Fred Hubbell s Plan And Priorities To Address Iowa s Mental Health Crisis The state of Iowa has a growing mental health crisis due to the mismanagement of the Reynolds administration. The Branstad-Reynolds administration unilaterally closed two (Mt. Pleasant and Clarinda) and slashed the number of beds in a third (Independence) of the state s initial four mental health institutions for in-patient services. Now, just Cherokee and Independence remain open. This has led to a shortage of in-patient beds. Utah, Mississippi, Arkansas and Kansas are all similar to Iowa in population but have nearly 4 times, and in some cases nearly 8 times, the amount of state beds. Iowa ranks dead last in the country for state psychiatric beds per capita, according to a new report from the Treatment Advocacy Center. The state s grand total of 64 beds for adults, down from 149 just a few years ago, lands us in 50th place. We have two beds per 100,000 residents. Kansas, Missouri and South Dakota each have about 15 and the national average is about 12 beds per 100,000 residents. ( Des Moines Register 6/11/16 ) Finding a bed is only half the battle for patients in a mental health crisis. More often than not, the available beds are in the far corners of the state. The most-often used facility for Marion County court committals in the last fiscal year was Council Bluffs. The next-highest was Des Moines with 17, but 13 other patients went to Cedar Rapids, and others were scattered around to other places such as Davenport, Mason City and Iowa City. ( Knoxville Journal Express 5/4/2017 ) Due to the closure of Iowa s in-patient institutions, many of those with severe mental health needs have been forced into our criminal justice system and hospitals as a last resort. 40 percent of male inmates and 60 percent of female inmates in Iowa have a mental illness diagnosis. ( NAMI and IA Dept. of Human Services ) The Reynolds administration has exacerbated the problem by forcing Medicaid recipients into new private managed care organizations (MCO). Before switching to the current MCOs in 2015, the state of Iowa used Magellan Health Inc. to manage mental health services for Medicaid recipients. Recently, one of the private MCOs pulled out of the Medicaid program and one of the two remaining MCOs is refusing to take new patients. The program is unraveling quickly. Providers argue that the MCOs are the single biggest problem in the state s management of mental health services. MCOs are notoriously slow in approving treatment, sometimes taking days or even weeks to authorize services. In addition, they regularly limit treatments recommended by providers and cut payments to providers. These cuts and delays are causing hospitals to eliminate mental health beds and services. 75% of adults with serious mental illness first experienced symptoms before the age of 14. One in five youth will have a serious mental illness. There are no mandated mental health services for children so there are major gaps in service for youth with a serious mental illness. No new or evidence-based services for youth have been added in more than 20 years. We know there are evidence based approaches to working with children and keeping them at home and in the community, but, few of these approaches are systematically offered and reimbursed for across Iowa. All focus has been on the adult system and redesign. Iowa began consolidating county-based mental health services by creating 14 regions across the state to deliver services on a regional basis. Each region has the authority to levy property tax, but it was capped in 1996. There have been legislative attempts to increase and/or eliminate the caps, but they have been unsuccessful.
Recommendations : Fred Hubbell believes that the state of Iowa is ignoring a growing mental health crisis largely due to Governor Reynolds mismanagement. As governor, Fred understands that there is no single solution to solving the problems for each community Iowa has a shortage of providers at all levels. The legislature s impulsive changes to collective bargaining make it harder to recruit and retain health care professionals for the state. Those changes should be reversed. The State of Iowa should increase residency programs for physicians and nurse practitioners that enter the profession. Loan forgiveness programs should be established for those who stay and practice in Iowa, particularly in rural Iowa. As governor, Fred would establish a review of the Iowa Medicaid Enterprise to determine the most cost-efficient program that provides the necessary services for patients and efficient distribution of beds and services across the state. We should empower local communities and stakeholders to determine their mental health needs and support local solutions and innovations. Reverse Reynolds disastrous Medicaid privatization failure and establish a review of the Iowa Medicaid Enterprise to determine the most cost-efficient program that provides the necessary services for patients and efficient distribution of beds and services across the state. Empower local communities to determine their needs and support local community-based programs to address prevention, crisis management, and short-term crisis intervention. Establish reimbursement schedules for Iowa providers that require a timely pay cycle to relieve the severe cash flow burden on practitioners, hospitals, and nursing homes around the state. Add at least 50-75 high-intensity mental health beds for in-patient treatment in a public/private partnership. Encourage more utilization of tele-psych services to bring improved behavioral health services to rural and underserved areas. Bring mental health and addiction services into closer and more efficient coordination in state government. The state currently manages them separately even though they are interrelated and often co-occurring. The state should manage them together. One in five youth will experience a serious debilitating mental illness that reaches epidemic proportions. We need a public health approach to education, outreach, identification and treatment with established measures that tell us how we are progressing on this critical threat to children s health and wellbeing. Create a first-of-its kind state program for children s mental health. This program will encourage programs and partnerships with school districts for identification, prevention, and treatment for children. We must include pediatricians and family physicians into the mental health screening process for youth. This effort would lead to early identification and treatment which brings improved quality and fiscal outcomes. Apply for the SAMHSA expansion grant for System of Care, an evidence-based approach which improves coordination of care, keeps children and families together, and decreases cost. SAMHSA offered system of care expansion grants in 2013 and 2016, but Iowa did not apply. All of Iowa s surrounding states applied for these grants. Iowa currently has four sites doing System of Care. DHS has proposed to cut these funds in FY 2019 as a cost containment measure.
Provide more assistance to local law enforcement and addiction service providers to deal with the opioid crisis and other substance abuse, while partnering with the Attorney General to hold pharmaceutical companies responsible for costs and damages to Iowans. Work with local communities to actively support jail and prison diversion programs, including after-care to reduce recidivism. It costs more than $30,000 annually to incarcerate a person in an Iowa prison. Based on local examples, using this money for drug and alcohol addiction and mental health services can do much more in the long-term and will result in saving the taxpayers money by reducing recidivism.