Fix Iowa's mental health system

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Our mental health system is broken. As Medical Director of Mercy Behavioral Health and psychiatrist for three of the East Central Region’s licensed residential care facilities (Penn Center in Delaware County, Chatham Oaks in Johnson County, Cedar Valley Ranch in Benton County), I believe that it is only getting worse.

The evolution of mental health care began in the 1800s with the advocacy efforts of Dorothy Dix to treat and care for psychiatric homeless individuals. State hospitals were built and by the mid 1950s there was one bed for every 300 Americans. However deinstitutionalization became the fad with cost shifting from state government to the federal government and finally to county government for funding institutional treatment and care sites. By 2010 there was only one bed for every 3,000 Americans. After Governor Branstad closed two of Iowa’s four Mental Health Institutes, the Treatment Advocacy Center rated Iowa dead last in the number of state psychiatric beds for the United States with only two beds per 100,000 population.

In the past, many patients have been discharged from the MHI’s to county residential facilities to continue treatment as they transitioned back to community living. However, cost shifting has resulted in fewer of these beds being available. (Examples include closing of Abbe Center for Community Care in Linn County in 2013 due to reduced funding).

Recently I attended a work group meeting and learned that our nine-county East Central Region (the entity responsible for funding stays at our licensed residential treatment facilities) is seriously considering more funding reductions to these treatment centers that would eliminate over 100 beds, further reducing the necessary treatment alternatives for some of our most vulnerable citizens. I can attest that these are not custodial care beds but are active treatment-oriented facilities. These facilities are designed to help adults with serious mental illness to stabilize and then return to community living. After an acute psychotic episode resulting in psychiatric hospitalization, patients frequently need these step-down facilities much like the rehabilitation period required to recover from a heart attack or stroke. This is especially paramount when the patient has been a danger to themselves or others.

A further reduction in residential bed will only result in more cost shifting as our emergency departments in our local hospitals are forced to bear those costs and our jails and prisons are increasingly populated with people with serious mental illnesses. All at a time when Medicaid Managed Care entities are also trying to reduce costs and services.

A majority of the individuals receiving treatment at our local residential sites are under involuntary mental health commitment to that facility. The state’s commitment laws only allow involuntary placement to hospital or residential facilities but not to supervised apartment living or community housing. Society must accept that there are patients who are treatment resistant and/or a danger to themselves or others and require supervised treatment and residential care.

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. I agree with The Gazette’s Aug. 13, 2013 editorial that “It is our responsibility to make sure that we have adequate and healthy mix of services for people with mental health challenges — including acute care and residential options”. Our residential treatment facilities provide such an alternative.

I urge the East Central Iowa Governing Board to reconsider any effort to reduce the number of licensed residential treatment beds available in our region. Some of Iowa’s most vulnerable adults and their families depend on it.

• Alan Whitters is the medical director of behavioral services for Mercy Medical Center in Cedar Rapids.

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