New effort to tighten regulation of mental health drugs in Kansas concerns advocates

By Andy Marso
KHI News Service

TOPEKA, KAN. — A legislative committee’s recommendation could reignite a debate over whether the state should have the power to regulate Medicaid reimbursements for mental health medications, as it does for other types of drugs.

Kansas law currently bars state officials from using regulatory tools — such as prior authorization and preferred drug lists — to manage the use and cost of mental health medication prescribed to Medicaid recipients. The Legislature’s KanCare Oversight Committee recommended repealing that law last week, saying the state needs to prevent inappropriate use of such drugs. But mental health advocates say there are other ways to do that, and they will oppose any repeal of the law.

“The issue is not new to me,” said Kyle Kessler, executive director of the Association of Community Mental Health Centers of Kansas. “You want to be really cautious how you proceed with policy changes for this population and people who suffer from mental illness.”

In suggesting the change to state law, Rep. David Crum, a Republican from Augusta, said he aimed to protect Kansans with persistent mental illness while attempting to prevent the inappropriate but common use of antipsychotic drugs for other types of patients.

“Patients with persistent, chronic mental illness should be able to receive antipsychotic drugs with no requirement for prior authorization,” Crum said. “However, for all other patients, Kansas Medicaid needs to be able to perform safety edits to assess whether drugs are being prescribed appropriately.”

What sort of change that would represent from current law is unclear, though, because the statute now on the books does not describe the threshold for “persistent, chronic mental illness.”

“That may be something we’re going to have to define if we’re going to put this into law,” said Sen. Laura Kelly, a Topeka Democrat. “I don’t have a problem with looking at that delineation, but I do think that’s going to be difficult to determine.”

Crum, who did not seek re-election and is serving his final weeks in office, said persistent, chronic mental illness could be defined in legislative hearings on the issue next session. He said he was especially concerned about antipsychotic drugs being inappropriately prescribed to control elderly patients and residents of nursing homes suffering from dementia.

Mitzi McFatrich, executive director of Kansas Advocates for Better Care, said she had warned the oversight committee about that practice’s prevalence in Kansas at previous meetings. However, she never suggested the solution was to repeal the ban on Medicaid regulation of mental health drugs.

“In my mind there’s no clear intersection on those issues,” McFatrich said.

Mental health task force report released

By Dave Ranney, KHI News Service

A 16-member task force that spent much of the past year looking for ways to improve the state’s mental health system released its findings today.

“I looked forward to reading this report and working to determine which of their recommendations we want to implement,” Gov. Sam Brownback said in a prepared statement.

Included in the 38-page report are an assessment of the system’s shortcomings and more than 40 recommendations for expanding access to treatment.

“The big thing to take away from this (report), I think, is that there needs to be a lot more integration of services,” said Ric Dalke, a task force member and executive director at the Area Mental Health Center in Garden City. “By that I mean community mental health centers, schools, law enforcement, substance abuse (programs), medical providers. We all need to be working together, more than we are now.

“The other big take away,” he said, “is law enforcement saying that for troubled youth there’s a lack of resources that really needs to be beefed up, especially for those with substance abuse and a co-occurring brain disorder.”

A sampling of the recommendations:

• Create a “standing intra-agency task force” to assess how well state agencies coordinate care and treatment;

• Financial incentives for ensuring that persons with serious mental illness have access to effective treatment, regardless of their ability to pay for it;

• Better coordination of services for mentally ill persons released from correctional facilities;

• Encourage police departments to create “crisis intervention teams” for calls involving the mentally ill;

• Explore the feasibility of assuring that all school children have access to counseling and nursing services.

“Much of what’s in here has been talked about in the past,” said Rick Cagan, executive director of the Kansas chapter of the National Alliance on Mental Illness. “But for this group, for this administration, this is taking a fresh look at the system we have in place. I think that’s a good thing, but the question now is how do we go about generating the resources that are going to have to be in place for these things to happen.”

Kyle Kessler, head of the Association of Community Mental Health Centers of Kansas, called the report, “a good starting point.”

Holland, James to hold community dialogue on mental health

KANSAS CITY, KAN. --- Unified Government Mayor/CEO Mark Holland and Kansas City, Mo., Mayor Sly James will be partnering later this month to increase awareness on mental health.

A community dialogue will be held from 9 a.m. to 4 p.m. on Sept. 21, 2013 at the Imperial Ballroom at the Kansas City Marriott Downtown hotel, located at 1213 Wyandotte in Kansas City, Mo.

The Kansas City metro area is one of 10 cities nationwide to be holding a community event centered around mental health. 

“Mental health issues affect all of our families and communities, but as a society we struggle to have open and honest conversations about it,” Holland said . “I am excited for the dialogue that the Kansas City region will create to raise awareness of mental health, and to help find community-based solutions to mental health needs."

More information below:

Mayor Sly James, of Kansas City, Missouri, and Mayor Mark Holland, of the Unified Government of Wyandotte County and Kansas City, Kansas, will hold a community dialogue on mental health on Saturday, September 21st. Earlier this summer, President Obama challenged Americans to hold a national conversation to increase understanding and awareness about mental health. The Kansas City community is one of only 10 nationwide chosen to hold this day-long event. The Mayors are working with Consensus, a local nonprofit dedicated to weaving together public policy and community input, to plan and promote the dialogue.

Three hundred residents will engage in this dialogue, forty percent of which will be individuals who are currently involved in the mental health system, including consumers, family members and service providers. The other 60 percent will be composed of interested citizens. Residents from the six-county metro area, including Jackson, Clay, Platte and Ray in Missouri, and Johnson and Wyandotte in Kansas, are eligible to attend. In particular, the organizers are asking young people ages 14-24 to attend and make their voices heard. Participants will discuss effective ways to recognize, prevent and treat mental and behavioral health problems, especially in young people. The public is encouraged to register for the dialogue online at https://www.surveymonkey.com/s/CreatingCommunitySolutionsKC. Registration is currently open and will remain open until 5pm on Friday, September 20th.

Governor Brownback announces new Kansas Mental Health Initiative

Kansas Governor Sam Brownback announced this week an initiative to provide $10 million in  targeted funding to better provide mental health services to the state’s most at-risk and challenging populations, as well as the creation of a panel of experts to re-evaluate Kansas’ current mental health system and make recommendations for improvements. 

Lt. Gov. Jeff Colyer, M.D., Aging and Disabilities Services Sec. Shawn Sullivan and Corrections Sec. Ray Roberts joined the Governor for the plan’s unveiling at Wyandot Center Community Behavioral Health Care, Wyandotte County’s community mental health center that serves the Kansas City area.

“Families with mentally ill loved ones face daily challenges the rest of us can only imagine,” Governor Brownback said. “We chose to make our announcement at Wyandot Center because it is representative of Kansas 27 community mental health centers, which together form  our state’s critical mental health safety-net system. “

“These publically funded community centers work tirelessly to provide accessible, affordable care to those affected. They bring hope to Kansans and their families. I am committed to strengthening this system and making it more effective,” Governor Brownback said.

The initiative will provide targeted funding to better serve Kansas most at-risk and challenging populations.

Some mental health patients, despite having access to care, are resistant to treatment and refuse to engage with organizations that can help them. These individuals often end up in crisis and experience repeat hospitalizations.

Mental health funding: More needs as dollars stretched tight

By SCOTT ROTHSCHILD, The Lawrence Journal-World

In the wake of the mass shooting in Connecticut, Kansas leaders say they want to examine the state of mental health services. Advocates will tell them that services are strained.

“It has increased the dialogue,” said David Johnson, chief executive officer of Bert Nash Community Mental Health Center in Lawrence, about the elementary school massacre.

“People are calling me, angry and upset and asking what they can do,” Johnson said.

Adam Lanza, the 20-year-old who shot and killed 20 children and six adults at Sandy Hook Elementary School before killing himself, has been described as someone who had mental issues.

Although the cause of his outburst is not yet known, other recent mass shooters have had psychiatric problems.

“When I look at the stories of the other shooters, these are people for whom their mental health problem was recognized, but they fell through the cracks,” Johnson said. “All we have done over the last five years is turn those cracks into canyons.”

During state budget belt-tightening in Kansas, several mental health programs have been reduced repeatedly.

'Everyone' can help prevent suicide by knowing warning signs, how to help

By KARREY BRITT, The Lawrence Journal-World via WellCommons.com

Every day, someone dies by suicide in Kansas.

Marcia Epstein, director of Headquarters Counseling Center in Lawrence, believes suicide prevention is everyone’s business.

“We all have the opportunity to say a kind word or smile at somebody, and it can make a difference in that person’s day. Those are the kinds of things that we are not going to know the impact necessarily, but that’s a starting point,” she said.

Headquarters has counselors who answer the state’s 24-hour National Suicide Prevention Lifeline and it offers bereavement support for those who have lost a loved one to suicide. Epstein estimated the center gets between 10 and 15 calls a day related to suicide. The center recently received a $480,000 federal grant to help reduce suicide attempts and deaths statewide.

According to the Kansas Department of Health and Environment, there were 385 suicides last year in Kansas, 408 in 2010, and 376 in 2009. In Douglas County, there were seven last year, 21 in 2010, and 12 in 2009.

“We need to be able to talk openly about suicide, and that means if we are the one who is struggling or if we are the one who notices someone who is struggling,” Epstein said.

The warning signs that someone may be suicidal include: