Commission turns down request to boot member off mental health board

By Charlene Sims

info@linncountyjournal.com

MOUND CITY – Commission Chair Jim Johnson was clearly agitated following a presentation by Tisha Coleman, one of two Linn County representatives on the Southeast Kansas Mental Health Center (SEKMHC) board, at the commission meeting on Monday, Dec. 29.

Johnson, who is the other appointee to the SEKMHC board from Linn County, asked fellow commissioners Alison Hamilton and Jason Hightower for their help.

However the kind of help he apparently wanted was for them to remove Coleman from the mental health board, a step they both refused to support. Hightower pointed out that her appointment would end in 2027.

Johnson, who had himself appointed to the SEKMHC board earlier this year after the commission learned that top positions in the mental health center were receiving salaries the commission considered excessive, had requested that Coleman appear before the commission to answer questions about SEKMHC.

And on Monday, Coleman complied with that request, giving a 10 minute presentation that included her experience, history on the board and other factual information.

Even though Coleman explained that she was not on the board when Executive Director Nathan Fawson’s salary was increased, Johnson repeatedly kept asking questions like “How did we get where we’re at on the salaries of the upper management? We’ve got a CEO making almost $900,000 with these benefit package.”

Internal Revenue Service Tax form 990 for the Southeast Kansas Mental Health Center in 2024 is shown on the Propublica.org website. The form shows Fawson’s compensation as a little more than $685,100 with additional benefits totaling nearly $204,000.

In 2023, Fawson’s compensation was more than $436,100 with nearly $192,000  in other additional benefits, almost $387,000 in 2022 with no added benefits, and nearly $211,700 with no other benefits in 2021. In addition, several SEKMHC department heads also receive substantial salaries.

At one point in her presentation, Coleman said that she had been appointed to the board by the commission in 2021 but was not notified and did not learn of the appointment until late in 2022. She said started attending board meeting in 2023.

In her presentation, Coleman told Johnson, “I don’t know where that took place but it was during that period that I was not present. I can ’t provide the information if I wasn’t there other than I just gave you suggestions on maybe where that could have come from.”

Hamilton reiterated to Johnson that Coleman was saying that she could not give him the information if she was not there then.

Johnson said that he had nothing against Coleman but he wanted a person on the board that had mental health experience and he had someone who had 15 years of mental health experience in Missouri and wanted to be on the board.

Johnson continued, “I’m asking for help that’s what I’m doing as far as mental health experience and that’s that and I’m not nothing against you I’m just saying when we have seven commissioners out of the 12 now are on the board. I think the commissioners have bought in.”

Coleman asked if the commissioners had that mental health experience.

Johnson said no, but we’re wanting to get the people to find out what’s happening. Why are we paying the CEO almost $900,000? There’s 26 mental health service organizations in Kansas and there isn’t one close to what he is making.

In her report to the commission, Coleman reminded its members of her qualifications. A career nurse, Coleman was former director of the Linn County Health Department and was architect of the wide range of services offered by that department today. She went on to take a position as a regional public health nurse with the Kansas Department of Health and Environment (KDHE).

She resigned the county health department in 2021 at the height of the COVID pandemic as state lawmakers were pushing for KDHE to stop reporting COVID-related deaths and the county commission was taking similar steps against the county health department.

Coleman asked the commissioners what directions they were wanting to set, excluding the leadership salary issue, for Southeast Kansas mental health center.

Additional SEKMHC services called into question

Johnson replied, “I want mental health services for Linn County and I don’t feel that we’re getting them because we bought a dental office in Yates center, and we bought a primary care facility in Chanute, Kansas, that was going broke and we bought them. So why don’t we have primary care through mental health in Linn County?”

“Is that what you are wanting?” asked Coleman.

Johnson answered, “No, that’s not what I want. I want mental health service.”

Johnson continued, “That’s my question. That’s that I want I don’t want our mental health services in Linn County to be broke because of what we’re doing in Neosho County or a dental office in Yates Center.

Until the 2026 budget, the Linn County Commission contributed around $70,000 annually, an amount SEKMHC officials said has been used specifically to underwrite treatment for Linn County residents who don’t have insurance or can’t afford the care. Because of the salary issue, the commission did not renew its contribution for 2026.

Coleman said she wanted to provide some factual information related to the questions about salaries and funding. Colemans said that her intent was to share what she had learned through asking questions and serving on the board.

She said factors that may have contributed to salary increases with all staff was the 2022 “State of Mental Health in America” report, which served as a wake up call when Kansas Mental Health America published the annual report based on federal data.

“It is designed to evaluate each state on criteria such as prevalence of mental health and substance use conditions, suicidal ideation, access to care, provider availability and other metrics,“ she said.

Kansas, once the model for health services as recently as the late 20th century, was now ranked dead last at 51st, Coleman said. This study spurred action, new requirements for new services and demands to hire providers to meet the unmet needs of the communities that mental health organizations serve. SEKMHC was among the first mental health centers in Kansas to become a certified community behavioral health clinic, known as a CCBHC to catch up with the national standards.

SEKMHC adopted the changes fast and was able to move more quickly and to maneuver to meet these unmet needs than its Kansas counterparts, she added.

On SEKMHC’s website, the organization highlights its efforts to meet the needs of residents in their catchment area, which includes Linn, Anderson, Allen, Bourbon, Woodson and Neosho counties.

“Whole Person Care, mind+body+smile,” is the text above a sliding gallery of services it offers in different areas of the catchment area. That includes not only the staples of mental health – behavioral care and crisis intervention – but primary health care in Chanute, Humboldt, Iola, and Yates Center; a dental clinic in Yates Center and a pharmacy in Humboldt.

Mental health service providers in Kansas are not limited to the kinds of service they can provide except that they are assigned to provide mental health centers within their assigned catchment areas.

That does not prevent mental health centers from providing services to residents outside of their catchment areas. Elizabeth Layton Center, an Ottawa-based mental health provider offers service in its catchment area, which is Franklin and Miami counties.

However, it has several clients who are from or have recently moved to Linn County. It is more convenient for people to visit the Paola offices of Elizabeth Layton when they shop in Paola or even in the metro area.

The message SEKMHC attempts to get across on its website is that it can step in when medical, pharmaceutical and dental services aren’t available.

And while Johnson claimed that SEKMHC’s offshoots into other medical care detracted from providing mental health services to Linn County residents, Coleman in her prepared statement offered statistics the refuted that claim.

In 2015, there were 3,679 individuals that were served compared to 2024 when 25,906 were served, a 604% increase, she said. Growth and services that were provided went from 117,036 to 313,000 annually which was a 168% increase,

Work force expansion was at 208 employees to now approximately 583, which was an 180% increase, Coleman continued. The budget in 2015 was at $8 million and now in 2025 it is $75 million.

For Linn County that means Improved access to care, she said. Service locations in 2015 in the whole SEKMHC area went from 15 sites to 95 site locations in 2025.

SEKMHC opens new offices

That includes the recent addition of a site in Mound City. And SEKMHC officials also were in talks with the city of Linn Valley about leasing space in a new city hall until the salary issue exploded.

Therapists have increased from 13 to 60, and wait times for appointments have been reduced from up to 60 days to same-day service for most programs, Coleman said.

“I’d like to highlight the importance of timely access given our ongoing mental health crises and service gaps within our community, she said. “So we expanded beyond many peer centers in volume and staffing. There’s an increased organizational complex including clinical, administrative and compliance responsibilities.

“And then the IRS 990 filings that are public perhaps there were changes over time that may have reflected evolving reporting standards and classifications.

“And then I just want to talk about the county funding because I know you guys had talked about  that in the past. In the past, it was used exclusively for indigent care for Linn County residents who 1) were not on medicaid or 2) could not afford services. No county funds were used for salaries executive compensation or benefits.

“Funding allowed the individual’s county of residence and use of the county funds is verified through annual audits. On a per capita basis, the average each county paid when they had received funding from the counties was $8.60 compared to the state average of $16.61 per capita per year.

“County funding represented less than 1% of Southeast Mental health’s budget and currently I don’t think that Linn County provides any funding. If it is, it’s very little.

“Just as far as compensation transparency goes, compensation was informed by independent national healthcare studies. All salaries and benefits are submitted to the state through required cost reports.

“The state reviews these reports to establish their Medicaid reimbursement rates. And studies in 2021 and 2023 found that SEKMHC wages were now below national average at the 25th percentile compared to the comparable healthcare organizations nationally.”

Any compensation adjustments were board approved and reported to the state, she said.

“The improved competitiveness helped to increase staffing, expand services and reduce wait times,” Coleman said. “All staff received salary adjustments not just leadership. Currently the lowest paid staff member for SEKMHC is $15.75 per hour.

“What distinguishes us different from other peer centers? We were one of the first Kansas centers to pursue the CCBHC status in 2021. They provide expanded services including crisis services, housing support and peer support and the only Kansas mental health center with the capability to provide mental health care, primary care, and dental services all together.

“Services and billing undergo annual independent audits with clean results, strong financial accountability and advanced accounting practices. They have a partnership with high schools and colleges and supporting the employees that work there in earning graduate degrees and licensure.

“Many staff are lifelong community members contributing to our local economy, schools and community stability. They operate on an integrated care model which is a model on how care is delivered. The whole person approach improving care coordination and communication among providers to aim for better patient outcomes requiring higher clinical and operational expertise.

Services include 24-hour crisis intervention

Because of the improvement of services overall, SEKMHC provides Linn County with comprehensive services such as 24/7 mental health crisis response, comprehensive outpatient mental health care, school-based services, jail-based services, crisis intervention team support, mental health first aid training and suicide prevention training, she said.

Johnson said, “In my defense as a commissioner, I had not heard anything about what the salaries for the upper management was doing in Southeast Kansas Mental Health. I hadn’t heard a word until some of us seen or the information came to us from the state level. I mean there I’ve gotten a lot of information from people in the state levels that are concerned about what we’re doing in southeast Kansas.”

                                                                                                                                                               Coleman asked, “So as far as mental health services, you’re wanting an expansion. Is there a specific program that you’re wishing for, or I guess I don’t know.”

Johnson said he wanted to see what we are actually doing in the programs and the questions I’ve been asked is what we’re going to do with the jail and they came in and talked with us.

Coleman commented, “I was super excited about that.”

Johnson continued, “We are, but I want to see the progress. I don’t want to see a pamphlet handed to them. I want to see what our success rate is from the people that we are dealing with on a day to day basis.”

Coleman asked, “Is that their intentions to come back to you with that information?”

Both Hamilton and Hightower said yes.

Coleman clarified, “So data, is what you’re looking for, numbers. Is that right? I mean I don’t I’m sorry . I just don’t I just want to make sure I have the right information.

Hightower said, “I think that’s important to us for you being on the board that you’re seeing that. I don’t think it’s something that I’m looking to see.”

Johnson, “I think that’s the reason why we have seven (county) commissioners on (the SEKMHC board)  because they are wanting to see what we’re doing. l don’t think anybody’s happy that we bought a general practitioner office in Neosho County when Linn County gets nothing out of that.”

Coleman asked,  “So, is that kind of where it goes back to then? Is that more of the focus that there’s more upsetness with that? I mean I’m just trying to understand. I mean, I know I totally get the leadership.”

Hamilton replied to Coleman’s question, “So to answer your question back on for me as perspective of what I would like to see for Linn County. My focus was always starting with the jail and the services in the jail.

“I’ve worked, you know, somewhat over the past year to try to figure out how to get that situation to where when people are being released that they’re not just going straight to the streets.  I think that was a concern for a lot of people in Mound City as well, just in the community. And I’ve heard a lot of comments based on that.

“Also veteran services was always a big that was I important to me personally and how to engage and get – I know we have someone that comes here monthly, but just how to intertwine all of that for the county but what you’re saying is, ‘What is our vision?’”

Hamilton said, “We’ve just kind of argued over salary. And I’m not saying I’m for or against the salary. I’m just I feel like my hands are tied with the salary in my position.”

Johnson asked, “Why do you feel your hands are tied with the salary?“

Hamilton answered, “I don’t sit on the board so you’re going to need help. What can I do though?”

Help me, said Johnson.

Hightower said, “I’m thinking that those discussions need to be made at the board and if everybody just has the same viewpoint and things that way then it’s not going to be the right decision being made. I think it needs to be discussions on this stuff happening at the board level.”

Johnson said there were discussions about it.

“We had a big (meeting), we had a big one last week,” Johnson said. “And my question is how did we get to the salaries on the upper management? That’s it. And nobody can answer that one for me and you know what? To get to somebody that is making $900,000 in southeast Kansas with a total benefit package. I got problems with that.”

Board members can't answer questions

Johnson said, “The people that was on the board can’t answer that question. I’ve asked four of them now, and nobody knows how we got there.”

Coleman asked, “So how do we move forward? Now that we’re talking about salaries, to help understand transparency, and mutual understanding I would like to hear what do you feel would be a reasonable justifiable leadership salary along with general factors that contribute to that decision.”

Johnson asked, “So do you think where we’re at now is good? I mean, is the you know, somewhere along the line the board voted to put that. . .”

Coleman answered,  “I think I answered that earlier and the the answer was no. I did not I was not here to support that That was not my intent.”

Johnson said, “So, what I’m saying is how did that a get there? There must have been people on that board that allowed that either that or he did it to himself somewhere. How did we get to that wage with the board? Because the board is the one that decided what he makes.”

Hightower said, “I think it should have been based more off of, you know, averages from the state of Kansas, more than averages for the national average.”

Johnson said, “Put him in the national average and you’ll see where he’s at.”

Hightower replied,”Okay Jim, okay, you, that’s my thoughts and feelings on it you know. We’re not always dealing with the same things as everybody else, and we also don’t have the funds that everybody else may or may not have, you know, is what I’m saying from that standpoint. You know I don’t want to be necessarily comparing him against the private sector because it’s not the private sector, is it?”

Coleman answered, “No, I don’t believe so.”

Hamilton asked, “So you think removing Tish and adding someone else would give a different vote to lower the salary? Is that what we’re talking about?”

Johnson answered, “Not the vote. I want someone on the board with knowledge of the mental health services that’s had (experience) in the state of Missouri.”

Hightower said to Johnson but you already have a person that has some certifications and things that way in Coleman.

Johnson said, “I understand that and appreciate that, but your specialty is not mental health.education. That’s what I want. I’m wanting the mental health.”

Hamilton asked Coleman about the qualifications of other people sitting on the board now.

Coleman said, “I don’t know the history or experience or what mental health background or healthcare background or I don’t know the answers to any of those questions.”

Hamilton continued, “The other thing too when I was talking to Nathan last week, he did mention that when Bourbon County removed two of their members and added the commissioners, right? That was illegal. It was against the by-laws. So there is an issue with that.

Hightower stated, “I’m not in favor of removing Tish.”

Hamilton said, “I’m not in favor of removing Tish either.”

Hightower said,  “I think that it should be on the board to have the discussions necessary to make the appropriate decisions. Whether that’s finding out those facts, Jim, that you want to know and being able to get that, you know, if management won’t provide you with those things.

Both Hamilton and Hightower thanked Coleman for serving in the unpaid volunteer position.