Mental health: Preserve options while building new approaches

When we look at the current condition of the mental health system in our community, state and nation, there are certainly opportunities for improvement. At the same time there are some exciting advances in the industry, including breakthroughs in brain research and improved treatment options. The challenge will be to prepare new programs and strategies before drastically changing the services currently in place.

Recently Gov. Terry Branstad, in his proposed budget, made plans to close the mental health institutes at Clarinda and Mount Pleasant. This represents closing 61 inpatient psychiatric beds and the removal of between $8 and $10 million from the mental health system. Both of these facilities have specialties that we are not prepared to absorb into our communities and the lack of funding will make it even more challenging. Clarinda specializes in geriatric psychiatry and typically has a several-year waiting list for admission. Mount Pleasant specializes in working with clients with co-occurring substance abuse and psychiatric conditions. Both populations can be complicated and difficult to treat. At this point there is not a clear plan for these patients after the closures and it does not appear as if the funding will remain in the mental health system to assist in creating new services.

UnityPoint-St. Luke's is a leader in the mental health community serving people from 18 months through the geriatric years in a continuum of inpatient and outpatient programs. We focus on evidence-based strategies to provide the best possible outcome for our patients and their families. In recent years there has been some excellent research on brain development and the impact of trauma on our physical and mental health.

Several years ago, Kaiser Permanente and the Center for Disease Control conducted a study that looked at the impact of adverse childhood experiences (ACEs) and long term mental and physical health. They asked the recipients if they experienced any of the 10 types of trauma which were divided into three categories - abuse, neglect and household dysfunction. The results were surprising for many. The study showed that ACEs are common and are also linked to a range of health and social outcomes.

In the 2012 the ACE questions were added to the Behavioral Risk Factor Surveillance System questionnaire in Iowa. The results were consistent with those from other states. According to the data, 55 percent of Iowans have experienced at least one adverse childhood experience, 20 percent have experienced two or three ACEs and 14 percent, four or more. This means they are at a higher risk for issues like substance abuse, depression, suicidal thoughts as well as many physical ailments as adults. Research shows us that exposure to toxic stress as a child disrupts the development of the brain and increases the likelihood of developmental delays and health problems later in life such as heart disease, diabetes and substance abuse. We also know that these children often experience behavioral and emotional challenges at school and in the community. These issues often continue into adulthood.

Where do we go from here? We need to take a two-pronged approach to address these issues. First, we need to focus on the issue of ACEs and how to better help these families and their children. In a similar way that hospitals practice universal precautions to protect patients and health care workers, we need to assume any child we come in contact with could be experiencing trauma in their home. This means we take a compassionate, trauma-informed approach when working with children in our schools and community knowing that many of them are coming from homes in crisis. By taking this approach we can help build resiliency and potentially prevent some of the long term effects of trauma.

Second we need to thoughtfully consider what kinds of treatment would be best for those already in our mental health system. It will not be helpful or safe to simply close 61 inpatient psychiatric beds without a well-designed and adequately funded plan. Both of these mental health facilities work with patients who, like the children, should be treated in a trauma-informed, compassionate manner.

At UnityPoint-St. Luke's our mission 'Is to give the health care we'd like our loved ones to receive.” Whether working with a child experiencing emotional challenges or an adult patient at an MHI they are loved by someone. What if it was your loved one? How would you want them to be treated?

' Carol Meade is Manager of the Outpatient Child and Adolescent Behavioral Health Services at UnityPoint-St. Luke's. Comments: carol.meade@unitypoint.org