Officials laud Iowa’s mental health care changes

DES MOINES - Iowans who work closest with those with mental health care needs are singing the praises of newly signed legislation that overhauls the state's mental health care delivery system.

The package of programs recently received unanimous approval from state lawmakers and was signed into law by Gov. Kim Reynolds.

The sweeping legislation makes myriad additions and changes to the state's mental health care delivery system, and mental health experts and officials are pleased with the contents.

'This is a real accomplishment for the state of Iowa,” said Peggy Huppert, executive director of the Iowa chapter of the National Alliance on Mental Illness, or NAMI.

One of the most significant elements of the legislation, officials said, is the requirement for the addition of critical access centers, which will provide a place other than jail or an emergency room for individuals experiencing an immediate mental health crisis.

'We know we need to be able to have a place where we can streamline the introduction of those folks into the mental health delivery system,” said Tony Thompson, the sheriff of Black Hawk County and a member of the state task force that researched the subject and made recommendations to lawmakers.

Thompson said the critical access centers will provide relief to law enforcement, which often is a first responder in mental health care crises. The centers will provide a better option for those who need treatment immediately when a psychiatric bed is not available.

'In the absence of a robust delivery system, the de facto or default system that will support, or is mandated to support, is the criminal justice system,” Thompson said. 'I'm the largest mental health provider in Black Hawk County with a 270-bed jail, and that is wrong, morally, ethically and otherwise. It is just wrong.”

Huppert said the centers also will help alleviate a perceived shortage of psychiatric beds across the state. She said the goal is to have six critical access centers so one is within 90 miles of every Iowa resident.

'There's this idea that the solution is always a bed. ‘We need beds.' Well, it isn't always a solution,” Huppert said. 'There's all this emphasis on beds, not enough beds. I'm not sure that we don't have enough beds. I am sure that we don't have enough of the right kinds of beds.”

However, the legislation does also remove a 75-bed cap on health care facilities that treat individuals with needs higher than, for example, those a nursing home would house.

Even though they are in the same mental health region - there are 14 in Iowa - Johnson and Linn counties were proceeding with their own crisis intervention centers before the new law was adopted.

How these facilities will fit in with the ones required by the new law is so far unclear. If the goal is to have a center within 90 minutes of each Iowan, it seems likely that at least one of the Corridor centers would be in addition to the six required under the law.

The legislation also requires a statewide crisis hotline - currently each of the state's mental health care regions has its own hotline - and other crisis-level services in reach region.

Another provision expands the use of assertive community treatment teams, which are groups of professionals that provide comprehensive and local treatment to individuals with serious and persistent mental illness.

The practice is evidence-based, officials said, and allows people with serious mental illness to remain in their communities while continuing to receive care.

'That's been lacking in Iowa for so long. We've been so dependent on facilities and places, and not focusing on resources, people being able to be at home, get back to work and be productive,” said Bob Lincoln, chief executive of a 22-county care delivery region in eastern and Northern Iowa.

Lincoln said assertive community treatment teams have been described as hospitals without walls.

'That's pretty cool. When people need assistance, they're not put in a car and taken across the state,” he said. 'Hopefully that will reduce the demand on psych beds.”

Huppert said the teams also will help ensure the basic needs of individuals with mental illness are being met 'so they can successfully stay in the community.”

Another requirement establishes intensive residential services for people with severe and persistent mental illness, and makes those services available 24 hours a day.

Huppert said these services will help individuals who do not need to be hospitalized but do require ongoing care. She said such options really don't exist now in Iowa. Some such people instead wind up in nursing homes or rehabilitation facilities, but that those places are not good fits for those people and sometimes are not equipped to meet those individuals' needs.

'A higher level of care needs to be in place for that to work,” Huppert said.

One key issue that remains unresolved is money. No new state funding was dedicated to mental health care services in the legislation, so the 14 delivery regions are expected to pick up the tab.

That should be fine for now, officials said, but in a few years those regions may start running short on cash as these new services are implemented.

The legislation did establish a task force to research possible ways of establishing long-term funding streams for the regions. Currently, most mental health care services are funded through local property taxes.

'The biggest part with all these services is they have to be sustainable. They have to be reimbursed at a level that allows fidelity and quality, and incentivizes providers to do it,” Lincoln said. 'So if you have good services but you don't pay for them, they'll soon go away.”

Mental health care officials said they are pleased the legislation approaches the state's delivery system from beginning to end. The legislation includes provisions that address individuals in immediate crisis as well as those with long-term needs; it addresses issues facing individuals, mental health care providers, law enforcement and the courts.

'This is a complete reformation of the mental health system,” Thompson said. 'We're talking about an entire continuum of care that, I don't want to say it doesn't exist, it does exist, but not to the robust nature of what this actually asks for. ...

'We are knowingly and purposefully addressing holes in the system, holes in the delivery. That makes our system much more robust, much more responsive and much more capable than we currently are.”

Huppert said that may be in part a result of the task force that worked to make the recommendations. The group included mental health care professionals and providers, law enforcement officials and state corrections officials.

'We had 22 people from across the state, all of whom had kind of different connections to the mental health system and different ideas of what was important and what was missing. And we had some pretty heated, passionate discussions,” Huppert said.

Huppert said the task force debated whether to narrow its recommendations in order to present something that would have better odds of gaining approval by lawmakers. Ultimately, the group decided the expansive, holistic approach was best.

The proposal passed the Iowa Senate 49-0, and the Iowa House 98-0. With dozens gathered in the Iowa Capitol Rotunda to watch, it was signed into law March 29 by Reynolds.

Huppert credited the task force's work and a societal shift in attitudes toward mental illness. She said more people are willing to talk openly about mental health issues, and the stigma associated with them is dissipating.

'It's really quite extraordinary,” she said. 'I've been around the Statehouse a long time, and you just don't see this.”