opinion

The missing pieces of Iowa’s mental health care puzzle

Access to acute care mental health care beds saves lives. Unfortunately, Iowa’s mental health care system is missing key components that negatively impact access to services.

Among these is the effective treatment of the small percentage of the population who suffer from a persistent serious mental illness. These Iowans require special consideration as their lives are severely impacted by these diseases and their use of services and cost of treatment are disproportionately high.

Effective treatment for these individuals does three things:

improves their quality of life improves access to acute care psychiatric beds reduces the overall operating costs for Iowa’s mental health care system

The Treatment Advocacy Center has been sounding the alarm about the lack of state-operated acute care psychiatric beds in Iowa for several years (currently 96 MHI beds). Fifty-seven percent of Iowa’s prison population suffers from ether a serious mental illness or has a chronic mental health diagnosis. These numbers are staggeringly high and many of these forensic patients are in the two remaining Iowa MHIs.

Iowa’s availability of acute care beds is at a crisis level, but how many additional beds are needed? The answer is not as simple as adding some arbitrary number of beds distributed across Iowa hospitals (which currently house 615 beds). The total count of staffed acute care psychiatric beds in Iowa is more than 700. That’s 23.3 beds per 100,000 Iowa residents. The Treatment Advocacy Center recommends having 50 state-operated acute care psychiatric beds per 100,000 residents — twice the total number of acute care beds in Iowa. Any discussion of access to acute mental health care in Iowa must start with these data.

Patients in these beds fall into several categories (e.g., forensic, intellectually disabled, eating disorders, serious mental illnesses, et al). These beds are further subdivided into adolescent, adult and geriatric beds. Each of these categories and subdivisions potentially affect bed access. Assessing how these acute care beds are used seems like an important priority for Iowa’s Department of Human Services. These variables dictate access and where patients are transferred once they receive initial treatment. How many acute care beds are occupied by patients waiting to be transferred to a lower level of care? If 10 percent of patients in acute care settings (~70) could be transferred to a lower level of care, this could potentially provide some relief for the current bed crisis. This begs the question – to where do you transfer these patients, particularly the seriously mentally ill?

Sub-acute care for the seriously mentally ill currently doesn’t exist in Iowa. As a result, discharges from acute care settings are made to residential care facilities, families, or community outpatient care options – who are generally not equipped to care for these patients.

This is where the Iowa Legislature can provide some relief for this problem. Senate Bill 2351 and House Bill 2327 are written using the recommendations of the Iowa DHS Complex Service Needs Workgroup Report. These bills provide for the expansion of Assertive Community Treatment (ACT) programs and establishing Intensive Residential Service Homes (IRSHs) – both helpful for those with serious mental illnesses. The bills include an amendment to allow for the enhancement of Iowa’s current Assisted Outpatient Treatment (AOT) law. AOT would allow judges, in collaboration with mental health care professionals, to mandate treatment for patients with a serious mental illness who have a history of repeated hospitalizations and/or arrests. AOT (e.g., Kendra’s Law in New York) dramatically reduces violent behavior, arrests, repeat hospitalizations and homelessness. In turn, the cost of care for these patients is reduced by as much as 50 percent.

A recent Iowa Poll indicates that Iowa’s mental health care system is the leading area of concern among voters. Given this level of concern, there should be a strong political will to act. I urge elected officials and candidates for office to listen to their constituents and consider improving the future of Iowa’s most vulnerable citizens.

Scott J. Carpenter is a co-founder of Iowa Mental Health Advocacy. scott@microsampler.com