Missouri Department of Mental Health Archives

Nixon proposes appropriation bonds to pay for state mental hospital, lawmaker calls plan ‘unconstitutional’

December 9, 2013 By Mike Lear

Governor Jay Nixon has announced a proposal to pay for construction of a new Fulton State Hospital using appropriation bonds.

Governor Jay Nixon (at podium) announces his proposal for replacing Fulton State Hospital joined by (from left) Behavioral Health Division Director Mark Stringer, Mental Health Department Director Keith Schafer and State Senator Mike Parson (R-Bolivar).

Nixon also announced he would release $11-million that he had withheld in a supplemental budget bill that included a total of $13-million for the purpose of designing a new hospital. The cost to design and build a new mental hospital has been estimated at $211-million dollars. Nixon proposes using a strategic bond issuance to make up the remainder.

The plan will be part of his proposal for the Fiscal Year 2015 budget.

Nixon says legislative support for replacing the current facility at Fulton grew last year as legislators were weighing asking voters to approve up to $1.2-billion in general obligation bonds to address capital needs at state facilities as well colleges and universities throughout Missouri.

He calls the project long overdue and says he wanted to separate it out from that discussion.

“I just don’t want this one to get into the complicated mish-mash of the session,” Nixon says. “It’s just too important a project to be put into the pile of all the projects.”

At least one state lawmaker says he would be a “nay” if the proposal reaches a vote. Representative Chris Kelly (D-Columbia) says issuing bonds without voter approval is unconstitutional.

This arial photo of Fulton State Hospital was taken in 1934, and shows many buildings that are gone including the main building destroyed by fire in the 1950s. (courtesy; Craig C. Chapman of Cx3 Photography)

“What the Governor is proposing is a creature that does not exist in our law,” Kelly says. “It’s been done before and I believe its been done before unconstitutionally … you can find a section of the Constitution that says the state shall borrow only under the following conditions, and the conditions the Governor sets forth are not in there.”

Kelly likens the proposal to deficit spending in Washington D.C.

“It would appear to me as if the Governor’s preparing to be a United States Congressman if he’s willing to borrow like this, because they have more experience with this borrowing than we do in Missouri.”

Nixon says the Metropolitan St. Louis Psychiatric Hospital, the Northwest Missouri Psychiatric Rehabilitation Center, the Bonne Terre Correctional Facility and the Truman State Office Building in Jefferson City are all public projects that were paid for with appropriation bonds.

Nixon says, “I don’t think that legislators and governors over the years have had any trouble doing this when it’s appropriate, and when we’ve done what we’ve done in a bipartisan way over the last fe years which is to lessen the debt load for the state. It is clearly a mechanism that … is appropriate for a project of this magnitude at this time.”

See our earlier story on administrators’ desire to replace Fulton State Hospital

Fulton Behavioral Health Division Director Mark Stringer was supportive of the legislative effort to pay for Fulton with general obligation bonds, but says he’s relieved at the Governor’s proposal because it wouldn’t take the additional time to go in front of voters.

He says the outdated facility lends itself to violence and workplace injuries with issues like poor lines of sight and echoing cooridors that can agitate patients.

“Fulton State Hospital is one of the most dangerous places in Missouri to work,” Stringer says. “I have staff there and patients who are getting injured every day in large part because of the sorry condition of that facility. Anything that we can do to get a new facility as quickly as possible and as safely as possible, I’m in favor of.”

Fulton State Hospital is the oldest operating psychiatric facility west of the Mississippi, having opened in 1851. The oldest building still standing on the site dates back to 1937.

Mental Health Director talks budget withholds, Medicaid expansion

July 8, 2013 By Mike Lear

The Department of Mental Health could take a $68 million hit to its budget if money withheld by Governor Jay Nixon is not released at some point.

Mental Health Department Director Keith Schafer (photo courtesy; Missouri Department of Mental Health)

Director Keith Schafer says $28 million of General Revenue was withheld. That money and the programs it supports draw down federal dollars, which account for the other $40 million. He says that’s how much the Department stands to lose if the legislature votes in September to overturn the Governor’s veto of House Bill 253. If that veto stands, he is hopeful that money will be released.

Of that $28 million, $20 million would go to mental health provider rate increases.

Schafer explains, “Our mental health providers are pretty significantly behind in terms of keeping up with inflation with their rates.”

$2 million was withheld that would go to services for non-Medicaid eligible individuals. Schafer says that includes, “about 500 adults in need of things like alcohol and drug abuse treatment, about 90 kids in need of a whole range of mental health services.”

$4 million was withheld for the Department in the state employee pay plan and $2 million for expenses and equipment.

Schafer says some important money was left in the budget, though. A $10 million increase proposed by the Governor in January remains in place to train professionals how to recognize early warnings signs of mental illness, to train law enforcement in mental health crisis intervention, to increase services at community health centers and to teach families how to care for loved ones with mental illness.

Also supported is a program called Disease Management 3700 that deals with people with serious, persistent mental illness and chronic, serious health conditions that are on the Medicaid rolls.

“What you’ll find is those people cost the state a lot of money and their outcomes are not very strong … we have begun to track them and provide better care coordination for those folks.”

The Governor also withheld $13 million in a supplemental budget bill for capital improvements that would pay for the design of a new State Mental Hospital at Fulton.

Many lawmakers echoed discussions taking place nationally about improving mental health care in light of incidence such as the shootings in Sandy Hook, Connecticut that left 20 children at a school and 8 others dead. Those discussions often focus on a need for earlier diagnosis and treatment of mental illness in young people.

Schafer says that $10 million dollar increase will help, but says the best way for the Department to reach young people earlier will be for Missouri to adopt Medicaid expansion.

“Had the state extended Medicaid to individuals up to 138 percent of the poverty level an awful lot of young people we’re talking about would have become immediately eligible for those services just based on income. We could have intervened much, much quicker and much earlier, so I’m still hopeful that will happen.”

Schafer estimates if Medicaid expansion is adopted in Missouri, at least 50,000 more people could benefit from greater mental health treatment.

“Because the issue is so large, it would be very difficult for the legislature to make a dramatic impact outside of the Medicaid extension program.”

So far, three legislative committees are going to study Medicaid reform and expansion during the legislative interim. Schafer says his Department expects to be very engaged in the work of those committees, beginning this afternoon when the Senate Interim Committee on Medicaid Transformation and Reform meets.

Administrators’ pitch: $211 million from bonds to improve Fulton State Mental Hospital

February 8, 2013 By Mike Lear

Legislators in the state House and Senate and Governor Jay Nixon have all mentioned Fulton State Mental Hospital in listing priorities for proceeds from the proposed issuance of bonds. Now its administrators have explained the Department of Mental Health’s plan for the Hospital to a House budget subcommittee.

The Department of Mental Health proposal calls for the replacement of the Biggs Maximum Security Forensic Center.

The House Appropriations Committee on Health, Mental Health and Social Services toured the Hospital on Thursday. During the tour its members were told the $211 million dollar plan would replace some of the buildings with more modern facilities, keep the state from having to build a new sexual offender treatment facility at Farmington and save the state between $78 million and $85 million in the next decade and $3.2 million annually.

Behavioral Health Division Director Mark Stringer says it would feature the replacement of the 186 bed, maximum security Biggs Forensic Center.

“The proposal is for a new high-security facility here at Fulton State Hospital to be part of the bond strategy.”

The plan includes demolition of the Biggs facility and other, vacant buildings on the Fulton campus. A new 300-bed maximum-security building would go on the site of the current dietary center, and a new dietary center would be built.

Staff pointed out aging facilities in the dietary center that is using equipment that came off of WWII era ships. Another door like this one can’t be opened because the frame will collapse.

It also calls for moving patients out of the intermediate-security Guhleman Forensic Center into the new building. The Guhleman facility would then be used to provide more space to treat a steadily growing number of patients in the Sex Offender Rehabilitation and Treatment Services program.

Administrators say the sex offender program gains 17 to 20 patients a year. Its current building is housing three patients to a room.

Stringer says, “We have to find a place to put those guys, and so if we are not able to vacate [Guhleman Forensic Center] then the state will have to construct what we estimate would be about a $77 million facility.”

The earliest portion of the Biggs facility was built in 1937. Stringer and other administrators and staff walked legislators through the center and pointed out what makes its design outdated and dangerous.

Stringer says an employee working at Biggs for 30 years, statistically, will be injured badly enough to require a trip to an emergency room six times.

“Some of those are life-altering changes from traumatic brain injury, permanent physical injuries … and so they are devastating.”

The Department says workers compensation injuries at the Hospital are more than double that of the Department of Corrections and more than four times state and private industry benchmarks. The cost of Workers Compensation claims at the Hospital have increased fourfold in the last seven years to more than $3.3 million.

Stringer says at least some of the danger is directly a result of the inadequacy of the facility.

Representatives Sue Allen, Tom Flanigan and Jeannie Riddle tour the Fulton State Mental Hospital.

He does not believe improvements at Fulton State Mental Hospital will happen absent a bond issuance to pay for it. When discussion of passing a bond package this year began building, Stringer says he was “ecstatic.”

“One of my dreams in this job would be to see the day when we actually had funding appropriated somehow or generated funding somehow to create a new high-security facility here.”

Even if the Department’s plan becomes part of a bonding proposal, Stringer knows voters would have the final say on that proposal.

He tells Missourians, “Even though we are in Fulton, Missouri, this facility serves people from all over the state … this is where people in … any county in Missouri will come if they simply can not be served anywhere else.” He adds, “We are also keeping this county and all other counties safe because of what we do here, so this is a great investment.”

See our earlier stories on bonding in the 2013 session.

To get the cost of the plan down from $320 million to $211 million, the Department worked to lower the population of Fulton State Mental Hospital between 2009 and 2011. Five short-term treatment wards and two emergency wards in St. Louis and Farmington were closed. Minimum and intermediate security patients were moved to those facilities in St. Louis and Farmington, taking the number of patients in Fulton from 451 patients to 330 today.

The Department says a new facility could save, annually, about $750,000 in energy costs and between $1 million and $1.5 million in staffing costs. It also says the current Hospital’s condition is jeopardizing about $40 million in federal money for Missouri from Medicare and Medicaid.

The Hospital’s administrators hope the $211 million plan will become part of a bonding proposal that would first have to be passed by the legislature before reaching voters. A House Committee took its first testimony this week on the issue. The Senate has yet to begin official work on creating its version.

The bills introduced in both chambers propose issuing $950 million in bonds and says no more than $250 million will be used for construction of state buildings, with $40 million of that required to go to parks and park facilities.

House holds first hearing on proposed bond issuance (AUDIO)

February 6, 2013 By Mike Lear

The Committee that will put together the state House’s version of a bonding proposal has heard its first testimony.

From right, the new House Appropriations Committee on Infrastructure and Job Creation’s Chairman Chris Kelly and Vice-Chairman Lincoln Hough listen to the committee’s first testimony. (Photo courtesy; Tim Bommel, Missouri House Communications.)

The proposal, HJR 14, has been introduced at $950 million dollars and is described as identical to one introduced in the Senate by Senator Kurt Schaefer (R-Columbia). Lawmakers say that figure could change however, either higher or lower.

The measure is sponsored in the House by Speaker Tim Jones (R-Eureka), who says it will change dramatically before it goes before voters.

“This is simply a starting off point. I’m sure this bill will undergo a lot of different changes and revisions throughout the process. We will have to marry it with whatever comes out of the Senate, so I would ask everybody to keep an open mind and be patient as we work through this. This is an extremely critical opportunity for our state but it is one that I think could result in a really bold and bright future for Missourians.”

Mental Health Department a no-show

In talking about possible targets for proceeds from a bond issuance, Jones, Governor Jay Nixon, Committee Chairman Chris Kelly (D-Columbia) and others have all said Fulton State Mental Hospital is likely to be included. Yet at Tuesday’s hearing the agency that oversees that facility, the Department of Mental Health, was not present as scheduled.

Kelly says he is disappointed the Nixon administration did not see fit to discuss the needs at Fulton, but says the no-show doesn’t hurt that hospital’s chances to be a priority.

“We all know the need is there, and it’s ridiculous to think about punishing the mental health patients because the administration doesn’t articulate it.”

Lawmakers will have to come to agreement on how much to spend on Fulton. Some have said a total replacement is needed, while others say that probably won’t happen.

It is estimated that a new mental health facility would cost about $211 million. The current language of the proposal says no more than $250 million will be used for construction of state buildings and $40 million of that must be used for parks and park facilities.

Mixing transportation with other needs

The hearing was held on the same day that a 10-year, one-cent sales/use tax proposal was introduced by Senators Mike Kehoe (R-Jefferson City) and Ryan McKenna (D-Crystal City) and Representative Dave Hinson (R-St. Clair) to support transportation. Kelly hopes the two issues can compliment each other.

“I believe that ultimately we can only have one proposal and I hope we find a way to comfortably combine the highway proposal and the general revenue proposal, and I believe we can do that.”

Jones says the two discussions could become one, but says he would rather see a revenue-neutral option to support transportation. Some transportation projects could also be included in the bond package.

Much of the testimony came from some of the state’s colleges and universities, who told the committee how great their backlog of needs has grown.

University of Missouri System President Tim Wolfe testifies on HJR 14, sponsored by House Speaker Tim Jones (right). (Photo courtesy; Tim Bommel, Missouri House Communications.)

University of Missouri System President Tim Wolfe tells lawmakers, his campuses could use all the $950 million being considered, and more.

“Because we’ve been chosen to invest scarce resources in mission-critical areas like education today we have a $1.3 billion backlog of renovation and repair projects on all four of our campuses.”

Wolfe says state support from the bonding package would encourage donors to the University system to accelerate their investments.

Missouri Parks Association board member Mike Sutherland told the Committee there are about $400 million in capital improvement needs at the state’s parks and historic sites.

Kelly cautioned those at the hearing that no one will get everything they want.

“Every single one of us will be disappointed, but every single one of us will also be delighted. There’s no way that we can do everything that we need to do but we can do some very good things and move our economy forward.”

See our earlier stories on bonding in the 2013 session.

No one testified against the proposal, which Vice-Chairman Lincoln Hough (R-Springfield) says shows there is bi-partisan support across the state for the issuance of bonds. One urged lawmakers to make sure to identify cost savings or a new revenue source to fund the debt service on bonds, to protect other state services like K-12 education, higher education and public safety.

Jones told the committee taxpayers will be protected under the proposal.

“By specifying that the proceeds from the sale of the bond can be only used for projects that meet the criteria of this legislation. Most notably that criteria will first be established by this committee. Additionally the revenue placed in the Fifth State Building Fund, as we’re commonly referring to this bill, can only be used to pay off the principal and interest of the bond.”

He encouraged the committee to investigate a “more official mechanism,” a sort of “taxpayer watchdog,” to watch the projects as they move forward.

As for when the bond proposal might be ready to go to voters, Kelly says he would like to see it done this year but says it’s an “organic” process. Jones says he knows development will take time.

“I am under no delusions that this is going to be an easy process, so I start with the premise that this may be a 2-year project.”

AUDIO: House Speaker Tim Jones presents HJR 14, Missouri Fifth State Bonding Issue, 6:38

AUDIO: University of Missouri System President Tim Wolfe testifies on HJR 14, 6:30

Mental Health Department director explains support for Medicaid expansion

February 1, 2013 By Mike Lear

The Director of the state’s Mental Health Department says there are several ways Missouri can improve mental health care, but says meaningful improvement will be difficult without Medicaid expansion.

Mental Health Department Director Keith Schafer (photo courtesy; Missouri Department of Mental Health)

Keith Schafer says one of the big problems with behavioral health care is that people can’t access his agency’s services without Medicaid eligibility. He says young people with mental illness could take 5 or 6 years to get a disability determination.

He says with expanded eligibility, “It will particularly allow young people 18 to 25, 18 to 30, to reach into our services much more quickly before their situation escalates to the point that it’s extremely expensive and very difficult to resolve.”

Schafer knows more attention is on mental health now, particularly after the shooting at a Connecticut school in December, but he says the mental health field has a long way to go to prevent tragedies.

“The vast majority of people with mental illness … are very vulnerable people who are often taken advantage of, they live in poverty, they struggle mightily with their health. Very small percentages of people with mental illness become dangerous. When they do, we hear about it, obviously.”

He says, “We need to get better, if we can, at detecting what combination of factors cause a young person who’s struggling with mental illness to move into that level of reacting against society … we will never have the ability to fully predict when a person with mental illness or without mental illness becomes violent.”

Schafer emphasizes working more with families of young people with mental health issues through entities like the Missouri chapter of the National Alliance for the Mentally Ill (NAMI).

He also says early intervention funding must be figured out.

“We can not wait until we become a high-end, crisis focused 42-year-old person who has already been through all the crises and has just now become Medicaid eligible. It just doesn’t work that way.”

Some Republican budget makers want to find non-budgetary ways to improve mental health care. Schafer says there are some possibilities, and they begin with public perception.

“The beginning of this process has to address greater understanding on the part of the Missouri public that mental illness can be understood and we can do the right thing when we identify a person who’s having problems. Beyond that, once we create that understanding I think services will come because people then will clamor for those services.”

Schafer says even developing that public perception, however, won’t make mental health care more accessible.

“Let’s suppose I get a lot better with Missouri citizens who are recognizing the need for mental health treatment and actually even talk their loved one into getting treatment but that loved one has no coverage whatsoever. Then the question is, what do we do? We rely almost totally on emergency room services, inpatient services, charity care and none of that is a coordinated, careful approach over time to making sure the individual understands the illness, gets on their medication, stays on their medication.”

Schafer says Republicans raise legitimate issues about accepting federal money to expand Medicaid eligibility.

“I can just tell you from my point of view as the Director of the Department of Mental Health, We need funding streams for young people. We can not wait until they go for years and years until they reach a categorical eligibility and then finally get them in service. If we’re going to make a difference here we’re going to have to reach them earlier.”

Dispelling the myth of the suicide-holidays link

December 27, 2009 By Steve Walsh

It is a common belief that stress and other challenges associated with the holidays bring an increase in suicides and suicide attempts. But that is not really the case. Scott Perkins, Project Director with the Missouri Suicide Prevention Project at the State Department of Mental Health, says it’s a myth.

“There’s a bit of a myth regarding the holidays and suicide,” said Perkins in an interview with the Missourinet. “It turns out, actually, that December usually has the lowest number of completed suicides of any month in most years.” [Read more…]