New plan for mental health services

By Mechelle Dhondt

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There has been a lot of attention recently on mental health services and the changes and reductions in service that have occurred locally and across the state. Change of any kind can be difficult, and changes in the mental health system have been particularly challenging. One of the challenges we face is helping people understand why the changes and service reductions are necessary.

Historically, mental health/developmental disabilities services (MH/DD) have been underfunded. Last year, Linn County faced a

$5.3 million shortfall in MH/DD funding. As a result, we were forced to cut services in Linn County, including vocational services, supported community living, payee and the jail diversion program. Some of these services are still provided by private organizations, but Linn County is no longer able to fund them.

The decisions to reduce funding for these services, or in some cases eliminate them all together, were incredibly difficult. They were made with input from the Iowa Department of Human Services, Linn County's MH/DD advisory committee, service providers, consumers and their families.

People often ask why Linn County didn't just transfer funding from another budget or reduce spending somewhere else to help cover the MH/DD shortfall. And the answer is this: We can't.

Iowa state law requires funding for MH/DD services to come from a separate MH/DD levy. This means Iowa counties have a set budget for MH/DD services funded by this separate levy. We must provide services within that budget, and that budget alone. Counties cannot use money from other department budgets or sources to fund MH/DD services, nor can counties increase property taxes to fund MH/DD. For example, if we have a mild winter and use less salt and sand on the roads, we cannot use money saved in the Secondary Roads department to fund MH/DD.

The Linn County Board of Supervisors has stood solidly behind services for people with disabilities for many years. The board would have supplemented the MH/DD services funding if the law allowed it, but it does not.

In addition to these changes in services, another change facing MH/DD is the Mental Health and Disability Services redesign bill passed by the Iowa Legislature last session. The redesign bill, also known as SF 2315, proposes to assist in re-establishing funding for the system and to make services more equitable statewide.

The purpose of the redesign has four main parts:

1) Change the management of the system from individual counties providing services to county regions.

2) Establish the county of residence as the county responsible for managing and paying for a person's services, rather than the county where the person was born.

3) Establish the core services that are to be available statewide to all who need MH/DD services.

4) Set a per capita mental health levy rate.

Linn County is talking with our colleagues in neighboring and nearby counties about forming a region. We are in the beginning stage of these discussions and not much is known yet about which counties will be in which region and what those partnerships will look like. Regions must be formed by April 2013, and the new system must be fully operational by July 1, 2014.

As we work our way through the redesign and forming regions, we expect more changes to how people and families receive services. This transition may be challenging, but we will work with our colleagues in neighboring counties, our partners in the mental health system, the Legislature and families to minimize disruption as much as possible.

We are optimistic that the Linn County MH/DD system will benefit from the financing changes when redesign begins in 2013. We expect the redesign to ultimately lead us to more evidence-based practices, to help us continue moving from institutional settings to more community-based settings, and to provide steadier, more predictable funding that will create a functional, regionalized system that offers equitable services statewide.

Mechelle Dhondt is director, Mental Health/Developmental Disabilities Services for Linn County. Comments: mechelle.dhondt@linncounty.org