February 12,1997 - Movement toward TSH closure on track as new admissions end

For successful closure of Topeka State Hospital (TSH), two key elements needed to be in place or well on their way to being in place by Friday at midnight, when admissions to the hospital end:

*Access to appropriate level of care for patients currently at TSH in a community-based program or in another state mental hospital; and

*The capacity for the surviving state mental hospitals and the Community Mental Health Centers (CMHCs) to absorb the approximate 700 annual admissions to TSH.

Because of work done by all parties in Kansas involved with the state's mental health system, both those all-important elements have been achieved. Ending admissions is necessary at this time in order to close the hospital by June 14 because the average length of stay at the hospital is between 60 and 90 days.

"Through effective planning and working together as a team, we have accomplished what we set out to do by this date," said Department of Social and Rehabilitation Services Secretary Rochelle Chronister. "The coordination and collaboration between the state and the stakeholders of the mental health system has truely been impressive."

Ron Denney, president of the Association of Community Mental Health Centers of Kansas and executive director of Four County Mental Health Center in Independence, echoed Secretary Chronister.

"There has been enough forethought in the way it has happened, everything has gone very smoothly," Denney said. "We have worked to move as many people home as possible and provide them treatment in their community."

On Tuesday of this week, 96 patients remained at Topeka State Hospital, down from about 160 in September, 1996. Since September of last year, 43 patients have been transferred to one of the other two state hospitals, Osawatamie State Hospital (OSH) and Larned State Hospital (LSH). 24 other patients, originally identified by hospital and community staff as needing hospitalization beyond closure, have moved into communities after supports have been set up by CMHCs.

The recent progress toward closure of TSH began after the 1996 Kansas Legislature concurred with the decision of the Hospital Closure Commission on which state hospitals to close. Hugh Sage, commissioner of Mental Health and Developmental Disabilities (MHDD) for SRS, formed a TSH Closure Advisory Committee with members drawn from each of the mental health consumer advocacy groups, the private sector, the Governor's Mental Health Services Planning Council, CMHC staff, and staff of Kansas Advocacy and Protective Services. The committee assisted MHDD staff in developing a plan to expand or establish community services across the state in preparation for closing state mental hospital beds.

The plan included expansion or establishment of community alternatives across the state which would allow the closing of 231 beds in the state mental hospital system. In late October, 1996, MHDD secured agreements with each CMHC that will close 74 general psychiatric beds for children and 157 general psychiatric beds for adults by June 30 at a cost of $4.6 in FY 1997 and not to exceed $7.89 million in FY 1998. One-time start-up costs of $3.6 million were also awarded the CMHCs in December to initiate services and supports, including housing and transportation.

Commissioner Sage outlined what is being done with the funds:

"New and enhanced programs have been developed," he said. "For children, these include case management, attendant care, and school-based liaison services -- all intended to help children and adolescents stay in their homes and communities. For adults, programs include housing, case management, attendant care, psychosocial groups, non-hospital crisis beds, and crisis case management -- all meant to help adults stay in communities."

With admissions ending at TSH, mental health centers and district courts in the 31-county TSH catchment area have been notified that any state hospital admission must be directed to either OSH for counties in eastern Kansas or LSH for counties in the west. Also effective February 15, all children and adolescent admissions for the eastern portion of the state will be directed to Rainbow Mental Health Facility in Kansas City. LSH will continue to provide beds for children and adolescents from western Kansas.

Denney said it is important that people recognize that the closing of TSH does not mean a state mental hospital is unavailable if needed.

"The end of admissions to Topeka State Hospital is a significant milestone in accomplishing a smooth closure process," Denney said. "But absolutely nothing has changed as far as state hospital accessibility for citizens of Kansas."

Randy Proctor, superintendent of TSH who has overseen closure operations, said the fact that CMHCs have worked with the hospital staff to discharge to the community 25 patients who previously were identified as being in need of further hospitalization after closure is significant. He said this shows that needed supports are being set up in the community.

"This speaks positively to the readiness of the CMHCs for closure," he said.

Proctor also said hospital staff and MHDD administrators have worked hard to make sure staff ratios at TSH during the closure process have been maintained. As closure nears, the hospital plans to further consolidate wards and units.

"We have maintained sufficient staff for safety and to maintain quality services for patients," Proctor said.

Proctor also spoke highly of the way various organization have worked to "wrap" services around hospitalized children so they can return to their homes and communities.