Improving Behavioral Health in Douglas County
The term “behavioral health” refers to the prevention and treatment of mental illness, suicide, substance use disorders and other addictions.
On the surface, Douglas County might not appear vulnerable to serious behavioral health risks. The population is predominantly young and educated compared to the rest of the country. The median age of residents is 30. About 95% of the total population 25 and older has graduated high school, and a substantive portion have college degrees or higher. When looking deeper, however, a number of critical factors create conditions that increase behavioral health risks. Douglas County is home to many populations who experience discrimination and health disparities. The county has a low median income and is characterized by extreme income inequality, with an inequality index of 5.2 (significantly higher than Kansas’ index of 3.7 and the U.S. index of 4.4). Median housing costs in Douglas County are higher than the state average and about 50% of the housing in Douglas County is renter occupied. There is also a sizable homeless population, which grew 20% (296 individuals) from 2013 to 2015. With a rise in inequity both nationally and locally, individuals with mental illness are more likely to be in poverty and lack quality health care. The confluence of these factors creates significant challenges for addressing mental illness and substance abuse disorders.
Nearly 1 in 4 Number of Douglas County residents diagnosed with a depressive disorder
#2 Rank of suicide as one of the leading causes of death for Douglas County residents ages 18-44
About 7.7% Percentage of Douglas County residents who meet the criteria for being heavy drinkers
14 Age by which one-half of all lifetime mental illnesses begin
About 3,900 The number of visits in LMH Health’s Emergency Department that involved a behavioral health issue in 2017
224 Average number of monthly calls from Douglas County residents to the local suicide prevention hotline
0 Amount of Medicaid expansion in Kansas, leaving thousands in our county with severely reduced access to mental health treatment and substance abuse services
Understanding the Needs
Substance abuse is the most preventable underlying cause of disease and death in Kansas.1
Millions of people around the United States struggle with substance abuse. A state report summary from the Kansas Department of Health and Environment reports that between 2005-2009, total drug poisoning deaths increased by 16% in the state. The Behavioral Risk Factor Surveillance System data for Douglas County suggest about 7.7% of residents meet definitions for being “heavy drinkers.” Of people age 18-25 years-old in the state, 20.7% meet the criteria for alcohol dependence or abuse. A 2016 study of Kansas’ youth reveals that drug overdose and death rates have quadrupled in the state over the past 12 years. In Douglas County, evidence suggests substance abuse may be an increasing issue. Despite low mortality attributable to illicit use, some data suggest that 9.1% of Kansas youth aged 12-17 reported having used illicit drugs during the prior month.2 Over a three-month period in 2017 (July to September 2017), 17,736 prescriptions for opioids were provided to Douglas County residents.3 Additionally, findings from the Community Health Assessment (2017) reveal growing evidence of opioid use and overdose. In order to effectively improve behavioral health, understanding substance abuse and suicide in our state is important.
Serious mental illness is a serious problem.
The percentage of people who report diagnosis of depressive disorder in Douglas County is 23.2%. The percentage of adults (age 18 and older) in Kansas who have been diagnosed with a serious mental illness (SMI) is 4.1%. For young adults (ages 18-25), it is 5.0%. A younger population in Douglas County highlights the importance of addressing behavioral health, as younger adults face a higher incidence of mental health issues in Kansas. Using these data, estimates suggest 3,868 adults in Douglas County may have a SMI. Considering 5% of 18 to 25-year-olds have serious mental illness, this may affect about 1,425 Douglas County residents ages 18-25. In addition, according to a report prepared for Douglas County in 2015, 18% of Douglas County jail bookings included individuals with serious mental illness. There are significant racial and ethnic disparities, as well as longer lengths of stay for those with serious mental illness.
Suicide affects survivors, their families and the community.
Mental health issues are a key component of factors contributing to suicide. According to the Centers for Disease Control and Prevention, more than 45,000 people in the U.S. died by suicide in 2016. In Douglas County, the age-adjusted mortality rate is 16.3 per 100,000 population—higher than the Healthy People 2020 goal of 10.2 suicide deaths per 100,000 population.4 The highest percentage of suicide deaths are found in individuals ages 25-64. Also, suicide is the second leading cause of death for 18-44 year olds in Douglas County. African Americans have the lowest suicide rate, while Hispanics have the second lowest rate in the state. The exception to that is children; there is a higher suicide rate among African American children under the age of 12 compared to white children. In addition to rates of completed suicides, data suggest 3.9% of adults age 18 or older have had serious thoughts of suicide in the previous year.5
1 Kansas Substance Abuse Epidemiological Indicators Profile
2 SAMHSA, Center for Behavioral Health Statistics, 2015
3 Kansas Department of Health and Environment, 2017
4 Oakley and Crawford, 2017
5 SAMHSA, Center for Behavioral Health Statistics and Quality, 2015
Rising to the Challenge
Rising to the Challenge
A quarter of a cent goes a long way.
The quarter-cent sales tax that was approved by voters in November 2018 is estimated to generate $4.9 million annually. That money will help finance safe and secure housing for people suffering with mental illness and substance use disorders—as well as expanded recovery services and prevention programs.
Did You Know
Between 25 and 30% of sales tax revenue comes from outside our county by way of visitors, tourism, and KU students.
Integrate Crisis Stabilization and Supportive Housing on a Recovery Campus
detox and substance
care staffed by
adjacent to the
crisis center and at
DCCCA First Step
Expanded Intervention, Recovery, and Prevention Strategies
include schools in
crisis summit in
program in the Douglas County Schools from the Bert Nash Community Mental Health Center
An Integrated System of Care
Douglas County Recovery Campus (to be located on W. 2nd St. between Maine and Illinois Streets)
Did You Know
The most basic of needs, like affordable and safe housing, are often key to someone’s recovery.
Working Together to Find The Right Solutions
to Find the Right Solutions
A coalition for prevention, intervention and recovery.
The Behavioral Health Leadership Coalition is composed of community leaders and subject matter experts from nine Douglas County agencies. The Coalition is collaborating with the Douglas County Commission to implement an expanded behavioral health system focused on the needs of individuals with mental illness and substance use disorders. Working together they have created a plan to build an integrated system of care that moves from crisis and illness as a norm to recovery and prevention as a practice. The result is a proposed recovery campus and expanded network of recovery services and prevention programs.
Timeline of Milestones
- Douglas County, Behavioral Health Leadership Coalition Partners, and CXNS Health Solutions recommend forming an independent nonprofit to operate the Crisis Recovery Center through a joint partnership.
- LMH Health and Bert Nash Community Mental Health Center agree to collaborate and propose a shared governance structure for the Crisis Recovery Center.
- SMART Recovery expands to offer seven meetings per week in Douglas County (sites include Lawrence Public Library, Bert Nash, Mirror Inc., KU, Douglas County Correctional Facility)
- A review of 2019 psychiatry and med appointment data at Bert Nash and Heartland CHC shows that Douglas County’s investment in new providers coupled with modified treatment policies and scheduling practices at Bert Nash and Heartland have led to a significant increase in the number of new patients, the overall number of patients served, and the number of patient encounters.
- For the first time since 2014, all four Douglas County school districts participate in the Kansas Communities That Care (KCTC) survey. Students in grades 6, 8, 10, and 12 are surveyed.
- Engage Douglas County sponsors Good Behavior Game training for Douglas County school districts and community partners.
- Douglas County Criminal Justice Coordinating Council and Behavioral Health Leadership Coalition form a joint workgroup to develop a plan to expand Mobile Crisis Response and bring a 24/7 Integrated Crisis Line/Call Center online.
- Baldwin School District launches Good Behavior Game pilot.
- Engage Douglas County forms a Youth Prevention Board.
- Douglas County, Bert Nash and United Way co-sponsor Alive and Well Trauma Awareness training to create a 32-member training team in Douglas County.
- Douglas County Criminal Justice Coordinating Council establishes a Mobile Response work group to explore potential models for expanding mobile crisis response in Douglas County.
- Douglas County is selected as a national finalist for the Robert Wood Johnson Culture of Health Priz
- LMH and Bert Nash present a draft pro forma to the BHLC for the operation of the Crisis Recovery Center.
- Integrated Crisis Team outlines proposal to expand ICT and pilot mobile response in 2020/2021.
- Lawrence Douglas County Public Health agrees to coordinate and compile the annual Douglas County Behavioral Health Report beginning in 2020.
- In the wake of COVID-19 pandemic and closure of Lawrence Public Library, Library Peer Fellows pivot to offer virtual peer support via Zoom or phone.
- SMART Recovery moves to an online format. SMARTLine phone pilot is launched.
- Greenbush releases 2020 KCTC Survey Data.
- Douglas County Peer Fellows Program completes its first year. Second cohort expands beyond the LMH Emergency Department to provide peer support at the Lawrence Public Library and Lawrence-Douglas County Housing Authority.
- Qualitative study by Lawrence-Douglas County Public Health shows the Integrated Crisis Team and related pilot projects are having a positive impact in promoting understanding and shifting staff attitudes toward behavioral health patients in crisis. Study highlights opportunities to improve education and communication between the ED staff and the Integrated Crisis Team.
- Douglas County is included in State of Kansas 2020-2021 budget with $750,000 to support capital costs for the Crisis Recovery Center.
- Psychiatric Infrastructure workgroup develops a draft job description for the medical director position at the Crisis Recovery Center.
- DCCCA and Kansas Suicide Prevention Headquarters certify two Sources of Strength trainers to support implementation of Sources of Strength in Douglas County secondary schools.
- Heartland RADAC joins the Peer Fellows Program as a host site. Two peer fellows are hired to support the Intensive Care Coordination team.
- Intensive Care Coordination team expands to four providers.
- DCCCA hosts second annual Behavioral Health Summit in a two-week virtual format.
- Eudora High School agrees to implement Sources of Strength in 2020/2021.
- Lawrence-Douglas County Public Health engages KU’s Cofrin Logan Center to create a shared data repository for BHLC partners.
- Douglas County Commission endorses Behavioral Health Partners’ governance structure and bylaws. BOCC agrees to appoint three members to the nine-member BHP Board of Directors.
- Douglas County hosts the first Zero Suicide Academy in the state of Kansas. Sedgwick County Suicide Prevention Coalition joins 15 Douglas County health care agency teams.
- Peer Fellows Hosts expand to include KU Med Department of Family Medicine and Community Health.
- Douglas County breaks ground on the Crisis Recovery Center.
- County Commission approves the expansion of the Integrated Crisis Team (ICT) in 2021. ICT expansion will: expand Bert Nash Access Center hours M-F until 8 p.m., expand Behavioral Health Crisis Clinician coverage 24/7, embed SUD peer support eight hours per day, seven days per week, provide additional support from Douglas County peer fellows 45 hours per week, and support Mobile Response pilot.
- Construction completed on Transitions and The Cottages at the Treatment and Recovery Campus of Douglas County.
- DCCCA’s Social Detox project expands scope with goal of increasing the number of clients engaged by 40%.
- Sunflower Foundation agrees to modify the scope of 2019/2020 grant to promote integration across Douglas County’s behavioral health system of care. Grant cycle is extended through the first quarter of 2021. Funding will continue to support technical assistance from CXNS, and provide support for physician oversight of the Integrated Crisis Team. Additional technical assistance from Treatment Advocacy Center will guide the potential implementation of Assisted Outpatient Treatment in Douglas County.
- Douglas County engages Treatment Advocacy Center’s AOT Technical Assistance Team to support the Care and Treatment workgroup’s efforts to improve outcomes for community members.
- County Commission appoints three members to Behavioral Health Partners Board of Directors.
- Heartland RADAC Intensive Care Coordination team invited to co-locate with Bert Nash Access Center team.
- Peer Fellows from Lawrence Public Library are engaged to provide support at Woody Park Campsite.
- BHLC Data Sharing Collaborative finalizes data sharing agreements between six BHLC partners.
- Engage Douglas County is awarded a five-year federal Drug Free Communities grant.