116 3rd St SE
Cedar Rapids, Iowa 52401
IOWA CITY — Six years after a Davenport veteran’s suicide sparked national attention and calls from members of Congress for an investigation after having been denied inpatient psychiatric care, the Iowa City Veterans Administration Medical Center is planning for a major expansion.
“Over the past several years, mental health — both in the military and civilian sector — has been recognized as a shortcoming in our medical treatment of individuals, whether they veterans or civilians,” Heath Streck, associate director for operations, said following a 9/11 flag-raising ceremony on Friday at the Iowa City VA Health Care System.
Streck, though, stressed several mental health initiatives and newly approved funding by Congress will “facilitate infrastructure improvements” and the hiring of additional mental health professionals and social workers “to help with workload and increased need.”
President Joe Biden in June signed the Sgt. Ketchum Rural Veterans Mental Health Act into law. The legislation was named for Sgt. Brandon Ketchum.
The 33-year-old served in Iraq and Afghanistan and struggled with post-traumatic stress disorder and substance abuse after serving in the U.S. Marines and the Iowa Army National Guard. He died by suicide in 2016 after being denied inpatient psychiatric care at the Iowa City Veterans Administration Medical Center.
The new law, supported by Iowa’s congressional delegation, will establish three new Department of Veterans Affairs (VA) Rural Access Network for Growth Enhancement (RANGE) program centers, which provide a small team of specialists to meet the needs of rural veterans with serious mental health and daily living issues.
It also requires the Government Accountability Office to conduct a study and report on whether the VA has sufficient resources to serve rural veterans who need mental health care that is more intensive than traditional outpatient therapy.
The VA’s Office of Inspector General concluded in a report that while VA staff were not directly to blame for the way Ketchum was treated by hospital staff, the system could be improved.
“The psychiatrist’s decision not to admit the patient was within acceptable practice based on the information available to him at the time,” the report states. “However, if the admitting psychiatrist had been aware of the extent of the patient’s psychosocial struggles … the psychiatrist may have decided to admit the patient. Moreover, the psychiatrist made a good-faith effort to reengage the patient after he abruptly left the session.”
Streck and Jamie Johnson, public affairs officer, said the Iowa City-based VA health system is in the process of developing a medical psych unit and plans to develop a community living center in addition to a residential rehabilitation treatment program to fill gaps and meet demand.
The VA Health Care System in Iowa City serves veterans and their families in Eastern Iowa and Western Illinois. About 35 percent to 40 percent are enrolled in the VA and receiving treatment.
And demand for inpatient mental health care is expected to increase 6.2 percent by fiscal 2029, according to a VA market recommendation report for Eastern Iowa.
The demand for long-term care is expected to increase by 64.9 percent by fiscal 2029, the report states.
Johnson said that demand is mostly driven by the health care system’s largely aging patient population, who mostly live in rural areas.
“There’s a large swath of veterans out there that just aren’t seeking the services that we would really like to have come see us,” he said. “There are things that we are doing to improve the services, or expand the services and offerings, to veterans that might fall into that category.”
The Biden administration announced plans in March to reposition the country’s veterans’ health care system to conform to new needs among patients in the coming years, which includes recommendations to build a new 30-bed residential rehabilitation and treatment program to provide mental health services and a partnership to expand long-term care services in a new community living center.
Johnson, the public affairs officer for Iowa City VA, said both projects had been planned for before the report was released. He also noted the recommendations must still be approved by Congress and Biden early next year.
Community Living Center
The VA will likely need to identify a new site to construct a stand-alone VA nursing home for dementia and post-surgical care, due to its Iowa City campus being small and landlocked, with a highway on one side and University of Iowa campus on the other.
If the proposal is approved, Johnson said he anticipates the VA would look to acquire land or partner with another organization in 2024 to lease a site to expand long-term care services
“That is in the preliminary stages, and that’s going to be a little further out,” Johnson said.
Residential Rehabilitation Treatment Program
Currently, Iowa City VA patients must travel to St. Cloud, Minn., or Des Moines to receive treatment under a rehabilitation and treatment program, which sometimes prevent veterans from engaging in inpatient treatment programs, due to the distance, transportation requirements and separation from family and local support networks, Johnson said.
“We’ll be able to offer extended residential treatment locally without having to transport our patients to other VAs,” he said. “The programming is group-based and focused on helping patients manage chronic disorders, including depression, (post-traumatic stress disorder), substance use disorders and other conditions along those lines. Often patients need weeks, sometime months, to regain function and be able to recover as best they can. So having an RRTP here will allow us to provide that longer-term care to our acute-care unit.”
Inpatient Medical Psych Unit
While the Iowa City VA Health Care System already has an inpatient mental health unit, its new medical psych unit will add 10 beds for veterans who have an acute medical issue combined with underlying mental health conditions.
Johnson said new inpatient unit — which would be housed in converted administrative office space at the VA hospital — is already being designed, and anticipates it will be ready for use in 2024.
It would be only the second such unit in the VA Health Care System nationwide, he said.
“Staff would be specially trained to treat combined illness, such as addiction, depression and PTSD, and serve as a training site for the University of Iowa Internal Medicine and Psychiatry program, where resident physician will be trained in both specialties,” Johnson said. “Our veteran population is aging, and that aging population also suffers from illnesses associated with aging, such as mood disorders (and) dementia — things that can lead to hospitalization.”
He noted many hospitals across the region have closed or reduced the census of their inpatient psychiatry units, resulting in more veterans seeking care within the VA due to a shortage of beds.
“Those things will help us fill those gaps for veterans,” Johnson said.
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