For all 22 years of his life, Vicente Granados knew exactly what he wanted to be: a bullfighter.

Even in grade school, he dressed up as a rodeo clown for the wax museum assignment, said his sister Esther Granados.  

That’s how she remembers him best — the passionate bullfighter, the committed brother nicknamed “Boy.” But before Vicente Granados died by suicide in 2015, his sister remembers difficult moments, too. Times she felt helpless, even as a clinical social worker, to manage his depression.

“There were several situations where he was in enough crisis that outpatient (care) probably wasn’t enough, but not in enough crisis to go to the hospital,” Esther Granados said.

Filling in this gap to treat midlevel mental health crises is essential, Granados said, which is why she’s a proponent of expanding COMCARE’s Community Crisis Center. The center provides 23-hour crisis observation beds to those in need of immediate mental health support, as well as sobering and detox beds run by the Substance Abuse Center of Kansas. 

COMCARE, the county’s mental health authority, also provides longer-term crisis stabilization and residential beds for those with serious and persistent mental illness in a separate building. 

Since the center opened in 2015, demand for its services has spiked:

• The wait time to see a licensed provider at the crisis center increased by 10% between 2015 and 2021. 
   
• The average length of stay in crisis stabilization beds increased by about one day from 2017 to 2021.

Increased need is why Joan Tammany, executive director of COMCARE, and Jennifer Wilson, director of crisis services within COMCARE, have been proponents of expanding the crisis center since 2019. But this is the first year Sedgwick County’s recommended budget includes nearly $15.5 million to design and build a new crisis center to house both the short-term and longer-term crisis services.

A majority of county commissioners said they would prioritize maintaining funding for the expansion in the final 2022-23 budget, which will be adopted Aug. 25. But even if funding does come through, a massive staffing shortage may make expansion difficult.

Sedgwick County mental health center ‘always full’ 

Cramped, lacking privacy, less than ideal. 

That’s how county officials describe the current crisis center.

The proposed center would remedy these issues by adding waiting rooms, meditation rooms and even sensory rooms for people with intellectual and developmental disabilities, Tammany said.

The new center would also have space to serve more people — a necessity, Wilson said. 

When the program is full, patients who would otherwise use the stabilization unit are often directed to a higher level of care, which can be more expensive, Wilson wrote in an email.

The proposed crisis center would add four beds to the observation unit, six beds to the stabilization unit and five detox beds. Pending funding, the new detox beds would allow for medical detox, meaning the center could accept patients with a higher blood alcohol content. 

The crisis beds can be indispensable tools for people experiencing psychosis or hallucinations who don’t require hospitalization, Granados said.

“But they also are scary enough that their families are like, ‘Ah, what do I do with them?’” said Granados. “Not everyone can go to the hospital, but it’s still scary for their loved ones.”

Adding beds to the crisis center has a ripple effect all the way to local hospitals, said Robyn Chadwick, hospital president of Ascension Via Christi St. Joseph. 

“That’s … more people getting the care they need at the right time, so they avoid having to come to the Emergency Department and be hospitalized,” Chadwick said. 

Since 2019, Chadwick saw a 380-person increase in behavioral health admissions, which she attributes to a lack of lower-level treatment.

The other piece of the puzzle for Sedgwick County mental health

But an increase in square footage is only one piece of the center’s problem. County Manager Tom Stolz recently shared that the county is facing “unprecedented” job vacancies, including 200 openings at COMCARE. 

At the crisis center, the number of clinicians is down 50% and children’s case managers are in short supply, Tammany said.

“People are leaving because the salaries they can earn elsewhere are life-changing,” Tammany said. “That’s what we’re losing people to — higher salaries, easier work.”

The expanded crisis center would eventually require an estimated 77 new staff members, including 22 full-time case managers and 10 clinicians, with an operating cost of around $3.6 million a year. Tammany emphasized that these positions would be added as needed over time and that operating costs are not an immediate ask of the county.   

The county’s effort to reclassify around 1,600 positions in the proposed budget — about 40 of which are in COMCARE — is one way Tammany is hoping to staunch the exodus of workers and staff a new facility. Some case managers will see salary increases of 28%, and clinical social workers will see an increase of 22%.