Lawmakers abandoned Iowans in crisis by shirking promise to pay for mental health reform

One of the significant casualties of the interrupted 2020 legislative session was any effort to pay for the ambitious mental health expansion that lawmakers have approved the past two years in a row.

Gov. Kim Reynolds has often lamented the toll COVID-19 has had on Iowans’ mental health, typically as a justification for starting to reopen the state before it met CDC guidelines for testing and reduction of new cases.

“You know when we look at our unemployment claims, we look at the increased food insecurity that we’re talking about, we look at the increased mental health concerns that we’re having and just from substance abuse to domestic abuse. There are a lot of criteria that goes into the decisions that are being made,” she said April 29.

She often said there was significant bipartisan support and commitment in favor of paying for the programs lawmakers created and she signed into law.

But when she submitted an updated budget recommendation to the Legislature last week, the governor proposed no additional state money be appropriated for mental health beyond an increase in Medicaid spending.

The governor had proposed an ambitious plan in January that would have raised about $540 million a year for mental health, water quality and environmental programs. That bill was already on life support before COVID-19 hit the state, however, as some top Republicans balked at raising the state sales tax by a penny in exchange for offsetting tax cuts.

Republican legislative leaders expressed hope before their 11-week COVID-19 session suspension that they could approve mental-health funding even without a sales tax increase. That didn’t happen before lawmakers ended their session on June 14.

That bipartisan support and urgency that has driven action the past few years was inspired by personal stories. Lawmakers responded when they heard about the tragedies that Iowans have experienced because our state lacks appropriate resources for people with complex mental-health needs.

One of those stories was about Sergei Neubauer, the son of my dear friends Mary Neubauer and Larry Loss of Urbandale. Sergei should be celebrating his 22nd birthday in September. Instead, his parents will mark the third anniversary of his death by suicide. Mary Neubauer sent me her thoughts on Sunday; they are at the end of this column.

Stories like Sergei’s brought our elected officials together.

That’s why the lawmakers voted unanimously in 2018 and 2019 to expand mental health services for adults with complex needs and to create a system for children’s mental health. The problems still exist today and COVID-19 may have made some of them worse.

“These were the legislators who should have been held accountable for fixing the funding,” Peggy Huppert, executive director of NAMI Iowa, a mental health advocacy agency, said in an interview.

Social distancing seems to have affected lawmakers in more ways than just squabbles over mask-wearing. Instead of remembering the faces and voices of people in need, all they could see were the spreadsheets and ideological arguments over taxes.

The consequences, however, will be all too human.

“There are people who are dying, you know, people who are still going to jails and emergency departments, and they’re homeless, and there are all kinds of dire consequences for not dealing with this,” Huppert said.

Iowa’s mental health regions are facing deadlines for adding staff and services, Huppert said. For example, the state is supposed to have three new access centers by July 1 to provide crisis stabilization, observation and emergency detoxification. Not even one new center has opened, she said, and it seems unlikely the state will meet a deadline for three more centers by July 1, 2021.

Polk County persuaded lawmakers to appropriate a one-time $5 million emergency payment to help address a shortfall in its revenue for mental health services. The county also received some flexibility to use money otherwise not available for mental health. But County Supervisor Angela Connolly said the county is still about $4 million short ꟷ and that’s if it gets the $6.5 million that Broadlawns Medical Center has been pitching in to help cover the deficit. That money is not guaranteed.

One of the services on the line is housing services, Connolly said, affecting about 800 people.  “If we don’t spend that money, those people, a lot of them, are going to be out in the streets,” Connolly said.

Connolly said an Iowa Department of Human Services may grant some flexibility and the governor’s office might make some federal CARES Act money available for mental health services. But those are temporary fixes. Reynolds’ office did not respond to questions about the issue.

Ultimately, what counties need most is an increase in the property tax levy, both Huppert and Connolly say. The levy is capped at $47.28 per capita. The governor’s proposal would have actually reduced the levy and replaced property tax dollars with money from the proposed sales tax increase.

NAMI has called for eliminating the dollar cap to allow the 14 mental health to raise the $126 million they have budgeted for next year, Huppert said.

That’s probably not going to happen under the current legislative leadership, however. The idea of raising property taxes has run into the “Farm Bureau buzz saw,” in recent years, Huppert said.

Investment in mental health is not only the right thing to do, it makes financial sense. Connolly said the county estimated that serving 1,200 people with mobile crisis units saved an estimated $5 million by diverting them from jails and emergency rooms. Lawmakers need to understand that, she said.

Lawmakers have heard those arguments many times over the years but what it takes to get their attention is for Iowans to demand action and accountability. COVID-19 is a reason for lawmakers to drop this issue but it’s not an excuse.

Yes, lawmakers have to work out the dollars and cents. But they must not be allowed to forget the faces and the names of our loved ones who are suffering. For far too many, it’s already too late.

Mary Neubauer:  Iowa has not kept its promise and it breaks my heart

Larry and I have repeatedly talked with each other during the past few months about how incredibly difficult the COVID-19 pandemic would have been for Sergei, with his depression and anxiety already overwhelming him  without the additional strain that has been brought on for us all by the worldwide emergency. In that way, we’re glad that our son has been spared from having to experience this. But the rest of us very much ARE experiencing this pandemic, and the stress of it is having an impact on us all.

The fact is that the pandemic is causing more people to struggle with their mental health, and that trauma is showing itself in a variety of ways, including an increase in suicides both here in Iowa and across the country. Mental-health conversations and resources are needed now more than ever, and tragically, Iowa has not come through with the additional help that we said we would. It breaks my heart and it worries me. If we can’t acknowledge now that additional mental-health resources need to be a priority in Iowa, when will come the time that we recognize it and are willing to do something about it?

Larry and I are thankful for the new psychiatric hospital that just opened in Bettendorf and the additional psychiatric hospital currently under construction in Clive. Private industry clearly sees the need for more mental-health services in Iowa and is willing to help fill the void. Thank goodness for that private investment here in Iowa. At this point, we can only imagine the type of real, meaningful help that could be achieved if additional state resources were coupled with that, and it’s so frustrating that the state help hasn’t come through.

We’re incredibly proud of the policy achievements that we and other mental-health advocates have achieved in Iowa during the past couple years, first with the 2018 legislation outlining additional services for adults with complex mental-health needs, and then with the 2019 legislation establishing a children’s mental-health program in Iowa for the first time. I’m proud to be a member of the Children’s Behavioral Health system State Board, and all of us on the Board are continuing to do our best to ensure that the children’s system is fully implemented. We recognize that Iowa needs additional resources to help and support its youngest citizens who are its very future.

There can be no doubt, however, that our Board’s work was dealt a huge blow this month when additional mental-health funding was not approved as part of the state budget. State lawmakers again and again pledged that the funding would be approved. Many of those same lawmakers repeatedly campaigned on the issue and said it was a top priority for them.

Within the world of government, your priorities are reflected within your budget. And the state budget that was approved this year lacks the additional help that was promised.

I’m sometimes so frustrated that I wonder if I can find the strength to keep pushing for change. But then another sign will come along that reminds us again of Sergei, and how we will always wonder if his story could have gone differently if the mental-health help he needed could have been found in Iowa.

It’s Father’s Day, and Larry again today received a Happy Father’s Day call from a young man who was Sergei’s roommate when our son was in mental-health treatment in Arizona. The young man is now doing well – he’s been sober for three years, he has a successful career and best of all, he’s happy and thriving. He told Larry today that Sergei is the reason he was able to turn his life around. He said he believes that the universe made them roommates for a reason.

And we’re reminded again that if our son was able to reach out and help those around him despite the enormous burdens he faced with his severe depression and anxiety, what excuse could the rest of us possibly have for not trying to build a better world for those who need help?

And so, today I am reminded that we need to push on. And we think of Sergei, and we miss him. And he continues to give us hope.

— Mary Neubauer