Mental health issues need more than 1 solution

By The Dubuque Telegraph Herald


While the political reaction to the Newtown, Conn., tragedy has primarily focused on gun control, the school shooting illuminated another issue sorely needing attention and resources: Meeting the needs of the mentally ill. This week, the Telegraph Herald has looked at many issues related to the mental health system, particularly the reformation of the program here in Iowa. While that is on the front burner for local officials, there is more than one problem to be solved. Helping mentally ill people in our society is an issue that must be addressed on several fronts.

Iowa has at long last begun the process of regionalizing its mental health care system. After decades of dealing with 99 different programs, counties are banding together in an effort to provide better services more efficiently. At least that’s how it is supposed to work in theory. Unfortunately, the details haven’t been spelled out, leaving those charged with providing mental health services nervous about how the regional plan will work. Dubuque County officials couldn’t get other counties to even discuss funding and staffing strategies, and the state has put no parameters on the regions to ensure that efficiencies are realized. Hammering out the expectations should be at the top of the list for lawmakers in the January legislative session. If saving money and improving services isn’t part of the goal, then why change the system at all?

Even if state and county officials work together to make regionalization a positive step, there are areas of concern that still need to be addressed.

Too often, mentally ill people end up in jail. Sometimes, like in the case of Justice Krambeer, of Garnavillo, highlighted this week, there has been no crime committed. But when there is no mental health bed available, jail is the go-to repository. Mentally ill individuals tend to not function well there, and law enforcement officials are not equipped to deal with the individualized regimens that can help keep mentally ill patients stable. Meanwhile, the lack of mental health beds is a growing concern. Iowa’s ratio of beds per 100,000 population is 4.9. Iowa is categorized in the “critical bed shortage” area, while Wisconsin (13 per 100,000 population) and Illinois (14.3 per 100,000) are listed as having a “severe bed shortage.” So far, the issue of increasing beds has not been on lawmakers’ radar. It needs to be.

Dubuque was doing a better job addressing this issue nearly a decade ago than it is today. In 2003, when the county had a federal grant to fund its Jail Diversion Program, the results were dramatic. Mental health professionals and substance abuse counselors worked with police and sheriff’s officials, and in the first six months, jail diversion staff assisted 275 times with 207 different people, getting help for individuals instead of placing them in jail. All stakeholders had positive things to say about the collaborative effort. But the grant only lasted three years. When the funding dried up, the program was cut to the bone — down to one treatment coordinator. No matter how good that coordinator is at his job, it is impossible for one person to take on the entire program.

Bridging the gaps in our mental health system will require a multi-pronged approach involving lawmakers, county officials, law enforcement and mental health providers. Better access to services will be a good start. Greater attention to assessment and appropriate treatment must follow, lest we find ourselves in our own tragic circumstance.


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