This commentary originally ran in the Kansas Reflector on June 2, 2022. About the authors: Dr. Tiffany Anderson, superintendent of Topeka USD 501, and Dr. Shannon Portillo, associate dean and professor at the University of Kansas, served as co-chairs of the Governor’s Commission on Racial Equity and Justice; David Jordan, president and CEO of the United Methodist Health Ministry Fund, chaired the subcommittee on healthcare.
The Governor’s Commission on Racial Equity and Justice repeatedly heard from community members, stakeholders, and those working in criminal justice about unmet behavioral health needs and how the lack of access to behavioral health care — both mental health services and substance use treatment — results in law enforcement encounters.
People with behavioral health conditions are three to six times more likely to be represented in the criminal justice system.
Additionally, data show racial disparities in the impacts of behavioral health systems on communities of color. For example, drug use rates are similar across racial and ethnic groups, but Black and Brown communities experience greater problems associated with substance use, such as legal issues, justice system involvement, and social consequences.
The commission examined behavioral health, seeking to understand how to address systemic issues that affect health outcomes, community vitality, crisis response and health care access. Behavioral health recommendations to address racial equity were included in the commission’s final report.
Law enforcement officers end up acting as de facto behavioral health providers. Investments should be made to increase the use of behavioral health trainings for officers to better prepare them to safely de-escalate and resolve emergency mental health situations.
Collaboration between local governments, law enforcement agencies and behavioral health providers can strengthen how law enforcement responds to behavioral health incidents. One successful model is the co-responder program, in which mental health professionals work alongside law enforcement to respond to mental health calls. Virtual models also show promise. This model contributes to positive outcomes and promoting treatment over incarceration for individuals experiencing mental health crises.
To address systemic behavioral health issues, we must invest in early interventions. Behavioral health services should be lifelong and more accessible to all.
Mental health services should target pregnant and new mothers so they can benefit from earlier diagnosis and treatment. We need to screen for and treat prenatal and perinatal depression to improve maternal and child health outcomes.
Kansas should utilize the DC: 0-5 diagnostic manual, which classifies mental health and developmental disorders for children ages 0 to 5 to enhance mental health professionals’ ability to accurately diagnose and treat mental health disorders and facilitate Medicaid reimbursement for appropriate treatments.
Children should be insured so that they can access behavioral health services. Kansas has a growing number of uninsured children. Between 2016 and 2019, the uninsurance rate for kids increased from 4.9% to 5.8%. In 2019, children who were racial and ethnic minorities were 3.6 times more likely to be uninsured than non-Hispanic white children. Implementing continuous coverage for children 0-5 would reduce the number of children who churn off Medicaid for administrative reasons.
Additionally, Medicaid should reimburse for evidence-based interventions such as home-visiting and early literacy programs that build safe, secure, nurturing relationships that improve health, educational and economic opportunities.
We need to ensure children are getting behavioral health services in early learning settings rather than being disciplined, which can have lifelong consequences. According to a Yale University study, preschool students are expelled more than three times as often as K-12 students. Expulsion rates were lower in settings where the preschool teachers had access to classroom-based behavioral consultants. The commission recommends increasing the availability of infant/early childhood mental health consultation services in the state to ensure children receive age-appropriate behavioral health support.
It’s important to improve behavioral health care access across educational settings. Possible initiatives include coordinating with local governments to ensure school-based services are available to the broader community, expanding hours of school behavioral health clinics, ensuring schools become Medicaid providers so they can directly bill and offering services in multiple languages.
Patients of all ages will benefit if behavioral health services are better integrated into our existing health care system and if the state supports the use of technology, such as telehealth or app-based providers, to make behavioral health services accessible
The current Medicaid eligibility limits are too low. Kansas should expand Medicaid, which would increase access to health care services and reduce uncompensated care — lowering costs for everyone. Hospitals and behavioral health treatment centers should automatically help eligible patients enroll in Medicaid upon discharge, increasing Kansans’ access to behavioral health services after release from treatment.
All levels of government can improve data tracking and coordination between systems within behavioral health, such as the criminal justice system. This should include maintaining race and ethnicity data on behavioral health incidents involving parents and young children to inform necessary interventions.
All Kansans would benefit from improved behavioral health services and access. To make these recommendations reality, we must urge our local and state representatives to support these changes that will improve the health of Kansans and address long-standing disparities.
About this series
In June 2020, Gov. Laura Kelly signed Executive Order 20-48, forming the Governor’s Commission on Racial Equity and Justice. The Commission studied issues of racial equity and justice across systems in Kansas, focusing first on policing and law enforcement and then on economic systems, education, and health care. The Commission developed recommendations for state agencies, the Legislature, and local governments. Through the end of 2022, commissioners will dig deeper into the recommendations in a monthly series.