The mentally ill stuck in the emergency room without treatment; reviewers don’t get full picture, group says

By Cristina Janney
Post Hays

Local officials have expressed frustration over issues of lack of communication, transportation and beds that have resulted in long wait times for adults and minors requiring hospital psychiatric care in western Kansas.

High Plains Mental Health sponsored a meeting with Scott Brunner, associate director of the Kansas Department of Aging and Disability Services; Andy Brown, Commissioner of Behavioral Health Services at KDADS; Bobby Eklofe, president of KVC Hospitals; and KC Johnson, president of HealthSource, Thursday at Hays.

About 70 members of the public joined the discussion, including members of law enforcement, mental health care providers, emergency care and hospital personnel, and educators.

RELATED STORY: Crisis patients wait up to a week to be admitted to Larned State Hospital

Citing the need for infection control and staffing difficulties, Larned State Hospital has not operated at full capacity since 2020. They currently have 74 beds.

Walt Hill, director of the High Plains Mental Health Center, said in February the waiting list for the state hospital reached 35 people and the average wait was 67 hours.

Brunner said the waiting list had dropped to 19 people for the month of May.

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The future home of KVC Hospital in Hays. File photo

KVC closed its acute care beds at Hays in 2019, but plans to reopen 14 acute care beds in a new location in January. The facility will also have residential psychiatric care for minors.

In addition to taking children from Kansas, KVC also takes calls from Missouri, Iowa, Nebraska, Colorado and Oklahoma.

National crisis of child psychiatric care

Brown said the nation is in crisis in terms of child psychiatric care. There is more demand for care and children have more severe needs, he said.

The latest state budget provided increased funding for youth residential treatment facilities to address staffing issues, Brown said.

Eklofe said KVC may have licensed capacity, but actual capacity may vary depending on staff. Eklofe said KVC had lost staff during the pandemic and was trying to recruit them to come back.

Hospitals struggle to find staff

He said KVC had seen a turnover rate of about 20% over the past two years and had struggled to fill all positions.

It is not only the number of employees needed, it is also the specialized staff that is needed, he said.

Beyond staffing, Eklofe said KVC also considers child safety when deciding admissions priorities. A child who is seated in an office may have priority over a child who is waiting in a hospital room or in the emergency department for safety reasons.

Area hospital staff expressed frustration with the expectations and screening process for minors. A worker said a youth was at her facility for 10 days and had to undergo multiple drug tests due to the long wait.

Brunner said the state hospital attracts as many employees as possible from Larned and surrounding areas, but struggled to find enough qualified employees even before the pandemic hit.

The hospital works with contract agencies to bring nurses into the facility.

Brunner said he doesn’t have specific figures on how many vacancies at Larned currently exist.

“Our main objective is to ensure the safety of our staff and our patients,” he said.

The hospital keeps workers on overtime or extra shifts or calls workers back to work to meet hospital needs.

“It’s a constant, dynamic and moving thing every day,” he said.

The severity of patients’ illness and their need for individual or bilateral staff may also alter the number of staff needed.

Patients wait in ERs, local hospitals without drugs

HealthSource works with most community mental health centers in the state to perform screenings to determine if people should be admitted to psychiatric hospitals.

These screenings are done by telemedicine. The average response time for these telemedicine screenings is one hour and 41 minutes. However, people had to wait until seven o’clock.

It also works with the state to manage waiting lists for state psychiatric hospitals. Twenty-one percent of more than 400 screenings in the Hautes Plaines mental health catchment area met the criteria for involuntary commitment to a public hospital.

Over the past six months, HealthSource has handled 1,200 calls to its crisis line. The average wait is 17 minutes, but Johnson admitted waits are often longer. Johnson said the agency is constantly working with staff to reduce those wait times.

Fifty-nine percent of their calls were from suicidal people. Nineteen percent of calls were from people with violent thoughts.

Johnson said the agency is working with community providers like High Plains Mental Health to try to keep people out of hospital when possible.

HealthSource also administers the State Institute Alternative plan, which pays private hospitals to treat people with acute mental illnesses.

Johnson said HealthSource is considering investing in a system that would allow law enforcement or hospital officials to see the progress HealthSource is making in placing someone.

Members of the public, including Ellis County Sheriff Scott Braun, said there was confusion over whether all patients admitted to a state hospital had to be medically cleared.

Braun said he was told they did, so they were all taken to HaysMed for this clearance. This takes time from emergency and hospital staff.

Johnson said not all patients need to be medically cleared.

Some emergency physicians are reluctant to prescribe psychiatric drugs to patients who come from the street. This results in patients waiting days at a local hospital to be admitted to a psychiatric hospital without any treatment.

“It’s like having a broken leg and not fixing it,” said an emergency room staff member.

Change of status envisaged for out-of-state patients

Thomas County Deputy Sheriff Eric Smith said as a result of Interstate 70 passing through his county, law enforcement is dealing with many people with mental health issues who are not of the area and have no plans to stay in Kansas after they are discharged from the hospital. .

He said there was confusion over who should be responsible for these patients.

Brunner said the law doesn’t give officials a clear path for these patients. He said state officials are aware of the problem and hope to come up with legislation to address the issue.

Officials raise concerns over the release of potentially suicidal and violent individuals into the community

Hays Police Department Lt. Tim Greenwood, along with other members of the audience, said they were concerned about the selection process. He said he felt screeners only spoke to patients and not law enforcement officers who might have spent hours with a patient.

He worried that some patients would be released into the community with safety plans that were violent or suicidal.

“We never want to do things that would put people at risk,” Johnson said. “We might have criteria that this person doesn’t meet certain expectations, but it’s still really scary. What are the things we can do? You can get a second opinion.”

Hill said High Plains Mental Health is the only community mental health center in the state to have an automatic secondary screening review for psychiatric admissions.

Johnson said he will work with his team to ensure law enforcement officers and medical professionals have the opportunity to report their sightings to screening officers.

“It’s not about us, it’s about patient safety,” he said.

Safe transport

Finding a safe way to transport patients from rural hospitals to public psychiatric hospitals has also been a challenge.

Sometimes law enforcement transport patients. However, this may depend on the agency’s willingness to do so and their available staff.

Transporting a handcuffed person with mental illness in the back of a police cruiser can be traumatic for the person with the illness, Hill said.

HaysMed has trained staff to carry out these transports. Some have suggested expanding such a service to other areas of the state.

Hill said high liability insurance could be a barrier for agencies to provide this type of service.

About Antoine L. Cassell

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