On Oct. 31, 1963, President John F. Kennedy signed the Community Mental Health Act, setting the foundation for cities like Topeka to meet the needs of their vulnerable populations and calling for a “bold new approach” to mental health treatment.
In Shawnee County, the task was taken on by the Shawnee Community Mental Health Center, established in 1966, but with operations in place in 1967, said Bill Persinger, who leads the most recent incarnation of that original organization, Valeo Behavioral Health Services.
Valeo celebrates its 50th birthday this year, growing and morphing in a challenging industry. Kennedy’s bold look to the future launched a national movement to take mental health care out of institutions and put services in the community, and it was reflective of what happened in Topeka.
It is a history Persinger, who has spent decades transversing the mental health field, knows well.
“We figured out in the ’50s and ’60s that there were medications, some of which were invented during or after the second World War, that would help modify or almost erase some of the worst symptoms of mental illness,” he said. “So people started getting medications that helped them function better and they didn’t need to live in hospitals anymore. They came back home. Well, what did they come back home to? There needed to be a safety net.”
Kansas ended up with 26 mental health centers, each with a territory of coverage and set by law, Persinger said.
Initially, those centers were funded 60 percent to 80 percent by counties, he said, with relatively little money coming from the federal government — although, as the owner of the Medicaid system, the feds now drive the community mental health system.
Donations, state grants, federal grants and fees for services made up what the counties didn’t. Today, and for about 20 years, Valeo receives about 8 percent to 11 percent of its budget from county dollars. Still, Persinger is quick to give thanks. The dollars from Shawnee County, which increased by $200,000 this year and $100,000 last year, help him to pay bills.
“They’re the fixture around which mental health centers are based,” he said. “They are our oldest and most loyal funder. County funding now, statewide, makes up about 10 percent of community mental health center funding, but it’s been the most steady, reliable, useful source of funding that we’ve ever had.”
One challenge Valeo faces today is many grants and funds are targeted for specific services, and it’s the county money that allows Valeo to pay its light bill and offers a foundational revenue stream, Persinger said.
About 60 percent of Valeo’s revenue comes from Medicaid, which he said “really drives the system, for good or bad.”
Those revenue changes have impacted mental health care in multiple ways. From a provider-driven system — “where you go to the doctor, the doctor tells you what to do and you do it” — the mental health community shifted to a consumer-driven system, Persinger said.
The consumer movement stirred about the same time state mental health hospitals were downsizing nationwide. Then, in the late 1990s or early 2000s, a payer-driven system emerged.
Valeo currently is engaged in a pilot program with Medicaid companies, utilizing an incentive-based way of operating. Incentives could be dollars, but they could also be a reduction in paperwork, Persinger said. Right now, a therapist working full-time, or 2,080 hours a year, produces revenue for about 900 of those hours.
Finding a way to more effectively manage the paperwork burden, maybe moving toward letting organizations handle their own managed care decisions internally, would be an “evolution,” Persinger said.
Mental health care will continue to evolve, as will the system that supports it. Donna Parks, who started at Shawnee Community Mental Health Center in 1982, is still surprised to see the organization’s growth to 29 programs and nearly 350 employees.
Initially hired for crisis services and working out of a “tiny” room at Stormont Vail Health, Parks moved to psychotherapy and is today the program manager of the outpatient psychotherapy service.
“The reason I stayed at Valeo is, throughout all those years, there was always a passion and commitment on the part of the staff here — that is not something you find every place,” she said.
Parks can quickly list the programs that keep Valeo connected with the community, fulfilling the mission Kennedy set out. A co-responder program puts clinical staff in police cars to reach out to the mentally ill who may become involved with law enforcement; the Navigator program reaches out to young people aged 15 and up who may be having their first psychotic break and getting a diagnosis with a major mental health disorder.
The addition of primary care health services, a dental clinic and an on-site pharmacy are pushing Valeo forward in its goal to treat people more holistically, Parks said. Both Persinger and Parks said they’d like to have the ability to gather more data, and use it to determine program effectiveness and community needs.
Eunice Ruttinger, former Valeo CEO from 1986 to 1999, retired from the mental health service industry about two years ago.
During her Valeo tenure, she expanded the organization’s facility footprint, offering accountability and accessibility for consumers.
Community mental health needs still are significant, she said.
Addiction services and mental health services need to be more fully integrated, she said, a process that started during her Valeo years. Ruttinger predicted more partnering between the legal system and the mental health system in the future, which may address problems with crowded jails.
She’s also concerned about the availability of inpatient mental health treatment settings and said Kansas is in “pretty dire straits” right now. Those types of challenges also strain community mental health systems.
“We still need to help people undertand how prevalent mental health issues are, and how lay people can be very supportive and helpful,” she said. “The average time it takes for people to be open to getting help is 10 years after they’ve been first diagnosed. About 41 percent of people who have a mental illness do not receive a treatment.”
The work Valeo does in the community is invaluable, said Amy Kincade, vice president for population health at Stormont Vail.
“When we talk about population health, and how we need to improve the overall quality of care and really impact health outcomes, while we continue to manage costs for a defined group of people, mental health as part of the safety net in our community is essential,” she said.
Community mental health services are an important part of how a community cares for its people, Kincade said.
“It’s a big piece of our safety net and it’s a big piece in empowering people in learning again how to provide self care,” she said. “Without it, they’re going to end up in our hospitals and in our jails, and really high-cost settings.”