By Dr. Alan Whitters and Dr. Rickard Larsen
The shooting deaths of 20 children and seven adults in Newtown, Conn., have raised the issue of access to mental health services in our state and our country. While the lifetime prevalence of mental illness affects one-quarter of all Iowans, another 5 percent have a severe and persistent mental illness such as schizophrenia or bipolar disorder that may impact an individual’s judgment.
The Sandy Hook school tragedy may provide a national platform for further discussion of the need to invest in a mental health overhaul, and work to strengthen safety net services that are the foundation of mental health services. Additionally, Iowa is also faced with a defining opportunity to fund mental health services through Medicaid expansion, as part of the Affordable Care Act.
In recent years, state lawmakers have cut or reduced county mental health services in favor of providing property tax relief. Iowa legislators have also chosen to move toward a regional system urging adjacent counties to merge mental health services.
This mental health “redesign” has created long waiting lists for needed services. County residential care facilities have atrophied or closed due to lack of funding. Psychiatric units at both Mercy Medical Center and St Luke’s Hospital in Cedar Rapids, are constantly full and many patients are transported hundreds of miles from hospital emergency rooms just to find vacancies.
Commitment statutes in Iowa are similar to those in Connecticut. It is virtually impossible to evaluate and treat people like Adam Lanza, until they have already demonstrated dangerous behavior. Moreover, even after an individual is committed, placement in a residential facility or mental health institute is limited. We have been forced to use group homes as placement options and therefore lose the power of an imposed residential placement.
Even more tragic is the fact that often funding is not available for further treatment or placement for these individuals.
Even under the best of circumstances, caring for a mentally ill child or loved one is a long, hard journey. But the challenges are even more daunting in a mental-health care system that is tragically broken. The solutions include early identification and intervention strategies.
As physicians, we believe the community must devote resources for its own safety. An additional deterrent, besides the stigma, is lack of health insurance coverage. We believe state lawmakers need to fully implement key provisions of the Affordable Care Act, allowing Iowa’s uninsured residents greater access to mental health services.
Because government officials are reporting record surpluses in the state, we believe this provides the perfect opportunity to ensure appropriate mental health services are funded. Specifically, we need legislative approval of “transitions funds” to help with county deficits for the remainder of this fiscal year, and the addition of treatment beds at appropriate, safe levels of care.
Treatment works if a person can get it.
Dr. Alan Whitters is Chief of Psychiatry, Mercy Medical Center, Cedar Rapids. Dr. Rickard Larsen is Medical Director, St. Luke’s Psychiatric Services, Cedar Rapids. Comments: (Whitters) firstname.lastname@example.org or (Larsen) email@example.com