News

ELLY GRIMM

   • Leader & Times

Liberal’s Southwest Guidance Center (SWGC) officially received its status as a Certified Community Behavioral Health Clinic (CCBHC) last week, and Michelle Ponce and Kyle Kessler from the Association of Community Mental Health Centers of Kansas (ACMHCK) were on hand to educate people in the community about what all a CCBHC does and how it came to be.

“In 1990, the Kansas Mental Health Reform Act was passed under Gov. Mike Hayden, and one of Rep. Shannon Francis' colleagues was in the Kansas House at that time and is still there,” Kessler said. “The idea behind doing this reform in Kansas was to help with dehospitalization – we had a lot of state hospital beds throughout the state, including at Larned State Hospital, and there's a new state mental health hospital in Wichita, which means is there shouldn't be any waiting list at Larned State Hospital. There's been a waiting list for probably the past two or three months comprised of five to 10 people, and that means you're two or three days away from actually getting someone in who's been deemed as a harm to themselves or others and are in a mental health crisis. Those are not situations where you would go to a regular hospital emergency room, and we've needed to lean on those partners far more than we should while they're awaiting the care they need. The new Wichita facility will come online Jan. 1, 2027, and it will definitely be a great benefit to that area.”

There are challenges in all corners of the state when it comes to the issue of mental health, Kessler said.

“With the Kansas Mental Health Reform Act, the idea was ... at that time, 31 mental health centers were going to get some funding because they were closing state hospital beds, and there was money sent to community health centers to push for community-based care and treating patients closer to home and their support systems,” Kessler said. “What happened over time, gradually, was instead of the state government sending money to community mental health centers, they basically said 'We get $1, and you get $1' and then it became 'We'll keep $2 and you get $1' and then 'We'll keep $4 and give you $1' but that reduced the amount of support that was provided and ended up being basically a false promise. Whether that was driven by economic factors or changes in tax policy or whatever circumstances, those investments in healthcare and that safety net didn't return like they were supposed to, especially for people who were victims of trauma or a veteran suffering from PTSD or anxiety.”

And the CCBHC model is not unique to Kansas, Ponce said.

“CCBHCs are a national model and we're well past calling it a trend or even new. At the last update from our national association, CCBHCs are now in 45 states and there are now more than 500 clinics across the U.S.,” Ponce said. “There were multiple challenges being faced in Kansas that made this model necessary, including a rise in deaths by suicide, overdose deaths, barriers to access to timely care, inadequate care for veterans and active military personnel, overburdened jails and emergency departments, and the CCBHC model was created to help address those, among other issues. To put things simply, the CCBHC is a new provider type under Medicaid, so it does provide additional funding to community mental health centers and other resources, and they must provide those services to anyone who walks through the door, with the additional payment structure applying only when serving a Medicaid client.”

To become a CCBHC like SWGC has done, there is a very lengthy list of criteria that must be met, Ponce continued.

“It's also a little different than how community mental health help has been provided in the past, and the CCBHC is truly an integrated care model. Again, facilities must meet all of a patient's needs and are required to screen for certain primary care needs, and if they find you have another need they're not fully able to meet, they'll find someone who can help and must ensure all of that care is coordinated,” Ponce said. “The criteria falls into six categories, with the first being a prescribed list of services facilities must provide in addition to services already being provided as a community mental health center. Another criteria is availability, and many centers either have implemented or are in the process of implementing some level of same-day access – that means if you go in and need services, you'll be able to get them. There are requirements with staffing and quality and other types of reporting, and it's great having that uniform reporting requirement will allow us to really see how we're doing and measure what's going on. In Kansas, we're just now almost three years into this transition, I know some facilities made the transition as early as 2022, and at this point, all facilities are at least provisionally certified. As the system continues to mature, one of the things I'd like to see for the ACMHCK is to develop a process and a way to gather that quality data, and we'll be able to report to communities, the Kansas Legislature and other stakeholders so they can see those results from what we've been doing.”

Ponce added there was a lot of work that had to be done in advocating for the CCBHC model for the state. 

“When we were originally advocating for moving toward this model, we looked at a couple other states who had made the transition, and in Missouri, not only did they see an increase in accessing services, they also saw a decline in the need for those more costly services,” Ponce said. “One of the other criteria is the use of evidence-based practices, and there is some latitude from state to state about what that can entail, and in Kansas, those evidence-based practices include assertive community treatment (enhanced case management for people with the highest risk of needs), supportive employment (helping individuals get and stay employed), medication-assisted treatment along with therapy, and care coordination. With crisis behavioral health, that's really important because what the CCBHC model requires from the state as a whole is to have a coordinated crisis response system, and there are many parts to that and how it's all been implemented in Kansas. One is with mobile crisis response – all CCBHC's are required to provide mobile crisis response, and crisis is determined by the individual, who might call 988 or the suicide prevention hotline or reach out in some other way. When people make those calls because either they are in crisis or a family member is in crisis, those calls get answered by someone who will work to de-escalate the situation. However, if the person taking that call determines the caller needs more assistance than they can give, they will dispatch someone from that local CCBHC or mental health center, and the goal of that is to get someone to that person's side within two hours, which we all know can be difficult in rural areas like Southwest Kansas. The 988 hotline has been fully integrated in Kansas for about two years now, and it's helped a lot of people, and I'm happy the state legislature took quick action to get the infrastructure in place to be able to get that done.”

And there is even more work going on to make sure patients receive necessary care.

“The last piece of our crisis system is our crisis stabilization units and crisis intervention centers. About half of our CCBHC's operate as crisis stabilization units, and those provide a level of inpatient care generally for 48 to 72 hours to help individuals who need that level of care while staying in their communities,” Ponce said. “One caveat to that is those centers are unable to take involuntary admissions. Within the past year or so, the state regulations for crisis intervention centers have been finalized, and we now have two of those operating in the state of Kansas, with other facilities poised to become intervention centers in the near future. The primary difference is the crisis intervention centers CAN take involuntary admissions. I think as we go forward and as we get additional crisis intervention centers on board, we'll see some of that pressure taken off of the state hospital system and not see as many of the lengthy waiting lists as we have the past few years.”

And there is still work to do, Kessler said.

“The overarching message from the Kansas Legislature and other policy makers was ... this came on the heels of a report which I maintain was full of bad data that ranked Kansas basically at the bottom in the country as it relates to providing mental health services,” Kessler said. “In 2021 or 2022, there was a legislative committee for mental health modernization and reform that came together and came up with these solutions and how to expand the scope of what we were trying to do. What we're working to do with the CCBHC model is, we got more funding to do more work, but then I had several folks coming to me and asking who we would hire to do everything. When we were working to figure out where those gaps were, we were not exactly recruiting, and there was a pretty big nursing shortage that still exists today, including at Larned State Hospital – six years ago, the state was spending $5 million a year on contract nurses there, and that number is $50 million higher, and that's unsustainable. We need to 'grow' our own nurses and have Kansans taking care of Kansans, it's one of the reasons we work so hard to convince young people to stay in-state. In terms of the overall mental health we as a state value, we did a public policy poll about a month and a half ago with a nationally known firm, and we learned a lot through that poll because it took into account ages and other similar demographics, political party and location in Kansas. We asked questions including 'Are you dealing with a mental health issue such as anxiety, depression, etc.' and 'Are you getting treatment for your mental health issue?' among many others, and we also asked how people felt about recent investments made in the state's mental health system and their health insurance coverage, which especially got quite the response. We hope to be able to continue this work so people everywhere can get the care they need, because it’s so, so important for them.”