A car crash that left her son with shattered hips, a broken foot, arm and jaw, and internal injuries requiring multiple surgical procedures was a telling point for Kristin Ertzinger.

Emergency personnel and hospital staff worked diligently to save her son’s life, but in the years leading up to that crash, and the aftermath, Ertzinger and her son experienced a different story with Iowa’s mental health system.

Photo shared by Kristin Ertzinger

“There are no other illnesses where patient history is treated with such utter disregard,” she said of her son’s battle with depression, anxiety and suicide attempts.

Simon Ertzinger, now 19, continues to heal physically from the crash that almost took his life in February 2017, but the struggle to find appropriate mental health care is ongoing.

Most recently, his managed care organization (MCO) denied the enhanced services that had been recommended for his treatment, including 1:1 staffing. Instead, he spends his days in a holding pattern at a crisis stabilization center in Cedar Rapids.

Ertzinger said she had hoped his insurance carrier would realize that approving services, in the long run, would not only assist her son, but save money by helping to keep him out of crisis situations and hospitalizations. He has been hospitalized more than 20 times, in various sites across the state.

“Some days are OK, some days are excruciating,” she said of her son’s current situation.

Ertzinger’s experience reflects what numerous families face throughout the state.

Photo shared by Kristin Ertzinger

The Treatment Advocacy Center of Arlington, Virginia, which pushes for stronger mental health treatment laws for patients, ranks Iowa at the bottom of all states in the availability of state psychiatric hospital beds. Iowa’s situation was exacerbated when then-Governor Terry Branstad shut down two of what then was the state’s four mental health institutes — in Mount Pleasant and Clarinda — in 2015.

That left Iowa with just 64 state beds for a population of 3.1 million people, or two state beds per 100,000 residents, compared to the national average of 12, the Treatment Advocacy Center report showed.

While Department of Human Services officials counter that Iowa has 730 public and private unit crisis beds, that number is only one part of the equation, said Peggy Huppert, executive director of the National Alliance on Mental Illness in Iowa.

“There are a number of concerns,” Huppert said, citing a shortage of psychiatrists and child psychiatrists among the issues facing Iowa, particularly in rural areas, as well as a lack of prescribers, such as Advanced Registered Nurse Practitioners and Physician Assistants with certification in psychiatry, who are proficient in prescribing psychotropic drugs.

An estimated 135,000 Iowans live with serious, chronic mental illness, the National Alliance on Mental Illness reports.

“That’s a lot of people,” Huppert said. “When they need a bed, they need a bed.”

A “bed-finder” tool, used by court officials, hospital personnel and others, shows on any given day, Iowa might have 60 to 70 open beds for psychiatric patients, she noted. “The problem is, we don’t have the right kind of beds.”

Beds are needed for patients with severe, complex issues, those who have co-occurring conditions, such as substance abuse with a psychiatric diagnosis or other factors, including intellectual disabilities. These patients are especially vulnerable, Huppert said, along with patients with a history of violence or aggression.

“And if you have all four,” she said, “God help you.”

ATTEMPTS TO BRING RELIEF

New state legislation offers some hope.

Note: This story was updated on Thursday, March 29, 2018, with information about the signing of House File 2456.

Gov. Kim Reynolds, on Thursday, March 29, 2018, signed a bill, House File 2456, that addresses a wide-range of mental health issues, including: establishing new “access centers,” allowing mental health professionals to disclose information to law enforcement to prevent a serious threat to the patient or identifiable victims; provides secure transportation with staff who have mental health training and establishes “assertive community treatment” teams and intensive residential service homes that accept court-ordered commitments and offer a “no reject, no eject” policy.

“This legislation was pushed over the finish line by individuals and families who knew firsthand the importance of having a robust mental health system and the pain caused when services they or a loved one needed weren’t there,” Reynolds said in a statement prepared for the bill’s signing ceremony. “I know we can do better, and with this legislation, we will do better.”

Some of the provisions include treatment of substance abuse, which often accompanies mental health conditions, and addresses needs of law enforcement personnel, who frequently are thrust into situations involving mental health crises.

Diane Brecht, vice president of residential treatment services for AbbeHealth, has been following the legislation, and hopes that funding will accompany it.

AbbeHealth’s Penn Center began in Delaware County, in northeast Iowa, with 60 residential beds for patients with brain injuries, mental health illnesses and intellectual disabilities and the elderly.

It since has expanded to include community-based services for people with severe mental health illnesses, providing “habilitation services” houses in Manchester, Vinton and the Cedar Rapids/Marion area.

Staff provide supervision and support with developing skills based on person-centered plans for each individual, such as cooking healthy meals, coping skills and stress management for adults with serious illnesses including major depressive disorder, bipolar disorder and schizophrenia.

“Drive past the house and you wouldn’t know there’s someone with a disability or someone with a mental illness living there,” Brecht said, citing going to work or to church among the activities that residents engage in, just as anyone else might.

The concept is a popular idea with waiting lists, and undoubtedly, more of the houses could easily be filled, but for a workforce shortage, she said.

“There’s a huge need for that service,” Brecht said. “The challenge is finding enough staff.”

One year ago, Penn Center formalized an affiliation with UnityPoint Health-St. Luke’s Hospital in Cedar Rapids to provide more continuity of care, she noted.

The hospital is among the largest providers of inpatient psychiatric beds in Iowa, with 24 for children or adolescents; 30 for adults and 18 for geriatric patients.

University of Iowa Hospitals and Clinics in Iowa City operates one unit of 15 child/adolescent inpatient psychiatric beds; two units of 22 beds each to provide 44 beds of general psychiatric care, and one unit of 14 beds that focuses on the geriatric population.

In addition, the hospital operates a 15-bed medicine-psychiatry unit, which treats patients with co-occurring physical medical and psychiatric disorders.

The Broadlawns Medical Center Inpatient Behavioral Health Unit has recently undergone changes at its 44-bed facility in Des Moines.

A four-seasons sunroom, with plans to incorporate a healing garden to promote patients’ access to sunlight, nature and fresh air, are among the physical improvements. Treatment includes medication, health coaching and exercise, and if a patient suffering from major depression has no positive response, electroconvulsive therapy is a new option at Broadlawns, said Dr. Earl Kilgore, director of government relations there.

All of the beds are for adults, but Broadlawns also has three adolescent psychiatrists on staff to help fill a need in central Iowa, Kilgore said.

At St. Luke’s, Carol Meade, director of behavioral health, said the rooms – including some that are double-occupancy – are often full, depending on the time of year. Summer, for example, is a less-busy time in the child/adolescent unit.

An average stay for adults might last six to seven days, with comparable numbers for both younger and older patients.

That’s because the units are not designed to be long-term. Rather, Meade said, they focus on those in crises, such as suicidal patients and those who pose a danger to themselves or others.

“Our goal is to stabilize folks and get them back into the community,” she said.

The short-term stays are a change from a few decades ago, when a 30-day stay may have been standard, she added.

Patients now see a psychiatrist and nurse practitioners, as well as social workers and registered nurses, and join in group therapy, recreational therapy and have one-on-one time with an assigned nurse.

Some patients are committals from the judicial system, while others are voluntary. Restraints and seclusion rooms are “not used lightly,” Meade noted, and are very closely regulated to keep people safe.

“We go through a lot of training to assure they are used as safely and as infrequently as possible,” she said.

Like other mental health professionals, Meade sees hope in Iowa’s new legislation, including better services for patients with complex cases. Similarly, as other health care providers in Iowa have experienced challenges with the change to privatized Medicaid, the hospital, too, has faced issues with reimbursements and sees patients and families affected, as well, she said.

FEELING THE EFFECTS IN A PERSONAL WAY

Courtesy Kristin Ertzinger

The Ertzingers have felt that impact.

Insightful and musically gifted, Simon Ertzinger had friends, but oftentimes struggled as a youth to get to school because of his anxieties.

“I knew I had potential, but I had too much anxiety and too much self-doubt inside me that I couldn’t enjoy it,” he said. “Not once.”

Photo shared by Kristin Ertzinger

His mother noted that teachers often said he was capable of doing his school work but wouldn’t complete it unless it was perfect. He suffered from depression and began skipping school in seventh grade.

While Ertzinger, who works as a graphic designer in the Quad Cities, sought help from multiple mental health care providers early on for her son, he didn’t find it helpful.

“The issues Simon had were deeper than anyone realized at the time,” she said.

She spent years shuttling her son across the state when beds weren’t available close to home, searching for help in various hospitals and treatment centers, and often taking time off work to attend to Simon.

During that time, she found the lack of continuity of care not only disturbing, but completely detrimental to her son. Psychiatrists offered different diagnoses at different sites and with that, prescribed different medications, but with little to no time to monitor the effects.

“(Hospital personnel) pretty much start talking discharge the minute they arrive,” Ertzinger said, adding that staff often seem only concerned with the days leading up to the hospitalization, and are unaware of his previous suicide attempts.

When patients like her son are shuttled all over the state, their records might be in 10 or 20 different hospitals, she noted.

Ertzinger also has found that residential care facilities for people with mental illness will not take a person if they are too sick – as in too suicidal – leaving the family scurrying.

“A lot of times, the only two options are bringing them home and living in terror, or putting their loved ones out on the street,” she said. “I know families who have done both.”

Having behind-the-scene experience, Ertzinger and her son have seen patients stripped of their dignity in psychiatric facilities, enduring what Ertzinger called “borderline barbaric” treatment, including a time when Simon was placed on a hard chair in a small, cold padded room, even as he was having complications from his internal injuries after being discharged from the hospital for those physical injuries.

He stillwas gravely injured, but the assistance, care, kindness and respect were no longer there, Ertzinger said, “because he was now a ‘psych patient.’”

Another time, he was hospitalized after a suicide attempt and placed alone in a “quiet room” at the end of a long hall, completely cut off from anyone, with only a bare mattress in the room.

“He told me he was going mad,” his mother said of the lack of contact with others, at a time when he needed to be around people. “Nothing about this technique helped him.”

Ertzinger often had to plea for help for her son, only to be told, “there’s nothing we can do.”

While she and her son advocate for changes, there is one thing that could make a big difference in Iowa’s mental health system, they said.

“The biggest thing lacking is compassion,” Ertzinger said.

ABOUT THE AUTHOR:

Freelance journalist Cindy Hadish is an Iowa native and experienced health reporter who has written for a long list of magazines, newspapers and other media outlets. Find her on Twitter: @HomegrownIA and on her website: HomegrownIowan.

TO LEARN HOW IOWAWATCH’S NONPROFIT JOURNALISM IS FUNDED AND HOW YOU CAN SUPPORT IT, GO TO THIS LINK.

This IowaWatch story was republished by The Gazette (Cedar Rapids, IA), Cascade Pioneer and CBJ Business Daily (Corridor Business Journal, North Liberty, IA) under IowaWatch’s mission of sharing stories with media partners.

The National Alliance On Mental Illness notes the following:

About one in five adults in the U.S. — 43.8 million, or 18.5 percent — experiences mental illness in a given year.

Among the 20.2 million adults in the U.S. who experience a substance use disorder, 50.5 percent —10.2 million adults — have a co-occurring mental illness.

An estimated 26 percent of homeless adults staying in shelters live with serious mental illness and an estimated 46 percent live with severe mental illness and/or substance use disorders.

About 20 percent of state prisoners and 21 percent of local jail prisoners have a recent history of a mental health condition.

Only 41 percent of adults in the U.S. with a mental health condition received mental health services in the past year. Among adults with a serious mental illness, 62.9 percent received mental health services in the past year.

African Americans and Hispanic Americans each use mental health services at about one-half the rate of Caucasian Americans

Half of all chronic mental illness begins by age 14; three-quarters by age 24. Despite effective treatment, there are long delays—sometimes decades—between the first appearance of symptoms and when people get help.

Serious mental illness costs America $193.2 billion in lost earnings per year.

Mood disorders, including major depression, dysthymic disorder and bipolar disorder, are the third most common cause of hospitalization in the U.S. for both youth and adults aged 18–44.

Individuals living with serious mental illness face an increased risk of having chronic medical conditions. Adults in the U.S. living with serious mental illness die on average 25 years earlier than others, largely due to treatable medical conditions.

Simon Ertzinger, who at age 19, has been hospitalized more than 20 times for depression and anxiety-related issues, offered the following suggestions to improve Iowa’s mental health system:

Shift the culture in care. Focus on human-to-human contact. Focus on feeding these patients food grown close to the ground. Not even special, herbal, remedy foods. Just real food. Food is the most important factor in inflammation. Inflammation is the root of all illness. Give up on Big Pharma. Heavy medications create fear and dependence, often putting you through more trauma and making things worse. BigPharma is for-profit. They will never stop adding more counter medications. This is never how humans were intended to live. It’s a very scary situation. Never commit people. This is my philosophical, highly debatable stance. In my opinion, individuals who are suicidal are not morally subject to forceful help. Let psych units be, but only let ones who volunteer to be there stay in contract. The units will have much higher success rates. What suicidal people need is help, sure. But that looks differently for everyone. In any case, everyone around them needs to comfort them. As for homicidal people, they may need committals. Cap psych unit sizes. Look at Des Moines Broadlawns. It’s a plain chaotic and scary environment. Now imagine they tell you that you can’t leave. Shift on an individual level. Focus on eliminating hormone disrupting, gut disrupting, and brain-altering, proven contaminants like wheat, corn, soy, and specific livestock hopped up on drugs. Eat close to the ground. Stop funneling money to AgriBusiness corporations at an individual level. It will decrease the incidence in sad, unhealthy people who need acute intervention in the first place. You rarely ever have sound mind when you are not of sound health. I believe we all have an inner-child. That inner-child doesn’t always agree with our conscious mind. Assess your subconscious mind and assess your mental blocks and fears. We need to then affirm ourselves and alter unhelpful subconscious messages that create chaos in the mind. This mental health thing works from the inside out. Use therapy, but be careful. Use it for a specific reason, but don’t become complacent. Don’t just go to go. Get something done, then start living again. We need to lean on our family and friends for affirmation. It’s the beauty of human connection.

Simon Ertzinger, talking with reporter Cindy Hadish