Editor?s Note: This is the second in a series of three articles in Iowa Patch?s look at the state?s mental health system, its deficiencies and whether a spate of mass shootings should change the conversation.
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What worries Earl Kelly, the CEO of one of Iowa?s largest community-based mental health providers, is the $18 million discrepancy between what legislators recommend and the amount state administrators say will be sufficient to implement reforms touted as equalizing Iowans? access to mental health care.
The battle could be contentious as the 86th General Assembly is gaveled into session today. Lawmakers completed an overhaul of the mental health care delivery system last year, moving away from a system under which Iowa?s 99 counties each ran their own programs to a system of 15 regional authorities.
Anything short of the full $20 million recommended Friday by the bipartisan group of legislators could mean that the latest in a line of reform efforts ? and there have been several over the last few decades ? is destined for failure, said Kelly, who oversees Des Moines-based Eyerly Ball, which provides mental health care to 6,000 Iowans.
The Iowa Department of Human Services thinks it can be done for $1.5 million.
Kelly?s taking a wait-and-see attitude about whether the Legislature finishes the reforms begun last year, but doesn?t think its track record for fully funding initiatives bodes well. Past mental health overhauls have all stemmed from the same concerns ? limited access and availability of professional mental health services ? and they?ve all faltered under inadequate funding, he said.
For this revamp to be any different, it will come down to what happens when the Legislature starts divvying up revenue.
?The Legislature will look at ?how much money do we have? and then throw it at the various players,? he said. ?You get this much, they get this much.?
In other words, everybody at the table will get some money, but unless lawmakers are feeling generous, no one will get enough money and the mental-health delivery system won?t substantively change.
?Mental health isn?t a big priority,? said Pat Schneider, who heads Eyerly Ball?s board of directors. ?We just don?t have enough people advocating for mental health.?
Retired West Des Moines City Councilwoman and activist Loretta Sieman aims to change that. She thinks that a spate of mass shootings, including last month?s horrific massacre at the Sandy Hook Elementary School in Newtown, CT, have opened a narrow window of opportunity to ?change the conversation? about mental health care in Iowa.
She?s putting together a coalition of advocates, including Schneider, to argue for full funding and to talk about mental health crisis in the larger context of a public health crisis. 2012 was a particularly deadly year, with at least 88 people dead in 16 mass shootings and 140 casualties (injuries and deaths), nearly twice that of other years.
Nationally, 2.4 million Americans live with schizophrenia, 5.7 million have bipolar disorder and 14.8 million American adults suffer from a major depressive disorder, according to the Centers for Disease Control and Prevention. That?s one in 17 Americans living with a serious mental health illness.
In Iowa, about 180,000 people, or 6 percent of the population, have a serious mental illness, according to the National Alliance for the Mentally Ill.
Overhaul ?a Significant Lift by Legislature?
To expand the conversation beyond funding the 2012 mental health redesign, Sieman and other mental health-care advocates will likely have to win the support of Republican Gov. Terry Branstad to do that. Tim Albrecht, the governor?s spokesman, said last year?s redesign was ?a significant lift by the Legislature? and mental health reform won?t be a priority issue beyond debate about funding.
?The focus is truly ensuring it?s implemented correctly and the level of care improves,? Albrecht said.
Sen. Jack Hatch, a Des Moines Democrat who is managing legislation as the chairman of the Health and Human Services Appropriations Subcommittee, says the reorganization is a first attempt in what will be a four- or five-year process to close the gaps in access to care.
Like Sieman, Hatch thinks the mass shootings should, if not change the conversation, loosen purse strings.
After the Sandy Hook shootings, which left 20 school children and six adults dead, politicians turned their attention to gun control. Hatch thinks that?s part of the solution ? ?the shootings are both a gun issue and a mental health issue,? he said ? but will leave that fight to others.
?Let them fight that fight,? he said. ?What we are hearing in the news is all about gun control, and what we should be hearing about is mental health services and how they are delivered.
?We have not been delinquent in this issue,? Hatch said, ?but I am hoping we can use the tragedy we have and divert the attention from gun control to rural mental health services, and continuing at a faster pace to get them implemented.?
?Fear of the Uknown? Among Mental Health-Care Providers
Hatch acknowledges ?fear of the unknown and competing interests? among mental health-care providers like Kelly at Eyerly Ball.
The legislation only tinkers with Iowa?s chronic shortage of acute psychiatric beds and psychiatrists. Iowa ranks 47th in the nation in both the availability of beds and number of psychiatrists per capita, and 46th in the number of psychologists per capita.
?The shortage of beds under the system we had was obvious, and there was no coordination of where the beds were located,? Hatch said. ?The new system will be more clear and beds will be available to all the providers in the region. If you have to go outside the region for a bed, there will be clearer coordination.
Hatch admits, though, that the reorganization doesn?t do much to increase the number of psychiatrists and psychologists. The regional approach should give them a larger area to draw from, providing ?greater incentive to go out to say, Carroll, Iowa, because you?ll be assured of more patients,? Hatch said.
And despite lawmakers? efforts to make access to mental health services the same regardless of what part of the state a person lives in, it?s not a perfect system, he said.
For example, one of the new standards under the redesigned system is increased crisis intervention training for police officers.
?Are you going to be able to train a two-person rural police force as effectively as an urban area? That?s going to be difficult,? Hatch said, ?but the training will be available.?
Counties will be able to ask for an exemption from participating in the system if they can show state administrators they have the resources to pay for their own programs. Otherwise, they will be required to join with at least two counties under the regional system.
According to the Des Moines Register, Polk County is considering going it alone rather than joining with Story, Dallas and Warren counties because of fears the regional approach could mean Polk County would have to trim services. Jefferson and Carroll counties are also considering seeking exemptions.
Hatch said Iowans should regard mental health reform as a work in progress.
?This is an issue that will be continuous for the next four or five years until we get it all straightened out,? he said.
Tuesday: Local legislators respond to issues surrounding funding Iowa?s redesigned mental health delivery system.
Read Part 1 of the series: Mom Whose Son Struggled with Mental Illness Says Shootings Should Change Conversation Iowa, Nationally
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