Here’s an audacious way to craft legislation: Bring together people with the greatest insights into a problem — those most impacted on a personal basis, those on the front lines dealing with it and experts in the field — and develop solutions.
Voila! Relying on an 18-page report compiled by a 22-person committee of families affected by mental illness, providers, law enforcement officials, advocates and representatives from mental health and disability service regions, the Legislature took the first step in addressing vexing mental health issues by unanimously passing House and Senate bills.
Depending on implementation, it may banish Iowa’s stigma as being the worst state in the nation on mental health issues.
A 2016 report by the Virginia-based Treatment Advocacy Center ranked Iowa 51st out of all states and Washington, D.C., with only two mental health beds per 100,000 people. It recommended 50 mental health beds per 100,000 people.
Iowa also was 47th in psychiatrists and 44th in mental health workforce availability.
An estimated 137,000 Iowa residents are afflicted with chronic and serious mental illness, including 8,000 in Black Hawk County.
The legislation signed into law by Gov. Kim Reynolds:
- Creates six access centers to provide short-term care for those in crisis but not so ill to require a bed in psychiatric hospital units, while providing resources to help them return to their families. Although psychiatrists wouldn’t necessarily be on site, medical professionals such as nurse practitioners could prescribe medication. The sites haven’t been determined, but committee members want them situated so no one drives more than 90 minutes.
- Increases the number of assertive community treatment teams from 10 to 22 to offer year-round, home-based treatment so individuals stay on their regimens and don’t spiral into crisis.
- Establishes a network of intensive, smaller residential service homes with 120 total beds statewide — preferably serving no more than four individuals at a site, 16 maximum — that would be relatively close to home.
- Implements a statewide 24-hour crisis hotline to connect people to local resources and gain referrals for treatment.
- Changes mental health commitment rules to encourage “subacute” treatment facilities to take patients ready to be released from hospitals but still needing oversight.
- Gives psychiatrists clearer guidelines for reporting potentially dangerous patients to police, balancing law enforcement and confidentiality concerns.
According to Peggy Huppert, executive director of the National Alliance on Mental Illness Iowa, Iowa had 7,000 mental health beds and four state institutions in the 1950s. That number significantly declined after the 1999 U.S. Supreme Court’s Olmstead decision requiring public accommodations for people with disabilities to live in the “most integrated setting appropriate.”
But Iowa was seemingly more focused on saving tax dollars than developing an integrated plan.
In 1995, the Legislature capped county tax levies for mental health at a strict dollar per-person amount. In 2014, Gov. Terry Branstad unilaterally closed mental health institutions in Clarinda and Mount Pleasant, reducing state psychiatric beds from 149 to 64 while saving $8 million. He vetoed a bill to restore services.
Branstad also privatized the state’s Medicaid system, which has resulted in companies cutting care for and payments to patients over the objections of mental health professionals.
To his credit, though, he did initiate a program to encourage psychiatric medical students to stay in Iowa.
State officials now cite a total of 731 staffed-psychiatric inpatient hospital beds, the vast majority run by private hospitals and agencies, often unequipped to handle patients with the most serious problems.
An estimated one-third of the inmates in county jails suffer from mental illness, putting sheriff’s deputies in unenviable positions, including finding beds in acute situations.
During legislative hearings, one deputy reported driving 720 miles in one day seeking an open bed with a patient in crisis in the backseat. Two sheriff’s deputies from different parts of the state converged on a Woodbury County hospital that had only one bed available.
Reynolds stressed more work needs to done. “Creating a mental health system that we envision is complex, and it can’t happen overnight. I look forward to building on the momentum that we have here today.”
Addressing mental health issues among youths is imperative.
“I hope that will be the next phase we work on because currently about 79 percent of children go without mental treatment,” said Rep. Lisa Heddens, D-Ames.
Northeast Iowa alone has seen the closures of the Quakerdale emergency shelter for youths in Waterloo, the pediatric unit at the Independence Mental Health Institution and the Iowa Juvenile Home in Toledo.
While the new law is a praiseworthy start, its effectiveness is dependent on funding and implementation, including attracting mental health professionals. As with the clean water bill at the start of the session, we’re wary that symbolism will trump reality.