Deliver local mental health services equally across the state

By The Des Moines Register

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If you had to devise a way to deliver mental health services to people, you wouldn't look to Iowa for guidance.

In this state, counties are responsible for managing and partially funding services for uninsured mentally ill and mentally disabled adults. Having 99 counties means Iowa has 99 different mental health systems. Each is at the mercy of local government budgets, which creates disparities in services.

Someone living in one county may get medications and counseling, while someone in the county next door may not. One Iowan is placed on a waiting list behind hundreds of names. Across the county line, another gets help quickly. It's unfair.

To recognize just how unfair, imagine counties were expected to take care of cancer patients or diabetics. A person's treatment options would depend on where he resided, and he couldn't move to another county for services because he didn't have “legal settlement” there.

After years of this absurdity, elected officials now seem intent on addressing problems with Iowa's system. The Legislature is considering a bill to create a statewide system where Iowans would get help in eight regions, rather than 99 counties. Senate File 481 encourages collaboration between service providers and eliminates the legal settlement requirement.

“This bill will be a culmination of three years of study by the Legislature and stakeholders to move us toward a more comprehensive system,” said Sen. Jack Hatch (D-Des Moines).

Chuck Palmer, director of the Iowa Department of Human Services, said it is a “workable way to get where we want to go” in creating a system that's fair for Iowans.

Now lawmakers and state officials must work through the details to ensure the final version provides equal access to services for all Iowans, no matter where they live. They also must fund it. House Republicans recently blocked a Democratic initiative to increase the state budget for mental health services. Lawmakers and the governor must ensure adequate resources, whether the money comes from state or local coffers.

Mental health reform isn't just about people afflicted with mental illness. It's about ensuring our loved ones and neighbors get needed care - and working toward making Iowa as safe as it can be.

Earlier this month, Jeffrey Alan Krier engaged in a standoff with law enforcement officers. In the end, both Krier and a sheriff's deputy were killed. The tragedy was the culmination of the Sigourney man's three-decade struggle with mental illness.

Two years ago, Aplington-Parkersburg coach Ed Thomas was shot and killed by a former student who had just been released from psychiatric care at a nearby hospital.

Then there are the stories that don't make the front page of the newspaper. Violent crimes. Families destroyed. Suicides. Prisons and jails filled with mentally ill inmates. While the best mental health system won't avert all tragedies, helping ensure access to services will better the odds.

This state ranks 47th nationally in the number of psychiatrists per resident. That underscores the need to ensure other medical professionals - from emergency room nurses to family doctors - are educated about treating mental illness. Iowans with mental health problems show up in hospitals, clinics and doctors' offices all over the state. Workers must know how to help them, which may require additional education and training for more professionals.

The proposed legislation is a step in the right direction to help ensure equal access to care. Changes could result in efficiencies in a system that costs $1.3 billion annually. But it's too early for lawmakers to justify reduced state funding for mental health. That risks causing more problems for Iowans already struggling to find help.

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