In a year of turmoil, mental health center finds financial stability, but state questions remain

Not quite one year ago, the agency that provides mental health services for some of Johnson County’s neediest residents was in turmoil. Revenues were so low, the Johnson County Mental Health Center needed an emergency cash infusion to end the year with a positive balance. The executive director had been placed on administrative leave. And clients were worried about cuts in services, particularly to vocational and teen substance abuse programs.

This year the outlook is more hopeful. Although the center is far from out of the woods, it now appears there will be no need for more emergency spending. The center is expected to end the year with a reserve of $878,000. And there is no more talk about closing the Adolescent Center for Treatment in Olathe, a facility that helps teens recover from alcohol and drug addiction.

It’s been a sometimes controversial path, filled with uncertainties about what will happen at the state level.

But Tim DeWeese, the newly named executive director of the center, said he is encouraged by improvements in finances and staff morale and hopes to be able to bring the center back to its former status as a statewide leader in treatment for behavior disorders.

The mental health center needed a half million dollars at the end of last year to be able to make its payroll and close out 2013 in the black. At the time, the county commission left the door open for another bailout, if necessary, at the end of this year. Instead, the fund balance will equal about 3 percent of the center’s annual budget of $28.4 million, DeWeese said. Considering how the year started out, he said, “I’d say that’s really, really good.”

That balance is only a small part of what is considered healthy for the county agency, though. Ideally, the center should have a reserve equal to 8 to 12 percent of its annual budget, he said. DeWeese doesn’t expect that level to be reached for at least a couple of years.

Besides demonstrating financial health, the reserve also provides a cushion for unexpected revenue losses, he said.

This year is the first year since 2006 that the state has not cut the amount it spends on the mental health center, he said. But there’s no guarantee they won’t cut again next year, he said.

“I don’t think the hard times in regard to finances are completely through,” said DeWeese.

The mental health center’s predicament last year was so serious that the county manager’s office asked for a review of its operations from the Association of Community Mental Health Centers of Kansas. That group listed numerous shortcomings and made recommendations for fixing them.

Shortly after, the county commission disbanded the mental health governing board and took over its duties — a move that was controversial among some who believed the commission did not have that authority. However a lawsuit over the move was later dismissed.

In the interim, the county manager’s office supervised the center, the commission appointed a new advisory board and eventually named DeWeese the new director to replace Maureen Womack, who had resigned.

DeWeese has worked for the center for 18 years, most recently as director of clinical services. He’s been executive director for three weeks.

News of the center’s financial problems had some clients on edge a year ago, DeWeese said. The center’s previous leadership had floated the idea of closing or cutting back on the substance abuse center as well as programs that line up the mentally ill with jobs and provide transportation for them, he said. The result was a loss of trust from some parents and from clinicians that provide referrals to the center, he said.

“It took some time to settle the providers as well as the parents and referral source that we’re going to be around for the long term,” he said.

But in general, he said the center staff worked hard to make sure the clients didn’t feel a direct impact from the center’s financial difficulties.

There have been some improvements in the past year. DeWeese said the staff had input into new, clearer guidelines on billing insurers. That has resulted in more money collected and better morale for the center’s employees, he said.

This year the center also began “open access,” which is a way of assessing and referring new patients more quickly, and so far it has been working well, he said.

But there are also challenges. DeWeese said he is concerned about providing services to the uninsured or underinsured people who do not meet Medicaid guidelines. Currently a person has to have a disability and make less than the federal poverty level to be eligible for Medicaid to pay for mental health services. The poverty level for 2014 is $11,670 for a single person or $23,850 for a family of four.

Getting the client into some type of employment is a key goal of treatment, DeWeese said, because working helps them get better. “There’s so much about employment that lifts a person’s spirit,” he said.

The problem is, once the client begins earning, often in a part-time job, he or she may exceed the Medicaid limit and have no money left to pay for treatment. About 83 percent of the

center’s clients have an annual income of less than $30,000.

The center also faces uncertainty about what kind of state grants to expect. The state has made $1.2 million worth of cuts to the center’s budget since 2006. This year was the first year there were no cuts, he said, but there’s no guarantee that will happen again.

And then there’s the matter of staffing. Clinicians and case workers are the ones who do the billing and bring in the revenue, but the center has lost a significant number of those workers. Before DeWeese took over, the equivalent of 78 full-time positions were permanently cut from the center workforce.

There won’t be a rehiring spree, at least until the center is on more solid financial footing, DeWeese said. “I don’t feel comfortable with our financial position yet to be asking for new positions,” he said.

However DeWeese is hopeful about a better future ahead for the center. “My vision is to assure the mental health center’s financial stability and re-establish (it) as the leader in Kansas in providing state-of-the-art mental health services,” he said. “We are not there yet, but we used to be.”

“People in need of any type of services should be able to contact us and we would provide either a referral or identify and access the appropriate level of care,” he said.

“If their first place to start is to call the mental health center, then I will be really pleased,” he said.

This story was originally published October 21, 2014 at 5:11 PM with the headline "In a year of turmoil, mental health center finds financial stability, but state questions remain."