Capitol Comments Articles
Special Committee on Mental Health Beds Meets

Pediatric Mental Health (Oct. 27, 2022) – Today, the Special Committee on Mental Health Beds, chaired by Senator Carolyn McGinn (R-Sedgwick), discussed workforce needs. The committee heard from the following:

Higher Education Conferees:
Akinlolu Ojo, MD., executive dean, the University of Kansas School of Medicine, reported on the pathway to becoming a mental health MD provider. He described the pathway and years of training available through the medical school four-year program, the four-year psychiatry resident and the one-to-two-year post-resident fellowships. He discussed state and national trends in training psychiatrists and the increasing interest in post-resident fellowships. He suggested Medicare rates for residency programs have not increased, highlighted that hospitals supplement those gaps in funding and emphasized that a limitation has been funding for the first two years of the residency training program. He suggested the approval of combined medicine-psychiatry residency for Kansas medical student loan eligibility and mentioned potential increases in medical school classes with the proposed KU-Wichita State University Health Sciences Center in Wichita. Finally, he suggested a comprehensive Kansas physician health care workforce study is needed.

Scott Sponholtz, director of student financial aid, KU Medical Center Psychiatry Program and Workforce, highlighted the number of loans and living stipends granted over the last several years. However, he explained the loans do not pay for exams, books or supplies.

Joyce Grayson, director of Rural Health and Education Services, KU Medical Center Psychiatry Program and Workforce, discussed what they are hearing from an employer perspective in rural Kansas. She highlighted we have employers that want psychiatry services but said there is a lack of candidates, partially due to a lack of community mental health infrastructure.

The committee also heard from Blake Flanders, president and chief executive officer, State Board of Regents. He highlighted the changes in overall enrollment in colleges, technical colleges and community colleges. Flanders gave an overview of student enrollment in health care professional certificates, bachelor's degrees, and psychology and social work. He shared pass rates for each program for nursing and mentioned it is more expensive to hire nursing faculty than other faculty. Flanders suggested scholarships for nurse educators and the addition of marketing funds for this program. He highlighted the nursing service scholarship program and mentioned the legislature could remove the requirement for a student to locate a sponsor or make it optional for those employers wanting to participate and could increase appropriations related to the program. Finally, Flanders suggested the Board of Regents work with the Kansas State Board of Nursing to look at regulatory needs in today's environment.

Heather Morgan, Kansas Association of Community College Trustees, shared with the committee what they see at the community college level. She indicated they are seeing an increase in those needing to take remedial classes before starting courses. She stressed finding nursing faculty is challenging and institutions have a difficult time keeping up with the market rates for clinical instructors. She recommended expanding the PROMISE Act to those students coming from out of state and suggested the program doesn't always bridge to the higher level four-year colleges. She reported the Association of Mental Health Centers is partnering with KCCA to discuss pathways for social workers and other behavioral health workers.

Steve Kearney, Kansas Association for Career and Technical Education, testified on behalf of the technical colleges. He emphasized the focus on providing technical skills needed by the industry. He highlighted a two-year curriculum from Southwest Virginia Community College. He testified those students graduate and stay in Kansas more than 80 percent of the time. Technical colleges work with employers to establish specialized curriculum and it differs from the Board of Regents process for coursework approval. More agile processes can provide quick solutions for employers.

Mental Health Center Conferees:
Robbin Cole, executive director, Pawnee Mental Health Services, testified they are working with Fort Riley and the Manhattan Chamber of Commerce to recruit mental health providers. She indicated that currently, it takes an average of 54.8 days to fill a position. There is an emphasis from employees on providing services solely virtually. In addition, she indicated the difficulty in hiring for overnight shifts and discussed some ways they partner to recruit and retain from the student community.

Julie Kramp, executive director, the Center for Counseling and Consultation, highlighted competitive wages between other providers and organizations hiring psychiatrists. She shared that a local school district has recently had to go from two school counselors to six and discussed further competition with state hospitals and travel agencies.

Walt Hill, executive director of High Plains Mental Health Center, highlighted that certified community behavioral health clinic funding has been helpful but will not solve all the challenges. He is concerned about state hospital waiting lists and the impacts on communities and law enforcement. He discussed the robust services they offer in telehealth and shared research on their patients who have suggested that one-third wanted telemedicine only, one-third wanted no telemedicine and one-third wanted a hybrid model. He also highlighted the benefit of telehealth to the farming community and suggested current loan repayment programs have not been accessed as robustly as possible. He highlighted licensure delays in both the Kansas State Board of Healing Arts and Kansas Behavioral Sciences Regulatory Board and the credentialing process. He suggested the payers come before them to testify about how they can assist in solving this problem.

Association Conferees:
Kelly Sommers, executive director of the Kansas State Nurses Association, stressed to the committee that nurses must be brought to the table to solve these challenges. She highlighted APRNs could be a solution to psychiatry problems. She stated getting orders can be a hurdle when the psychiatrists can be so limited. Sommers highlighted former programs for rural nurses to be able to pay off student loans and cautioned against decreasing rules and regulations and looking at non-licensed positions. She expressed concern that the hospitals were using RNs as security and described current challenges in cultures for nurses. The conferee reviewed with the committee various levels of nursing staff. She explained there is a lack of specific education for mental health nurses.

Agency Conferees:
Andy Brown, the commissioner of behavioral health services for the Kansas Department for Aging and Disability Services, appeared to discuss the Crisis Intervention Center regulations that have been being worked on for the last four years. He testified the regulations had been sent back from the attorney general's office with recommendations. It will likely take six months or longer before it goes through the final process.

Other conferees discussing the privatization of hospitals:
Bob Quam, a retired hospital administrator from the state of Florida who worked for public and private hospitals, appeared to share his experience. He mentioned union hesitation transitioning from the public to the private sector and shared that bumping rights in state positions was a significant source of frustration. He suggested a one-to-two-year window so employees who don't want to go private can make retirement-based choices. The conferee said one priority is ensuring a well-qualified administrator and leadership team are in place. He highlighted security and staff safety concerns, as well as vacancies and burnout. He suggested that proximity to urban areas is critical for workforce recruitment, allows for sharing of best practices with other hospitals and can ease patient transfer concerns.

Amy Campbell, Kansas Mental Health Coalition, appeared by video to support adding capacity to the state hospital system. They believe this increases innovation capacity and assists existing state hospitals. She thanked the Legislature, agencies and the governor for their support in helping with the continuum of care for mental health in Kansas. Her members have expressed hesitation about workforce concerns in the South-Central region. The Hays youth beds were highlighted as a positive work product of policymakers coming together to address a need. Campbell requested additional investments in programs such as State Institution Alternatives beds. She expressed opposition to previous privatization attempts of existing state hospitals and testified it is a private contract to ensure very active contractual controls to ensure the quality of care.

The committee members held a general discussion on the mental health workforce pipeline. The chair opened the discussion by expressing a need to build a mentorship program to address the pipeline issue and highlighted a program offered through Johnson County Community College. Chair McGinn also discussed training program needs and emphasized a desire to establish a scholarship program and the need for more marketing in this critical area of need. Committee members also expressed a desire to right-size other state hospitals in places like Larned. They also expressed a desire for any new hospital to be able to be expanded that can be should additional needs arise.

The committee will meet again on Nov. 28, possibly for its last meeting.