If We Dream It, We Can Do It

One of four Iowans (more than 775,000 people) will experience a mental health challenge this year. Depression is the number one cause of workplace absenteeism. Suicide rates are rising among almost all demographic groups. Ninety percent of chronically homeless people have a serious mental health condition. There are 10 times more people with serious mental illness incarcerated than receiving inpatient care. Jails and prisons have become the mental health providers of last resort. The pandemic has made anxiety and depression worse among people who already suffered with it and created new cases. Iowa is consistently ranked near the bottom of states on a host of measures related to mental health care.

All these statements are true. If we left it at that, we could feel even more depressed and anxious about the state of our world, our nation, our state, our community and perhaps even our family.

To provide some context, other than the pandemic, none of these things is new. We’ve been talking about the “broken” mental health system in Iowa for many years. We’ve bemoaned how inadequate it is, how many lives have been lost or lessened, how we could and must do better.

I would argue that a system that was never built, or never built right, cannot be broken. President John Kennedy began the process of deinstitutionalization in 1963. He dreamed of a robust, community-based mental health system to replace the large institutions that were, in many cases, providing poor care and quality of life for hundreds of thousands of citizens. (The large state institutions were themselves a “reform”, meant to improve care for people previously left homeless or jailed.) Unfortunately, that dream was never fully realized in most of the country, resulting in widespread, chronic homelessness in urban centers and the criminalization of mental illness.

It has been a long and winding road since then, with fits and starts of reform and progress followed by periods of inactivity and even regression. But during the past three years in Iowa we have made steady progress toward building a system that will get people the care they need when they need it, regardless of diagnosis, geography or ability to pay.

We “dreamed” a system of care for adults with complex mental health needs, the people most likely to end up jailed or homeless, and we passed a law putting it into place in 2018. We then “dreamed” of a system of care for children, from prevention to diagnosis to treatment, and passed a law in 2019 establishing it. Finally, we “dreamed” of a more equitable, sustainable and robust way of financing the mental health system and advocated for that with legislators for four years. The start of achieving that dream began with a law passed and signed into law last year phasing out the mental health property tax levy and replacing it with state funding. That transition will be complete in July 2023.

We know that this is an issue that Iowans care about. Poll after poll have shown that, and politicians have heard about it from their constituents.

It’s not as though we don’t know what to do. Although mental illness cannot be cured, it can be effectively treated. There are plenty of evidence-based programs and treatments available that we know would make life better, healthier and happier for tens of thousands of Iowans and their loved ones. Effective and timely treatment will allow them to be productive and independent, to raise families. It will prevent hospitalization and incarceration, which is costly to everyone. Unfortunately, we’re just not doing them, or not doing them consistently and in enough places to make a difference. What that takes is resources and the political will to use them.

If you or someone you know have been affected by a mental illness and have failed to get the care or help you needed when you needed it, this is a good time to act! Because, if you haven’t noticed, it is an election year. Every member of the Iowa House, half the senators and the governor are all up for re-election. First are the primaries in June. Then there will be many open seats with two brand-new people running this fall. After a two-year hiatus in many areas, door knocking and in-person events are resuming.

All you have to do is say “Mental health care is a top priority for me. What do you think we should be doing to make sure every Iowan gets the help they need when they need it?” Then listen. Ask again if they don’t answer. Ask every candidate for every local, state and federal office. Let your friends and neighbors know what you learn. Share on social media. Join the NAMI grassroots advocacy army at www.namiiowa.org. Support candidates who respond strongly with your time and money. Let them know that you’re not going away, that you will hold them accountable if elected, and you will not rest until Iowa does better. Because we must. And we can.

Peggy Huppert is Iowa executive director of NAMI (National Alliance on Mental Illness) the oldest and largest grassroots organization in the U.S. devoted to issues around mental health. It has chapters in all 50 states and more than 600 local affiliates. NAMI Iowa has 14 local affiliates. We provide help and hope for anyone experiencing mental illness and their loved ones. Visit our website at www.namiiowa.org, email info@namiiowa.org or call 515-254-0417.