Branstad willing to consider revamp of Iowa mental health institutions in 2013

Gov. Terry Branstad says Iowa has a system of “ancient” mental health institutions that should be redesigned to better deliver services more efficiently and effectively.

The governor said Monday he would like in 2013 to have someone with “outside expertise” review the facilities at Cherokee, Clarinda, Independence and Mount Pleasant from the perspective of “taking a clean piece of paper and saying, ‘okay, how do we redesign the system that's going to meet our needs going forward?'”

Branstad noted that some of the facilities on the four MHI campuses already have been converted to other uses or to deliver other services. He said the review also would be in cooperation with the affected communities to consider how best to use the facilities to meet their future needs as well.

“I think we need to look at all these institutions because we have these ancient institutions,” Branstad said during a fiscal 2014 budget discussion with state Department of Human Services (DHS) officials who oversee the institutions. “They once had thousands of people in them and now we have very few, and then we have to have all of these professionals to try to serve this population, so the cost per person is huge.”

Yearly costs for some psychiatric services top $400,000 per bed within the MHI system, according to DHS budget documents.

Currently, DHS Director Charles Palmer said the 224 total beds being utilized include 36 at Cherokee, 35 at Clarinda, 75 at Independence and 78 at Mount Pleasant. Mount Pleasant, which opened in 1861, is the state's oldest mental health facility, while Cherokee, which opened in 1902, is the newest.

A 2009 DHS study that was part of efforts by the former Culver administration and the Legislature to streamline state government via reorganization recommended that the MHI facility in Mount Pleasant be closed and that its patients and staff be moved to Independence – a move estimated to save about $1.7 million a year. Lawmakers required the department to recommend closing one of the four state facilities to cut costs, and then-DHS head Charles Krogmeier proposed closing the Mount Pleasant facility because it would cause the least economic fallout and be the least disruptive for families of patients.

However, the issue got caught up in an east-west tussle in the Iowa Senate, which voted in February 2010 to keep the Mount Pleasant MHI and establish a structure to shift some programs from the Clarinda MHI and eventually close that facility – an approach rejected by the Iowa House.

Branstad said the issue should be revisited, but he wanted to “try to get it outside of politics” with a comprehensive view of how best to deliver mental-health services going forward. “If they determine that means there are changes in these institutions, we then need to work with the communities to say how can we best utilize these facilities to meet the needs of the communities,” he said.

Palmer said there probably were savings that could be achieved through economies of scale versus the current MHI system. “The question is always out there. The question is alive and well,” he said.

However, Rep. Dave Heaton, R-Mount Pleasant, co-leader of the House-Senate human services budget subcommittee, said the Legislature looked at that issue before and concluded the state needed all four current MHIs. He also believed the state institutions could provide services for “a lot less money” that what hospitals would charge for mental-health care.

“I think that each quadrant of the state needs access to acute-care services,” he said. “We need maybe to expand what we do at our mental health facilities and start to develop that sub-acute level of care that we keep talking about that would be less expensive. I think it's very important that people should be as close to their community as possible when addressing an acute level of care.”