Unfortunately it was a scenario Michael Shanks, a longtime Lawrence police officer, was familiar with.
I was not.
It was my task to ask Shanks if he was thinking of committing suicide and if he had specific plans on how he would do it.
In this Mental Health First Aid exercise, Shanks was my friend. I had grown concerned about his depression, lack of energy and unwillingness to carry out duties in his daily life. I show up to his house, which is a mess, according to the Bert Nash Mental Health Center instructors teaching the course.
We’re not really at his home but in the basement of the police department’s Investigations and Training Center, 4820 Bob Billings Parkway.
“Oh, it’s always like this,” Shanks says nonchalantly and back in the scenario.
I keep at it and say I’d never seen it like this before.
He’s just been busy at work lately, Shanks says.
“Oh yeah? What’s been going on at work?” I ask.
“I don’t know. I haven’t been for a couple days,” he says.
Apparently the question mark that popped into my brain is now visible on my face.
“That’s what they will really say sometimes,” interjects Shanks, who as an officer has had to check on people at the urging of friends or family.
His expertise in this area becomes valuable because I am clearly out of my element.
Try to find a hook or something to connect with the person in an aim to get them to open up more to you, Shanks says.
Our instructors for the day, Bert Nash CEO David Johnson and Chief Operating Officer Pat Roach Smith, tell the class it’s best to state the facts, be confident and compassionate, and ask the person if they have specific plans about committing suicide. Don’t express any negative judgment to try to scare the person but express that you can get them professional help and treatment.
They likely want someone to notice.
“People typically are looking for an out,” Roach Smith said.
First aid class
The classroom last Wednesday was filled with close to 30 police department employees, both officers and civilian staff members, and one reporter, myself.
The Bert Nash course will be given across the department in coming weeks.
“This is a great baseline class for both dealing with people who may have mental health crises and issues, but also this is important in giving employees themselves to look at their lives, their own mental health and what it means,” Police Chief Tarik Khatib said.
It has been a difficult 18 months for the department with several employees losing loved ones, he said.
Department employees will join about 500 people in Douglas County who have completed the Bert Nash course in recent years.
The Mental Health First Aid course came to Douglas County as one of a few pilot programs across the country based on a successful program started in Australia, Johnson said.
It’s aimed at making community members aware of mental health issues and trying to reduce stigmas. It also teaches how to identify problems and how to help someone before they make it to the hands of mental health professionals.
A 2003 survey found that 26 percent of U.S. adults experience a type of mental disorder in any one year.
People with mental health problems usually do not seek help, and not everyone with a mental health disorder knows they have one, Roach Smith said.
“We really are the first line of defense,” she said.
On this day it was a one-day, 10-hour crash course, but it’s also offered in shorter class periods over several weeks. Bert Nash staff members have trained Kansas University police officers and Douglas County Sheriff’s jail staff as well, Johnson said.
The course covers everything from depression, anxiety disorders, psychosis, substance use disorders and eating disorders.
We’re taught an acronym, ALGEE, over and over:
• Assess for the risk of suicide or harm.
• Listen without passing judgment.
• Give reassurance and information.
• Encourage the person to get appropriate professional help.
• Encourage self-help for the person and other support strategies.
I had little experience before the class, and by no means am I an expert now.
However, it has made me more aware and got me thinking about how I would help someone, either a stranger, friend of family member.
The section about helping someone after a traumatic event was eye-opening.
“It is more important to be genuinely caring than to say the ‘right thing,’” Roach Smith said.
There is another angle in this for the police department and its officers.
“We have to become street-wise psychologists,” Shanks said at the end of Wednesday’s class. “This puts a little more official training into it.”
Khatib said the department is planning to have some officers participate in additional in-depth crisis intervention training to give them more knowledge about how to help manage through a situation when a mentally ill person might be doing harm to himself, herself or others.
“We’re making an effort to fulfill that public expectation to get that done,” Khatib said.
In the last five years, the department has seen an increase in calls about someone acting suicidal or having a mental health crisis.
It also can be a balancing act for officers who are trained to either prevent or, if they have escalated, stop dangerous and violent situations.
But when police are called to help someone, perhaps by a neighbor or family member, having mental health emergency, officers have to focus and attempt to calm the person. It can be a challenge because patrol officers are often busy with several calls.
“You can’t shortcut this,” Khatib said. “It takes discipline. It takes understanding.”
TOPEKA, Kan. (AP) — About 220 troubled young Kansans who have been diverted from psychiatric residential treatment facilities were the subject of a joint hearing before two House committees.
The diversions occurred after the Kansas Department of Social and Rehabilitation Services began reviewing the screening process for the residential facilities last spring.
SRS acting deputy secretary Gary Haulmark said 25 of the 220 youths diverted from residential care from July 2011 to February appealed their diversions. Twelve of those diversions were overturned.
The Topeka Capital-Journal reports that all but 33 of the rest of the youths received some community-based mental-health service.
But Linda Davis, of Manhattan, testified that her grandson attacked her after he was twice denied admittance to a residential treatment facility in favor of home-based services.
Caitie Hilton’s academic transcript at Kansas University, at first glance, doesn’t look very impressive.
Multiple withdrawals from classes, entire semesters missed and only two year’s worth of credits despite being at KU for five years since graduating from Lawrence High School.
But looked at from another perspective, Hilton’s academic progress is an inspirational story of a local woman who refuses let her mental illness keep her from success.
Beginning after the death of a close friend when Hilton was 15, she’s battled severe depression, facing multiple in-patient hospitalizations and periods when she couldn’t do much.
“It’s been a long road,” said Hilton, outside of Twente Hall on campus recently. Now 23, Hilton has been accepted into the KU School of Social Welfare. She said there have been times when “it took all my effort to get out of bed and go to school.”
Hilton is just one example of the many Lawrence residents who battle mental illness every day. And for each person struggling with a mental illness, measures of success vary. For Hilton, getting that KU degree and becoming a social worker would mean success.
For others, such as LaTonya Johnson, 55, it’s simply staying out of homeless shelters and remaining in a stable living situation. Three years ago, Johnson hit rock bottom after depression led her to homelessness.
“I didn’t want to do anything or be around people,” said Johnson, who describes her depression as a strong “heavy” feeling. “I was closed off for a long time.”
After being laid off from her job as a data entry operator, the Kansas City, Mo., native became homeless for the first time, bouncing around shelters in Kansas City before ending up in Lawrence. She spent eight months at the Lawrence Community Shelter, where social workers helped her access disability services and find local subsidized housing.
While Hilton has been receiving help for her illness for years, it took Johnson decades before she accepted help. Even then, it was a struggle.
“They had to pull it out of me,” said Johnson of her Bert Nash caseworkers when they asked about her psychological troubles.
Johnson is a member at the Recovery and Hope Network in Lawrence, where she participates in social activities with others who have a mental illness. In addition to medication and therapists, Johnson said that staying social is one of the tools she uses to stay stable.
“I’ve just found a better way to handle it,” said Johnson, who encourages others to seek help. “There is help available and it really does work.”
Staying busy and keeping her mind on her goal — graduation and possibly graduate school — is what keeps Hilton going. In recent years, she’s worked with other mental health advocates on several initiatives, including a push to increase crisis intervention training for police officers.
She’s received positive assistance from the KU community, she said. Despite her spotty academic record, Hilton said, “all of my professors or GTAs have been more than willing to work with me.”
Hilton receives services from KU’s Supportive Education Services, available to students from certain backgrounds, or those with a qualifying disability, including mental illness.
“KU has been awesome,” she said.
But before she got to KU, Hilton said, she faced low expectations and negative opinions from people who doubted whether someone with a severe mental illness could make it through college life.
“‘You shouldn’t be trying to go to college because you won’t make it through because of your mental illness,’” said Hilton, characterizing some of the comments she’d hear.
She has had to adjust her own expectations, but said she’s determined to graduate.
“I’ve come to accept that maybe I’m not going to graduate in four years,” she said. “The road that I take to graduate isn’t what most people do.”
• Bert Nash Center, 200 Maine: Provides case management services for those with mental illness, 843-9192.
• Recovery and Hope Network, or RAHN, 1009 N.H., Suites C and D: Provides social and supportive services for those with a mental illness, 856-1222.
• Kansas University Disability Resources: Helps KU students with accommodations for a wide variety of disabilities, including mental illness, 864-2620.
• KU Counseling and Psychological Services (CAPS): Provides counseling services to KU students, 864-2277.
• Headquarters Counseling Center: Operates a 24-hour crisis call center and provides referrals, 841-2345.
Bill Simons, of Lawrence, shared his personal story about mental illness in today’s editorial section of the Journal-World.
He also shared his concerns about the lack of in-patient treatment options in the area. Simons said:
“Remember that “saved” money that was supposed to go from reduced state hospitals to local mental health centers? With the new cuts proposed by the state, our local Bert Nash Community Mental Health Center will have suffered approximately $1.5 million in cuts in the past several years.
“So Lawrence now has access to a grossly underfunded mental health center, no local hospital mental health unit, and state and larger city hospital mental health unit beds greatly reduced in number.”
For more, click on the full editorial: “Mental heath care takes turn for worse.”
I wrote a story last week about the possible effects of Gov. Sam Brownback's proposed cuts to community mental health centers. The effects include: more suicide calls, increased emergency room use, and lost worker productivity. For more, visit my story on WellCommons.
Health leaders say more mental health funding cuts would cause increased ER visits, suicide calls, lost productivity
Bert Nash Community Mental Health Center’s CEO David Johnson is pleading for no more cuts in state funding.
The center, which serves 5,600 Douglas County residents annually, already has lost more than $1.1 million during the past several years.
In state fiscal year 2010, the center lost $565,000, which resulted in cutting a program that helps people transition from a hospital into the community. It also cut funding for a housing assistance program.
Over the years, it has reduced community outreach and staff.
Gov. Sam Brownback has proposed cutting $15.2 million in funding to community mental health centers. Johnson estimates that will cost Bert Nash, located in the Community Health Facility at 200 Maine, another $372,000.
“I was not expecting this cut, and we still have some hopes that the administration will take a little closer look at what these cuts actually mean,” Johnson said.
Kansas’ 27 community mental health centers have lost about $33.5 million in state funding since 2008.
Michael Hammond, executive director of the Association of Community Mental Health Centers of Kansas, said the result has been increased hospital admissions, emergency room visits, jail time and suicide calls. He expects the problems will only be exacerbated if the Legislature approves the proposed cuts.
“State aid allows CMHCs to serve as the mental health safety net clinic for all Kansans,” he said. “As one of my directors explains, ‘We are the fire department for mental health. The beneficiaries of these services are the uninsured and underinsured, over 70,000 Kansans.”
Area hospital leaders agree.
“I think if access to outpatient mental health care is compromised, individuals may be forced to rely on the emergency room services,” said Lawrence Memorial Hospital CEO Gene Meyer. “Obviously, the numbers show that we are meeting a pretty significant community need and fully expect those numbers to rise.”
In 2010, Lawrence Memorial Hospital had 1,031 patients visits that required psychiatric assessment. Of those 626 required an in-depth evaluation and stabilization. The hospital transferred 391 patients to in-patient hospitals. Forty-five percent of the transfers were to Stormont-Vail Hospital, which has 64 in-patient beds.
“We’ve been able to handle what we’ve been faced with, and we have a seen a steady increase in the past 10 years and an acceleration in that increase in the past 12 months,” said Nancy Burkhardt, spokeswoman for Stormont-Vail.
She said occasionally there is a day’s wait for a room.
“If the funding cuts were to affect those organization’s crisis services, then we definitely would see an impact and an increase because that would be the patients’ only other option,” she said.
Kansas Department of Social and Rehabilitation Services spokesman Bill Miskell said patient volume fluctuates at the state mental health hospitals and currently is holding steady, but last summer they did have to delay intakes.
A Lawrence resident, who wanted to remain anonymous, said having access to such in-patient mental health services was critical for her son two years ago.
“If a room wouldn’t have been available, he wouldn’t be here,” she said.
Johnson said he strongly believes cutting mental health services will not save the state money. He said studies have shown:
• People with mild depression use two to three times as much health care, or resources, as other people.
• Workers with depressive disorders are absent five hours more per week than the rest of the work force.
• The treatment success rates for such disorders as depression (more than 80 percent), panic disorder (70-90 percent) and schizophrenia (60 percent), surpass those of other medical conditions such as heart disease (45-50 percent).
“They (people with mental illness) are not going to get better without treatment. The problems are going to show up some place if we are not providing services,” Johnson said. “It’s not like the problems are going to disappear.”
Hammond said those places include: psychiatric hospitals, correctional facilities and homeless shelters.
On average, it costs:
• $428 per day in a state psychiatric hospital.
• $80 per day at Larned Correctional Mental Health Facility.
On Thursday, Brownback acknowledged his proposed cut would be difficult for community mental health centers, but he said the state faces a large revenue shortfall. He welcomed alternative suggestions.
“This is a tough budgetary atmosphere,” Brownback said.
He added that the $200 million in additional funds he is proposing for Medicaid will indirectly help community mental health agencies.
Johnson said they already are losing money on Medicaid patients and the population is growing.
“Overall, we don’t break even on Medicaid so providing more services means we need the grants to cover increased losses due to inadequate Medicaid rates,” he said.
Lawrence Memorial Hospital’s emergency room had 1,031 visits for patients who required psychiatric assessment and emergent care in 2010.
Of those, 626 were transferred to LMH’s Crisis Stabilization Service, an area adjacent to the main ER dedicated for more in-depth evaluating and stabilizing psychiatric patients. Here’s a breakdown on usage of the service in 2010:
• 32 — average age.
• 305 — male.
• 321 — female.
• 445 — consultations by Bert Nash Community Mental Health Center provided.
• 391 — transferred to a psychiatric hospital.
• 13 — admitted to LMH for medical care.
• 214 — discharged.
• 8 — left against medical advice.
Their symptoms were:
• 284 — depression.
• 89 — anxiety.
• 36 — bipolar.
• 22 — schizophrenia.
• 249 — suicidal.
• 11 — homicidal.