Don’t be hasty in closing Iowa MHIs

At first glance, Gov. Terry Branstad's call for closure of two of Iowa's state-run mental health institutions could be viewed as a push for innovations in care for some of our most vulnerable residents with mental health issues.

One might, for example, see parallels between the governor's proposal to defund institutions at Clarinda and Mount Pleasant and the phasing out of sheltered workshops for workers with significant disabilities. In both cases, the push from outside could be seen as a catalyst for change.

But to shutter half the state's MHIs with less than a year's notice and no alternative plan in place (or even a plan to create a plan) is not in our state's best interest.

We have seen nothing to lindicate this is a case where the state should jump and expect the social safety net to simply appear.

Large, state-run institutions once filled an important need, bringing Iowans with mental illnesses out of attics and off the streets to receive treatment and care.

Today, community-based and outpatient services fill much of the need Iowa's four MHIs used to meet. But the institutions still provide critical services that otherwise are difficult, if not impossible, to access.

Four state-run MHIs - Mount Pleasant, Clarinda, Cherokee and Independence - serve adults in their region.

Each has also developed specialty services:

Clarinda is home to a nationally recognized geropsychiatric program which often is a place of 'last resort” for elderly with significant mental health issues who have posed too high a burden on other institutions.

Mount Pleasant offers a dual-diagnosis unit and residential treatment center.

The remaining two mental health institutions provide specialized psychiatric services for children.

It is true that five years ago a consultant recommended closure of two state mental health institutions, but a follow-up investigation by an all-Iowa task force recommended keeping all facilities open until expanded community-based mental health models were able to meet the need.

We have yet to see evidence that has happened; in fact, we've seen the contrary.

This past summer, while providing an update to the state's Mental Health Planning and Advisory Council, an Independence staff spokeswoman lamented an inability to provide adult psychiatric services to an average of 10 callers per day.

The facility has a waiting list for admissions, the spokeswoman said, and some community alternatives for placement have 'dried up.”

Which brings us to another of the governor's budget proposals: Slashing $30.6 million from funds earmarked to help growing counties meet mental health needs.

It may be the time is coming to close one, two or more of the state's mental health institutions. But without adequate funding for community based services, and a plan to make sure Iowans don't fall through the gaps, that time is not yet here.

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