Mental health advocates say change to Iowa law could help prevent tragedies

DES MOINES — Iowa mental health advocates say a proposed change to the state’s involuntary commitment law will help provide earlier intervention to loved ones in the grips of psychosis who refuse or don’t seek treatment.

Iowa lawmakers have advanced legislation that would allow Iowa courts to order treatment for individuals showing psychiatric deterioration when people can’t recognize they need help and are unlikely to seek it on their own.

Under current law, a judge may order the commitment, treatment or hospitalization of an individual if the court finds by “clear and convincing evidence” that the person is seriously mentally impaired.

According to the Iowa Judicial Branch, a person with a serious mental impairment lacks sufficient judgment to make responsible decisions about his or her hospitalization or treatment, and is a danger to himself or herself or to others, or has a history of not complying with prescribed treatment that has led to harm.

Leslie Carpenter, cofounder and lobbyist for Iowa Mental Health Advocacy, said the current language requires “the person to become so sick that he or she has to become a danger to themselves or others.”

“When there's a tragedy in which someone with an untreated mental illness dies by suicide or hurts or kills someone else, there is very often a public outcry of, 'Where was the family? Why didn't they get him or her help?'” Carpenter told Senate lawmakers during a legislative hearing Monday. “Well, I'm here to tell you where those families are.”

Carpenter’s son has a schizo-affective disorder. She and her husband, Scott, co-founded Iowa Mental Health Advocacy in 2018 after running into barriers securing treatment for their son. The pair advocate for improving the treatment of people with serious brain illnesses in Iowa and across the country.

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“They usually been trying years to get their loved ones a treatment that they so desperately needed, and too often were told, ‘Well, you have to wait until he becomes suicidal or homicidal’,” Carpenter said. “It makes no medical sense, as we certainly don't wait for someone having a heart attack or a stroke to be on the verge of death before we step into treatment. I can tell you that it is excruciatingly painful and scary to know your own child is that desperately sick, but can't recognize his own illness” due to changes to the frontal and parietal lobes of the brain

“Put another way, when someone passionately believes that they are the second coming of God and that they need to go to Washington (D.C.) and save the world, you can't talk that person to go into the hospital,” Carpenter said. “ … I have a friend who said, ‘My son finally qualified for treatment the moment he jumped off the roof and plunged to his death.’”

House File 312 would allow a court to also order the treatment of a person if the court finds the person is experiencing “psychiatric deterioration” where based on that person’s history he or she is unlikely to seek treatment, is unable to understand the need to treat the mental illness and is likely to develop a serious mental impairment without treatment.

Iowa would join 34 other states that have similar laws.

“Our son has now been hospitalized 29 times so far. There's plenty of documentation that if he goes off his meds, his illness has only worsened,” Carpenter said. “It is important to know that our best chance to help people with schizophrenia and other severe mental illnesses is with early and consistent treatment. This bill helps us to provide that earlier treatment.”

Kali White VanBaale, an advocate with Iowa chapter of the National Alliance on Mental Illness, said such a law could help prevent tragedies like the 2017 killing of a Bondurant family.

Chase Nicholson was sentenced to three life terms for killing his parents and sister in their home. He had been diagnosed with schizophrenia and bipolar disorder and had a history of self-harm.

VanBaale said the legislation could have helped the Nicholson family and her own nephew, who suffers from anosognosia, a neurological condition where a person is unaware of or denies having physical or mental health problems.

She said her nephew was in the Polk County Jail for seven months this past year, “and is once again homeless in downtown Des Moines.”

“But he's not sick enough, he doesn't meet the deterioration criteria for involuntary commitment, and so we just keep riding this revolving door of hospitalizations, arrests, homelessness and starting over again,” VanBaale said.

Nina Richtman, with the nonprofit Treatment Advocacy Center, described the challenges faced by individuals with psychosis, who often cycle between hospitals, jails, prisons and emergency departments, and emphasized the importance of involuntary intervention for those with untreated psychosis, citing the high cost to communities and the risk of lasting brain damage.

Carpenter said the change would maintain due process and civil rights protections currently contained in Iowa law. Individuals petitioning a court for involuntary commitment or treatment would still have to provide supporting affidavits or a written statement of a licensed physician in support of the application, or both.

If the application is adequate, a judge would schedule a hearing, where both the petitioner and respondent would each be allowed to testify and to present and cross-examine witnesses and present other evidence.

“Being in psychosis is not a right that we need to protect. It's an illness that we need to responsibly and compassionately step up to treat,” Carpenter said.

Lobbyists for Iowa medical groups, though, expressed concerns about the availability of psychiatric beds across the state and the definition of psychiatric deterioration.

Iowa has a total of 875 licensed psychiatric beds, with 759 of those beds actually staffed, according to data from the Iowa Department of Health and Human Services.

Seth Brown, a lobbyist for the Iowa Medical Society, said psychiatric deterioration is a "term of art" with a specific, precise meaning within the field of medicine, and prefers the bill be limited “to medical professionals who can make that determination.”

“But at the end of the day, we do want to make sure that individuals can seek that help, and they have access to those resources,” Brown said.

The Iowa Medical Society was registered undecided on the bill.

Emily Piper, representing the Iowa Psychiatric Physicians Society, echoed concerns with the portion of Iowa’s commitment code that would allow two individuals to request a commitment by using a medical term of art, “rather than simply saying, ‘Is this person a danger to themselves or someone else?’”

She raised concerns about the bill further stretching the state’s existing limited capacity to provide psychiatric care.

“We also have some concerns about that capacity if we begin to add a second route for a civil commitment hearing,” Piper said. “We know that the capacity is a problem across the state. … At this point we need to also address that if we are going to end up seeing more and more people committed because of psychiatric deterioration.”

The bill passed the Iowa House, 91-1, last month. On Monday, all three members of an Iowa Senate subcommittee signed off on advancing the bill to the Senate Health and Human Services Committee to continue work on the bill.

“I think we have some open questions to address, but this is important enough I'd be willing to sign on and move it forward and let us see if we can get some more feedback,” said Sen. Kara Warme, R-Ames, who served on the subcommittee.

Comments: (319) 398-8499; tom.barton@thegazette.com