Brain illnesses are no-fault illnesses. They are not caused by bad parents or cell phones or video games. No one wakes up in the morning and wants to get a brain illness and no one deserves a brain illness.
Mental illness is a brain-based illness, just as diabetes is a pancreas-based illness. The very least we can do for those who live with these horrific illnesses is to provide the treatment and support which allows for them to live as healthfully as possible.
In 2018 and 2019, Iowa passed laws to improve the adult and child mental health care systems. Many wonderful people worked together to accomplish this, and the bill signings were truly celebrations filling so many of us with hope for improvements. Sadly, the state has not fully funded these systems.
As a result, many of the mandated services and facilities still do not exist. Although some progress has been made, people needing treatment for serious brain illnesses in Iowa still struggle each day to find beds, providers, services, and facilities. The COVID-19 pandemic has only increased the demands on these already stressed systems.
Now is the time for state legislators to come together again, and finally fund the Iowa mental health care s ystems in a sustainable way that we can be proud of.
For far too long the narrative of reforming mental health care has been based on a false premise: that all people with brain illnesses are better off “in the community.” This concept was initially well-intentioned, as people believed atrocities that had been happening in large institutions could be avoided if people were able to get treatment in communities instead. Sadly, this has resulted in closing too many of our long-term care facilities and underfunding the few that remain.
The atrocities never ended. People with the most serious brain illnesses have the least access to the medical treatment and supportive housing they truly need, and many are left being untreated or inadequately treated, homeless, in our jails and prisons, and/or dead. The few who are in our underfunded state facilities too often become victims of other atrocities, as the recent tragic events at Glenwood Resource Center and the State Training School in Eldora have illustrated.
To simply ignore that a certain number of people living with serious brain illnesses like schizophrenia truly need more treatment and long-term supportive housing is to leave them to suffer and die. Furthermore, it costs more to care for the ones abandoned to the revolving door of homelessness, repeated hospitalizations, and incarceration. Ironically, the outcomes are worse than if the treatment and supportive housing with services were funded in the first place.
Iowa needs to fully fund services, providers, and facilities all along the continuum of care. In addition, Iowa needs to fund oversight of the facilities with regular and unannounced inspections, chart reviews, and monitor for quality of care. This oversight needs teeth: actual consequences for these actions and solutions for improving these facilities.
Here are some specific solutions for improving Iowa’s mental health care
- The most direct way to increase our mental health professional and direct care staff workforce is to increase reimbursement rates for their services. This will help with recruitment and retention of quality individuals to this work, which is quite demanding. This, in turn, reduces turnover and improves the quality of care.
- Have the state of Iowa apply for the Institutions of Mental Disease 1115 waiver. This would allow for Iowa to obtain federal Medicaid matching funds for facilities with more than 16 beds dedicated to the treatment and care of people with “mental diseases” which includes both mental illnesses and intellectual deficits. This would lead to more beds being available for people with serious no-fault brain disorders and to help pay to staff those beds.
- Provide funds to allow for development of assisted outpatient treatment programs working in conjunction with civil and criminal mental health courts. These programs have been shown to reduce re-hospitalizations by 77%, arrests by 83%, homelessness by 74% and costs by 40-50% in other places in the country.
These programs support people being able to remain in least restrictive environments in the community, while providing them with the support they need to remain healthy and well.
During this past year, there has been a focus on racial justice via law enforcement reforms and adjusting budgets to support more social services. One good example is to have social workers respond to mental health 911 calls along with police officers trained in crisis intervention. Ideally, police officers should not have to become involved with people who have brain illnesses. Funding for people with brain illnesses to get the treatment and supportive housing they need will reduce the stress on law enforcement and limit tragedies.
Solutions exist. If they are fully funded, these solutions save Iowa money, do a better job of caring for people with no-fault brain illnesses and keep everyone safer in the process. This can be a win-win-win instead of so much suffering, stress to our police and health care systems, and cost.
For anyone interested in more information about any of these solutions, please feel free to reach out to me: [email protected]