in Kansas were never implemented. Community based mental health centers never received the funding necessary to create a viable network of mental health providers.  They are doing the best they can with limited resources, but without the necessary additional funding, they cannot provide essential services to those who need them. The system is simply stretched too thin.

As a law enforcement officer and director of the Riley County Police Department, I see the negative consequences of this situation every day. In the Riley County jail, a snapshot of inmates taken at any given time reveals approximately 20 percent of our inmates have been diagnosed with mental health issues and are receiving medication to treat those illnesses. These numbers have been rising steadily for years. For many of these inmates, mental health issues have, at least in part, contributed to the behavior that caused their incarceration.

While inmates at the Riley County jail receive adequate mental health care, I think everyone can agree that there are far better alternatives available. We should reach people in need of mental health services much earlier, before they're confined, when they can benefit from early interventions and before they become a law enforcement issue. It costs taxpayers an average of $65 per day to house an inmate at the Riley County jail. Compare that to an average of $22 per day for a Medicaid member at a community mental health center.

And yet, despite the strong economic arguments in their favor, community based providers are unable to meet the demand. Steady cuts to community based care funding -- a 50 percent reduction in Mental Health Reform grants since 2008 -- means the most cost-effective option is not available. When people do not get the care they need, they get worse. Ultimately, too many of them end up in our ERs and our jails where they receive more expensive -- but certainly not more effective -- care.

The result? According to estimates from the Health Care Foundation of Greater Kansas City, the annual cost of untreated mental illness in Kansas alone is a staggering $1.17 billion.

Once again, it is time for a change. Legislation being considered in Washington would go a long way toward solving this problem. The bipartisan Excellence in Mental Health Act would provide additional funding to community mental health centers. The centers would be obligated to meet strict requirements to deliver a comprehensive range of high quality, evidence-based interventions, including 24-hour crisis care.

While Washington may not have all the answers, in this case we think the Excellence Act is an important part of a larger solution. If enacted, the new funding would go a long way toward identifying and treating mental illness sooner, treating it more effectively and ultimately reducing the costs associated with treating people in jails and emergency rooms. The Excellence Act is a good investment in our future and I urge our representatives in Washington to support it.

Brad Schoen is director of the Riley County Police Department, Manhattan.

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