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Kansas Prepares to Take on Decarceration

October 31, 2019
Ron Manderscheid
By Ron Manderscheid, Executive Director, NACBHDD and NARMH
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

On Wednesday, the Association of Community Mental Health Centers of Kansas (ACMHCK) partnered with the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD) to host a Community Crisis Services Summit at Valeo Behavioral Health Care in Topeka, Kansas. The purpose of this first-ever event was to explore ways in which the state can respond more effectively to the growing problem of incarceration of persons with mental health and substance use conditions in county and city jails.

In many Kansas jails, estimates range as high as 70-75% of detainees with a substance use condition, and as high as 30-35% with a mental health condition. Development of an opportunity for better care in the community could divert many of these detainees, thus freeing up law enforcement for other needed activities. As elsewhere in the United States, this problem has grown from a very small issue two decades ago, to a huge problem today.

The Summit was opened enthusiastically by Kansas Gov. Laura Kelly, who stated her strong support for identifying ways to deliver better community crisis services so that peers can be served there rather than in county and city jails. She emphasized that this effort will require new services, and it will require Medicaid coverage to pay for these services.

Leon Evans, an expert consultant on decarceration and community re-engagement, described important work that he has done at the state and county levels in Texas to address this problem. His very successful program in San Antonio is well-known nationally.

Evans was followed by a very interesting series of panels and presentations designed to sharpen understanding of current efforts in Kansas and needed next steps. The first discussed county decarceration efforts today. Subsequent discussions focused on a range of related efforts—at the national level; by Kansas behavioral health centers; by the Kansas legislature; and by Kansas state agencies and associations.

Over the course of the day, attendees moved toward consensus on two key actions: Undertake Medicaid Expansion in Kansas and develop a set of regional crisis centers that could both divert and serve persons with behavioral health conditions who are at risk of incarceration. Next steps will involve clear operational specification of each of these steps and close work with the governor and state legislators.

A consensus has been developing nationally that crisis response centers are a cost-effective mechanism to promote decarceration of persons with behavioral health conditions. With recent changes in the Institution for Mental Disease (IMD) provisions of Medicaid law and regulation, Medicaid has become an appropriate mechanism for funding these services.

NACBHDD has been undertaking a special decarceration initiative for the past four years. After developing essential information through focus groups, NACBHDD undertook national technical assistance, followed by a pilot project that included four counties from Kansas. The current work with Kansas involves building partnerships between county and state entities.

Our hats are off to ACMHCK executive director Kyle Kessler and program director Michelle Ponce for organizing and undertaking this watershed summit. We also look forward to the next steps by the state of Kansas, related state organizations, and the behavioral health community to turn these recommendations into reality for all Kansans.

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