Nicole Nesmith shows a picture of her child, Phoenix, from when the two went to see the musical “Rent” in Omaha, Nebraska. Earlier that school year, the Nesmiths had been denied psychiatric residential treatment for Phoenix. MADELINE FOX / KANSAS NEWS SERVICE Nesmith was working on a social work degree, so she was familiar with self-harming — she just hadn’t expected to deal with it so close to home. Phoenix’s confession started a cycle familiar to families who have kids with severe mental illness — therapy, crisis hospitalizations, medication, more therapy, new meds when the old ones stopped working well, more hospitalizations. But in the fall of Phoenix’s freshman year of high school, even that exhausting pattern wasn’t enough. “There was a two-week period when I really didn’t leave the house at all,” said Phoenix.

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When kids are chronically in distress — suicidal, self-harming, harming others, running away repeatedly — there had been a place for them: psychiatric residential treatment facilities. That’s where the community mental health center treating Phoenix sent the Nesmiths when the care it could offer no longer kept Phoenix stable. Residential treatment centers take children for long periods of time — weeks, sometimes months — to do more than talk kids down from crisis. They work to get at the root causes of their distress and help patients develop coping mechanisms to better manage the stressful things that set off a crisis. Cost-cutting measures In 2011, the state decided Kansas was sending too many kids to residential facilities for too long. At $500 a day or more, it cost too much. The state pushed to divert kids from residential care and bring down the length of their stays.

That loss of business prompted many treatment facilities to close some or all of their beds, resulting in a sharp drop from nearly 800 spots for care to the current 282. More changes swept through with Kansas’ privatization of Medicaid in 2013.

Under KanCare, community mental health centers no longer decided whether kids needed residential treatment, as they had for Phoenix. Instead, that decision passed to the private companies managing Medicaid under KanCare. In 2015, the Nesmiths sought a third residential stay for Phoenix. After years of struggling with depression, anxiety, and thoughts of suicide, the looming milestone of a 17th birthday, college and a future prompted the Nesmiths to seek another round of longer-term intensive care. “I was trying to figure out a future I never thought I’d have,” Phoenix said. “And that was just another source of stress.” But the Nesmiths say Phoenix’s insurance company denied residential treatment.