New Zealand mental health system worth consideration

By Dr. Alan Whitters

While I currently live about as far from Iowa as is possible, the Internet allows me to keep in touch with local and state topics. I am in the middle of my a sabbatical in Taranaki, New Zealand.

Taranaki region is somewhat smaller in size but similar to Iowa in its rural and socioeconomic base. One of the reasons that I chose this region is its similarity to Iowa in language and medical technology. Having practiced in Cedar Rapids for the past 25 years, I am astounded at the difference in mental health care delivery between the two areas.

I have read the recent stories regarding the ongoing deinstitutionalization and mental health care cutbacks proposed by the Iowa Efficiency Report and subsequent DHS recommendations. Ironically, New Zealand has had its own discussions of providing more efficient care and has implemented a strong community infrastructure for those with “serious mental illness” - 3 percent of the population.

The Kiwi system is very community based with an effort to identify problems before hospitalization (or imprisonment) is necessary. Each patient has a case manager who provides compliance with treatment including free transportation to appointments, medications and community resources. There is a liberal use of compulsory treatment orders by the legal system to enforce compliance.

Every patient has a mandated treatment team review every three months. The system is integrated so that the same team takes care of the individual whether treatment is inpatient or outpatient.

Conversely, Iowa (and the U.S. in general) continues to labor under a poorly funded and uncoordinated system. We have a treatment disconnect between the community and the hospital care. Psychiatrists may be paid for hospitalizing ill patients (if insurance present) but not necessarily for keeping them well.

For example, the medications that allow a fast discharge from the hospital may not be the best long-term treatment due to side effects such as weight gain and diabetes.

This “down under” mental health system may be considered expensive in direct costs. However, the community saves money over the long run due to reduced hospitalization, imprisonment and a better quality of life for the individual.

In Iowa, there is not enough infrastructure or community funding to care for present needs, much less absorb the increased needs by the closure of a mental health institute in Iowa. As Jenifer Hemmingsen noted in her Dec. 12 Gazette column, “mental health is no place for a money grab.”

Dr. Alan Whitters has practiced psychiatry in Cedar Rapids for the past 25 years.