Iowans must fight again for state support of mental health

Two years ago, Iowa had a breakthrough.

After decades of dedicated but frustrating work by many Iowans, policymakers finally made progress on addressing urgent needs for mental health services. But they didn’t finish the job.

Now, COVID-19 has heightened the need for these services while creating complications and hurdles no one ever imagined back in 2018. Isolation, fear,  the stress of job losses and uncertainty have challenged even healthy individuals. Practitioners in our state report more depression and anxiety among Iowans and an increased severity of both conditions.

The demand for help has ramped up even as providers have continued to struggle with inadequate reimbursement, staffing shortages and the need to manage COVID protocols.

Mental health professionals say Iowans will need to renew and recreate the public attention and focus on this issue that inspired action two years ago.

“We have to keep this momentum forward,” said Okpara Rice, CEO of Tanager Place. The social-service agency supports about 3,000 children and their families in Linn and Johnson counties and southeast Iowa. “That means we need to continue to listen to voices, people need to continue to hold legislators accountable, they need to hold us accountable. We need to make sure that this continues to be an important part of what we say we want to do to build the best state we can to help kids be healthy.”

What it took to finally break through decades of indifference in 2018 was an unprecedented level of public attention and engagement that started with Iowans telling their personal stories.

For me, it started when my friends, Mary Neubauer and Larry Loss, lost their teenage son, Sergei, to suicide. The obituary that Mary wrote went viral. Their story and the concerns she raised with the inadequacy of mental health services in Iowa were amplified by the media. The Des Moines Register, my employer at the time, helped make mental health a central issue in the governor’s election by hosting candidate forums.

Other families and individuals who have suffered from the lack of mental-health services were inspired and emboldened to come forward as well. People who had stepped up in the past were given renewed attention. Organizations that have long been fighting in vain were reinvigorated. Lawmakers not only listened, but they disclosed their own experiences to each other and in some cases to the public. Newly elected Gov. Kim Reynolds made mental health a centerpiece of her legislative agenda.

The Iowa Legislature, in a rare display of solidarity, unanimously approved significant policy changes in 2018 to expand access to a wider array of mental health services statewide. The next year, lawmakers kept the momentum going with the creation of a mental health framework for children but stopped short of providing the money needed to implement it.

This year, Reynolds made a good-faith effort to create a sustainable source of state money for the system. Her proposal, which involved a sales tax increase but cut taxes overall, ran into political headwinds despite bipartisan commitment to paying for mental health programs.

Then COVID came to town. The Legislature, in a truncated session, provided some money for mental health but scrapped talk of any long-term commitment. And that has slowed down progress, according to mental health professionals who spoke last week at the NAMI Iowa annual conference.

Mae Hingtgen, CEO of Mental Health/Disability Services of East Central Region, said there needs to be a concentrated effort to support providers “in order for them to feel stable enough to grow.”

One in five Iowans is likely to be affected by a mental health challenge in a normal year. In 2020, that estimate has increased to one in four, according to NAMI Iowa’s strategic plan. But Iowa continues to fall far short of the number of mental health providers needed to address the need. The state ranks 48^th overall in the provision of mental health services, according to NAMI Iowa, with fewer than 100 psychiatrists accepting clients in the state.

It’s difficult to ask providers to expand services if they don’t feel confident in the financial support and the staffing needed to carry out the work, Hingtgen pointed out.

That concentrated effort needs to be directed at elected officials: the governor, state legislators and the county supervisors who oversee the mental health regions across the state.

Iowa Department of Human Services Director Kelly Garcia, speaking at the conference earlier Friday, said the department submitted a “status quo” budget request. But, she said, she is anticipating “a significant conversation” during the upcoming legislative session around mental health funding.

“And it is a unique time to be trying to analyze bringing services on with the backdrop of COVID and we can’t ignore COVID,” Garcia said. “We can’t ignore the strain that is put on our provider capacity. We also can’t ignore the strain it’s put on individuals and households and the tremendous effects that we’re seeing, not only from the prolonged response to COVID-19 but also the derecho and other mounting pressures that Iowans are seeing today in their everyday lives.”

In other words, this won’t be easy and it has rarely been more important. The governor and lawmakers have a lot of critically important issues to deal with, from getting the virus under control in this state to rebuilding the economy during a potentially tight budget year while working to continue to make progress on chronic workforce, environmental and education issues.

Lawmakers have kicked this particular can down the road for several years, and now the path is much rockier. But unless Iowa decides now to finally make a real investment in mental health, we’ll never fully recover from coronavirus. Unless the state makes this issue a priority, it will never reach its workforce goals and economic potential.

Now is the time for Iowans who care about this issue to get involved or to reengage. An easy way to start is to call or email NAMI Iowa, [email protected] or (515) 254-0417. (The non-crisis line is open weekdays from 8:30 a.m.-4:30 p.m.)

“We need to hear from you. So please, please, please use your voice,” Rice said. “That is the most important thing that can be a catalyst for making sure this does not fall by the wayside.”