By ROBERT PIERCE
• Leader & Times
Last year, as was the case with many hospitals across the state, Southwest Medical Center had its psychiatric unit closed. Because of this, the Southwest Guidance Center has taken on an extra patient load, but that facility may now have to cut back on its clients.
SWGC Executive Director Jim Karlan said at the April 18 Seward County Commission meeting, the state is considering cutting funding for mental health, and this would continue a pattern that has been in place for a few years.
Karlan said Governor Sam Brownback’s fiscal year 2012 budget wiped out two line items on which community health centers have depended, including state aid of $10.2 million and Family Centered System of Care funds of $5 million. He said these cuts follow earlier trims in 2008 and 2009 of $20 million in Mental Health Reform Funds.
Karlan said of the $20 million, SWGC’s own loss is an annual $314,000, money he said will never be reinstated. Of the $10.2 million in state aid, he added the center stands to lose more than $111,000, and $80,000 would be lost from the FCSC money.
Karlan said the budget for SWGC has been cut about as far as it can be, and many of the center’s employees have taken on an extra workload.
“We lost people, and we have people who are double and triple trained, especially our support staff,” he said. “There wasn’t a lot of fat there to cut, but we had to cut.”
Karlan said all of the state’s 27 mental health centers had to cut their budgets.
“With all this money, which at that time was $18 million for all the mental health centers, we built this extremely complex system of care which allowed us statewide to close 270 state psychiatric beds in those three psychiatric hospitals, which saved the state on an annual basis operationally $9 million,” he said. “This year, at this time, you can double that amount. We lost $316,000. It’s not coming back. That was the promise made by the state that ‘Don’t worry. We’ll always be behind you.’ That money is gone.”
Governor Brownback was in town in February for Pancake Day, and Karlan said he and other local mental health officials talked with the state head, telling him to be careful about making any further cuts to mental health.
“We’ve already lost $20 million out of $30 million, and we’re hurting,” Karlan said. “We’re really bleeding bad. ‘We understand, understand, understand.’ Two weeks later, his budget came out with these cuts in it.”
Karlan said there is a bit of good news at this point, however.
“Instead of losing the $15.2 million (state aid and FCSC money), my assessment right now, it’s in conference committee up in Topeka, is if we’re lucky, we’ll get about $7.2 million saved from the $15.2 million. We’ll lose a little overhead,” he said.
Also causing problems are rapid changes the state is making to Medicaid, according to Karlan.
“The state had told us years ago to use all this state money for your system,” he said. “Then they started collapsing that, and they said, ‘Good news. We’re opening up Medicaid to you.’ Everybody jumped on Medicaid. This governor has said, ‘No, no. We’re downsizing Medicaid.’”
Karlan said Brownback’s goal is to downsize Medicaid and make it a block grant, which would allow the governor to put the money where he wants to instead of where the federal government wants it.
“We believe that when that happens, for a number of reasons, it will be very, very, very difficult for your community mental health center system as you currently have it to survive,” Karlan said. “That means some of it won’t survive. There’s going to be a lot of changes in mental health in the next three years.”
All of this, Karlan said, will determine who is treated, and this will primarily be the worst cases.
“There will be people we won’t be able to treat over time because they aren’t the worst cases,” he said. “The reason is we just won’t have the staff or the money.”
Karlan said SWGC is working full tilt at this time seeing as many clients as possible with the money it has in place.
“We are not saying, ‘If I spend this much money, I will lose money. Therefore, I will spend this much money and break even,’” he said. “My staff is down to the point where if I cut any further into the staff, I don’t have a viable operation.”
At SWGC’s current level of operation, Karlan said the full effects of what is happening will not be felt for about the next year and a half.
“We’re feeling it right now,” he said. “We are seeing a lot of people, but we’re seeing them for less time, and we’re seeing them for a lot less money. My concern is, especially for the smaller mental health centers, that over time, they will not be able to sustain themselves given the current and projected financial situation that we’ll be in.”
Karlan said an absolute must for a mental health center is having someone to handle emergencies.
“The one thing I fear above all else is eventually, you won’t have emergency services, and you won’t have people behind the emergency services to deal with these people even on a fundamental level,” he said.
Karlan said local mental health officials are working with the state to assure as little money is lost as possible.
“One of the things that’s going to happen in the next year is that the contract for the state and Medicaid is up again for bid,” he said. “If we don’t get it, someone else gets it, we believe there’s going to be less money in the system to serve people.”
Karlan said last year, SWGC served 880 people in its four-county service area of Meade, Seward, Haskell and Stevens counties. This is about 2.5 to 3 percent of the population base in those counties of about 36,500.