At least once a week, Kimberly Rowlands talks to someone contemplating suicide.
“It’s a big chunk of what I do,” she said.
Rowlands, 48, is what is called a mental health co-responder. When Olathe police respond to reports of someone threatening to kill himself or herself, she goes with them.
“I wouldn’t even guess how many times I’ve been called out,” she said. “I’m not on duty 24 hours a day, but when I’m working and a call comes in, I go out.”
Rowlands is on the front line of a problem that is growing nationally and in Kansas.
In the U.S., suicides have exceeded automobile deaths since 2009 to become the 10th leading cause of death. According to the Centers for Disease Control and Prevention, suicide accounted last year for more than 1.4 million years of life lost before age 85.
The number of Kansas suicides increased more than 31 percent between 2011 and 2012. According to the Kansas Department of Health and Environment’s recently released vital statistics report, coroner’s offices across the state reported a record-high 505 suicides last year.
There are significant regional differences in suicide rates. For the past decade or more, the rates typically have been highest in the states of the mountain west and lowest in the more heavily populated states of the northeast.
But with Kansas’ significant recent increase, it has moved into the rank of states with the highest rates. No one seems to know why, or whether the dramatic one-year increase was an aberration or the beginning of a disturbing trend.
Between 2011 and 2012, the state’s suicide rate went from 13.4 deaths per 100,000 population to 17.6 deaths per 100,000 population.
“The numbers are very troubling,” said Miranda Steele, spokesperson for the Kansas Department of Health and Environment. “We’ll be working with our partner agencies and with KDADS (Kansas Department for Aging and Disability Services) on seeing where we go next with our interventions.”
Funding an issue
Historically, much of the state’s response has been defined by its support for community mental health centers; the work of groups such as the Governor’s Mental Health Services Planning Council, and education campaigns.
“We’ve made a good start,” said Michael Garrett, chief executive at Horizons Mental Health Center in Hutchinson. “Every mental health center in the state puts on programs for educating the public about depression and how to recognize the signs that someone is contemplating suicide. We do training five or six times a year in Reno County.”
But the mental health centers’ initiatives, he said, have been squeezed by cuts in state spending.
Morgan Murray is too young to have any idea who Doogie Howser is, but the 16-year-old from Shawnee is cut from a cloth similar to the prodigy doctor in the '90s TV show.
Even while finishing high school and getting a jump on college, Murray finds time to be flown across the country several times a year to help teach doctors twice her age how to perform challenging tracheal intubations, a procedure to get oxygen to patients with blocked airways.
"It's a very high-stress, very time-oriented procedure," said Murray. "I am helping teach the doctors how to intubate using high-fidelity simulators. I act as their nurse, getting them anything they need. Then I help debrief and tell them what they can do better."
Murray came into the teaching opportunity while sitting in on classes, which were taught by her mother. Two years ago, the instructor in the nurse role was out sick, and Murray seized the opportunity to fill in.
Now Murray is seizing another opportunity to get a jump on her career at the Kansas Academy of Mathematics and Science.
The two-year program is a sort of fast-track boarding school at Fort Hays State University. Each year, up to 40 high school juniors from across the state move into a campus dorm and complete their last two years of high school coursework while also taking college math and science courses.
Murray said that the academy — often called KAMS by students — provides an environment where staff and other students drive each other to set goals high.
"I've been wanting to pursue medicine since I was in third grade," Murray said. "KAMS has pushed me to do even more than I thought I could. I've done more in this semester than I thought was even possible."
Plugging the brain drain
Murray is one of 68 students currently enrolled in the academy. Another 53 students have graduated from KAMS since the first class in 2009.
The Kansas Legislature founded KAMS in 2006, in part to give students like Murray a learning opportunity in Kansas that would challenge the state's most talented students, said director Ron Keller.
"The academy was formed to keep the students here in the state — to keep intellectual capital from leaving Kansas, to keep from losing our best and brightest kids," Keller said.
Detailed spending proposals for the coming fiscal year prepared by officials at the state’s three top health agencies outline how Gov. Sam Brownback’s administration is planning to cap or cut spending on a broad range of health-related programs.
The governor’s formal budget recommendations for fiscal year 2014, which begins July 1, 2013, won’t be delivered to the Legislature until January when its new session begins. But agency chiefs were told as early as August by the governor to keep spending in check and to present alternatives for cutting 10 percent from each department’s upcoming state general fund budget.
The documents presented by the Kansas Department of Health and Environment, the Kansas Department for Children and Families, and the Kansas Department for Aging and Disability Services to the state budget office as part of the governor’s budget building process were obtained by KHI News Service and are made available here.
Administration officials declined to answer questions about their spending plans.
“We will not comment on the budget proposal at this time,” said Angela de Rocha, spokesperson for the Kansas Department for Aging and Disability Services and the Kansas Department for Children and Families.
Fading state aid
But there is abundant comment contained in the budget documents themselves and representatives of many, if not all, the organizations and programs that rely upon state health dollars have been advised informally within the past couple of weeks by administration officials of the planned spending limits and possible cuts. However, none of the representatives interviewed by KHI News Service had been given the full details laid out in the documents.
“We actually had a meeting with the secretary (Shawn Sullivan of the Kansas Department for Aging and Disability Services) but he didn’t give us any numbers,” said Cindy Luxem, chief executive of the Kansas Health Care Association, which represents for-profit nursing homes and some of the state’s providers of home and community-based services for the elderly.
“The providers at this stage of the game are not getting any kind of bump in the rates (for Medicaid services). The intention of the state is to keep the rates flat, essentially for the next two years, is what he told us,” she said.
Michelle Ponce, executive director of the Kansas Association of Local Health Departments, said she was alerted that the “reduced resources” budget proposed by the Kansas Department of Health and Environment could mean a cut in state aid to the local health agencies.
If adopted as outlined in the agency’s budget plan, 40 local health departments would see their state grants cut with the biggest decreases falling on the state’s largest local agencies.
“It’s maybe too early to tell you exactly what it would all mean,” Ponce said. “But it is unlikely all those agencies could absorb those cuts and maintain current services.”
Ponce said state support for local public health agencies hadn’t increased in years despite the added costs of inflation so any cuts would fall all the harder on the departments. She said association research had showed that since at least 1984, local governments have been stuck with absorbing the growing costs of health department programs as state aid has faded.
Health and Environment
Throughout the budget documents, officials note the need to hold down spending, though sometimes the notes are accompanied by caveats that seem to argue against some of the possible reductions.
At KDHE, officials said “that in recognition of the reality we find ourselves in as a state agency in the current budget environment, the (agency) will not be asking for budget enhancements” in fiscal 2014.
In fact, agency officials proposed total state general fund spending of about $1 million less than for fiscal 2013. About 80 percent of the agency’s $2.6 billion annual budget comes from fees, grants or federal aid as opposed to state tax dollars.
As part of the agency’s “reduced resources” options for cutting 10 percent from the state general fund portion of its budget, officials said they would trim administrative costs by almost 34 percent as a way to forestall more cuts to direct services.
A new inspection report on the state mental hospital here has underscored the severity of what has been a major problem at the facility for months and years: Because of the poor working conditions, state officials are having a hard time keeping doctors, nurses and others on the job.
The Joint Commission, a national organization that accredits hospitals, found that the facility in the past five years lost more than two-thirds of its medical staff due to budget cuts, turnover related to poor working conditions and other factors.
Employees complain they have been forced to work overtime to the point they are mentally and physically exhausted. Many have left in frustration. And now, according to some at the hospital, state officials have difficulty getting nurses from temp agencies to take shifts at the hospital even for short spells.
Currently, the hospital has 790 employees. It’s authorized to have 886. The hospital’s 467 mentally ill patients are at the facility because they have been deemed a danger to themselves or others. The hospital complex includes three 30-bed psychiatric units, a 190-bed forensic unit and a 177-bed sexual predator treatment program. Of the 467 patients, 217 are in the sex predator program.
State officials acknowledge that the staff shortages, starting earlier this year, required some direct-care workers to sometimes work 12- and 16-hour shifts.
“Our primary challenge at Larned is staffing,” said Angela de Rocha, a spokeperson for the Kansas Department of Social and Rehabilitation Services, which oversees Larned and the other state hospitals.
Since July 1, 2011, according to state figures, the hospital has paid almost $1.4 million in overtime wages. It’s spent $135,000 on temp-agency nurses.
The staffing dilemma has created or contributed to other problems noted in the report from the Joint Commission.
The commission’s inspectors called the hospital’s high turnover rate “alarming,” and told state officials they must quickly correct 30 problems — most of which stemmed from the staffing issues — or potentially lose accreditation.
The inspection team visited Larned between March 5 and March 9. It found 14 problems serious enough that the state was given 45 days (until May 5) to correct them. It was given 60 days to correct the other 16 problems. After the 60 days, an unannounced return visit will come as inspectors check the state's remedies.
Among the findings outlined in the 37-page inspection report:
• The hospital has been without a medical director for three months. It also lacked a director of pharmacy. (Officials currently are in the process of hiring a new pharmacy director, de Rocha said. And a New York doctor who likes to hunt and seeks a rural setting has shown interest in the medical director's job. He might be coming to Larned for an interview within the next two or three weeks, according to SRS officials.)
→ More findings and the full report at khi.org.