Iowa needs money for mental health care. Here’s one place to get it.

Governor signs mental health legislation
Gov. Kim Reynolds signs mental health legislation at the Iowa Capitol on May 1, 2019. Photo by Kathie Obradovich/Iowa Capital Dispatch

Over the last two legislative sessions, many have worked to improve the treatment of adults and children who suffer from mental illnesses in Iowa.  The recommendations of workgroups yielded bills that legislators overwhelmingly passed, and Gov. Kim Reynolds signed into law. These laws call for enhancing the continuum of care for adults with complex mental health care needs and establishing a mental health care system for Iowa’s children.  We should commend all involved for their efforts and for the progress that has been made.

However, Iowa is still ranked last in the nation for the number of state-operated acute care beds for adults (64) and children (32).  Iowa has only two beds per 100,000 people, when the recommended minimum number is 50 beds per 100,000.  When privately operated hospitals are included, there are still fewer than 800 actively staffed, acute care beds in Iowa (25 beds per 100,000 people).  These beds serve adult, adolescent, geriatric, and forensic patients. These patient populations seldom mix. Therefore, access is limited by current staffing and bed availability within a cohort group.

Here are just two of the many headlines and stories that illustrate the consequences of having too few long-term treatment options:

“After each violent outburst, family and police couldn’t find lasting help for a mentally ill Iowa man.  Now he’s charged with murder.”

“Voices told a Bondurant man to kill himself.  Then, he says, they told him to kill his parents and sister instead.”

Until we choose to increase the number of beds and enhance the options within the continuum of care from acute care to outpatient care, tragedies will continue to happen.  We lack enough long-term treatment options needed for people with the most serious brain disorders like serious depressive disorders, bipolar disorders, schizophrenia, and schizoaffective disorder.

What are the solutions?  How do we fund the mental illness treatment system in a meaningful and sustainable way?  These are some of the questions that many have been asking of state legislators, CEOs of Iowa’s Mental Health and Disability Services (MHDS) regions, and mental health advocates.  There are many good ideas out there that deserve consideration.  One solution hasn’t been discussed enough.

If you examine what’s caused providers to go out of business, end certain services, and close sub-acute beds (for example, Hillcrest Family Services in Dubuque), it’s due to insufficient reimbursements for the services they provide.  Increased rates are needed for everything from telehealth, to Assertive Community Treatment (ACT) teams that help patients to remain “in the community,” through all levels of facility care.  This is vital to help care providers recruit and retain caring, skilled, and experienced mental health professionals and to stay in business.

In addition, there’s a funding source available to the state of Iowa for the first time since 2005. Iowa DHS could apply for an Institutes for Mental Disease (IMD) 1115 waiver. This waiver would allow federal matching Medicaid dollars to be available for hospitals and facilities with more than 16 beds for people with “mental diseases” which include mental illnesses and intellectual disabilities.  To date, Iowa has not applied for this waiver — but it could.  Vermont and the District of Columbia have had their applications approved and Indiana has also applied. This funding could make reopening long-term and sub-acute beds possible.

Beyond that, the arbitrary cap on property tax levies that fund Iowa’s 14 MHDS regions needs to be lifted. Policy-makers in many regions want to better support mental illness treatment for their residents — but are restricted by this cap.  This is necessary until a different sustainable funding stream is legislated.  While some may not like having their property taxes increased, these increases would be modest for most households.  Importantly, this funding is needed to provide humane and effective treatment for Iowa’s most vulnerable citizens.

As a serious brain disorders advocate and a NAMI volunteer, I give many advocacy talks to a variety of audiences.  I often ask if those in attendance know someone with a mental illness — perhaps a family member, colleague, neighbor, or someone who shares their religious beliefs.  Nearly everyone raises his or her hand.  Mental illnesses affect people from every political party, race, and walk of life.  Nobody wants a mental illness, and nobody deserves one.

Numerous Iowa polls have shown that a vast majority of Iowans (over 70%) find mental health care and Iowa’s “inadequate mental health care facilities” a major concern.

This bipartisan issue brought our Legislature together during the past two sessions.  Let’s move forward in 2020 with this same type of cooperation.  Solutions exist.  It’s often said that if you want to know a state’s values and priorities, look at its budget.  Let’s have Iowa’s budget reflect the priorities and values that over 70% of Iowans have made clear they share.  Fund the improved mental health care system.  Lives depend on it.

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