Bert Nash Community Mental Health Center has scheduled two listening sessions for late September, but some clients are sounding off now. They say unfilled medications, a lack of available appointments, and unresponsiveness are keeping them from staying on track with their mental health care.
On a hot morning in late August, Thereska sits on her screened-in porch next to a tiny table that holds two almost-empty prescription bottles. One contains a daily antidepressant and the other a benzodiazepine to be taken as needed for anxiety and panic attacks.
This interview, the Lawrence resident explains, will likely be the one big task she can complete today. Afterward, she’ll take a two-hour nap and spend the rest of the day dealing with the setbacks of chronic pain and fatigue, anxiety, depression, panic attacks and post–traumatic stress. She also struggles with akathisia — a movement disorder that’s been linked to the use of antipsychotic drugs and fluctuating dosages. It can trigger restlessness and an intense need to move. Even suicidal thoughts.
Despite these challenges, she’s cheerful.
“I’ve taken a lot of different medications. They call it treatment-resistant depression,” says Thereska, a pseudonym used on the condition we would not reveal her real name.
Treating treatment-resistant depression can prove challenging; it involves trial and error to find effective medications and therapies. Once a successful care regimen is achieved, consistency is key.
Thereska’s prescriptions from Bert Nash Community Mental Health Center usually contain one or two refills, and she can only make a refill appointment one week before her medications are due to run out. Slots fill up quickly, Thereska says. That leaves her and other clients feeling frustrated, ignored and helpless, and phoning the center “over and over” — sometimes not getting an appointment until two to three weeks later.
“They won’t give me an appointment a couple of weeks out,” she says. “I’m having withdrawal symptoms today because I’m running out of meds, so I decided to split pills until I can get Bert Nash to refill my prescription.”
While self-reducing her medication isn’t ideal, quitting her meds “cold turkey” is even more dangerous, Thereska says. That starts a chain reaction that begins in her digestive system and leads to pain, cramps, loss of appetite, diarrhea, dehydration, brain fog, memory gaps and brain zaps — bothersome electrical shock sensations that can occur after stopping certain medications.
Going off antidepressants abruptly can be very dangerous, especially when it leads to suicidal thoughts. And it has for Thereska.
“It creates a lot of really intense emotional fluctuations. Other folks in town have had fluctuations so intense that it caused them to lose their job or have to go to the E.R.”
Thereska changed her medication management to Bert Nash after leaving Heartland Community Health Center. Both clinics serve the community’s most vulnerable as “safety net” providers, or centers that accept all patients regardless of their ability to pay or their insurance status.
She called Bert Nash’s medication practices “negligent and unethical” and she’s worried someone will get hurt in a situation that’s “completely preventable.”
“I really want them to do better. And I’m just tired of seeing friends and community members thrown into crisis, when all they’re trying to do is maintain their stability by following what their doctor orders,” Thereska says. “I’ve been saving documentation of people’s testimonials on social media because it’s not just me.”
We reached out to Bert Nash with questions about the center’s medication and appointment procedures. Spokesperson Jeff Burkhead responded via email that when a client leaves a session, they receive a call-back date to make their next appointment. When the client phones the center on that date, they’ll receive an appointment within five to seven days. At that point, they should have about a week’s worth of medication left. This protocol is referred to as Right Time Care and the center has utilized it since 2019, Burkhead said.
When the client attends their follow-up appointment, the provider will evaluate whether medication adjustments should be made and how many refills to authorize until the next appointment. Refill amounts are a clinical decision a provider makes, he said, based on the client’s stability and treatment progress and whether they might need a different dosage at the next appointment to achieve a therapeutic level of care.
Federal regulations on controlled substances including benzodiazepines and stimulants (such as medications used to treat attention deficit hyperactivity disorder, among other conditions) limit the number of refills a provider can authorize at a time.
“We recognize clients may forget to call and schedule their appointment or may forget to attend their appointment. We understand the importance of taking medications on a consistent basis, without interruptions,” Burkhead wrote. “So, if a client missed their scheduled appointment, failed to call to schedule their appointment on their call-back date, or if the provider is not available on the day of the client’s appointment, refills can be requested by calling the nurse line and leaving a message with the client’s name and medication requested.”
Thereska and the mother of an adult client with bipolar disorder, however, said they’ve left multiple messages phone messages without a call back. The latter said she reached out to Bert Nash more than a dozen times in December but was unsuccessful in receiving a timely response for refill of their medications. She asked that her family not be identified by name to protect their privacy.
The mother eventually sought help through a primary care physician during the crisis and vowed never to return.
“It’s devastating when you can’t get proper treatment for the person you love struggling with a mental illness,” she said.
In the past, Lawrence resident Chess Fletcher’s work/sleep schedule has made it very difficult for him to call at 8 a.m. on his assigned call-back date.
Several times, he said, he’s called closer to 10 a.m., and by then, all appointments had been taken. That meant he’d have to attempt another call each subsequent morning until he could find an open slot. Not only does that unpredictable process cause his anxiety to spike, it also increases the likelihood he’ll run out of medication.
Wait times
The first step for new Bert Nash clients is registration. The second step is an intake evaluation. On average, the time between those first two steps is six business days. As of Monday, Sept. 12, 76 community members were on step one or two.
After new clients complete the evaluation — and how long that takes can vary, depending on the client’s schedule — they move on to one of four services: Adult Outpatient Therapy; Children and Family Services; Dialectical Behavior Therapy; or Medication Evaluation. But the waiting period between evaluation and first appointment can be lengthy, and most clients will have long lines ahead of them.
Clients awaiting medication evaluations number highest on the list and average the longest wait time. From registration to first appointment for psychiatric care, a new client should expect to wait no less than one month for an appointment to manage their medications.
When asked about the center’s staffing vacancies, Burkhead said 301 team members are employed between Bert Nash and the Treatment and Recovery Center. There are 31 open positions, including one in medical services.
When providers leave or become unavailable for extended periods of time, every attempt is made to shift caseloads to the other providers. He said that’s “increasingly difficult because every provider has a full caseload with minimal capacity to add more.”
“But our system, like virtually all of the healthcare industry, is overwhelmed and the demand for services has never been higher due in large part to the pandemic.”
Changes afoot
Like Thereska, Fletcher sometimes reduces dosage to make his medication last longer. When that happens, he, too, deals with bothersome side effects — including nausea and brain zaps.
“It’s like my brain needs a reset. I have to stop and think about what I was doing and start over.”
Fletcher said he’d like to see Bert Nash offer an electronic option for clients to communicate with staff.
That relief could be on the way — but not until next year. Burkhead said the center had begun implementation of a new electronic health record system scheduled to go live in May 2023.
“We anticipate this system will significantly improve the client experience and ability to interact with their provider through a client portal,” Burkhead said.
Fletcher said despite all the problems he’s encountered making appointments and obtaining medications, he’s stayed with Bert Nash largely due to the help he’s received from his case manager. He called the added level of care “a game changer.” His case manager has helped provide wraparound services, such as housing and utility resources, that have improved his quality of life.
“If a client who has a case manager is having difficulty scheduling an appointment or obtaining medication refills, the case manager can help by contacting the scheduling line and the nurse line, respectively,” Burkhead said.
Although not all clients qualify for a case manager, they can access the services of care navigators. They’re part of a new approach to care within the Certified Community Behavioral Health Clinic (CCBHC) model. Care navigators help identify the needs of a client, connect them with the services they need, and track their progress through the system.
How to share feedback
Thereska shared copies of separate complaints she made earlier this summer to Bert Nash and the Kansas Department for Aging and Disability Services, the state agency that oversees behavioral health clinics. She insisted her intentions were not “to destroy them” but to help improve services, especially in light of Douglas County’s commitment to expand care for those with serious mental illness and substance use disorders through the Treatment and Recovery Center.
“I think they clearly need to do some tweaks because people are being forced off their meds again and again. Other mental health places I’ve gone in the past, that wasn’t an issue. They were really on top of that because they understood the danger.”
Community members have an opportunity to offer their own feedback on Bert Nash during two listening sessions on Sept. 29. Find out how to register and learn more about the in-person and Zoom sessions here. An annual client and family survey was also distributed Sept. 6 to solicit feedback about program-specific services.
Burkhead said the center has a long-standing policy “for clients, their family members, or any community member to communicate a complaint/grievance, in person, in written format, via email, or by phone to the BNC Risk Manager.”
Client complaint forms are available in clinic lobbies and residential homes or can be sent via email upon request, he said. Complaints are addressed based on the type of complaint, client needs and treatment recommendations. The center also accepts feedback via email at feedback@bertnash.org.
In response to questions about the status of complaints involving Bert Nash, Cara Sloan, spokesperson for Kansas Department for Aging and Disability Services, declined to provide an update.
“We cannot comment on the status of ongoing complaints registered to our staff,” Sloan said in an email. She said complaints regarding Community Mental Health Centers and Certified Community Behavioral Health Clinics can be directed to Stephanie Simpson, behavioral health licensing director, at stephanie.simpson@ks.gov.
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Tricia Masenthin (she/her), equity reporter, can be reached at tmasenthin (at) lawrencekstimes (dot) com. Read more of her work for the Times here. Check out her staff bio here.
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