116 3rd St SE
Cedar Rapids, Iowa 52401
Editor's note: Iowans' Ideas is a guest column featuring the views of different Iowans each edition of Iowa Ideas magazine. This column was featured in the Oct. 27, 2019, magazine.
As a child advocate by profession and the parent of a child who's struggled mightily with depression, I've been quite moved by the degree to which Iowans are talking about mental health and want to see our state do better serving folks with mental illness.
It's been especially heartening to see the focus on the unique mental health needs of children. Children are in fact not small adults, but growing humans whose brains are still developing and whose well-being is inseparable from the well-being of their family.
Advocates cautiously celebrated earlier this year when Gov. Kim Reynolds signed into a law a children's mental health bill that laid out a policy framework for a children's mental health system. The framework holds the promise of fixing our current patchwork of mental-health services that may or may not be available in any given Iowa community — and are usually insufficient even in the best-resourced places.
Advocates also cheered some modest new funding for school-based mental health services, a statewide crisis hotline and buying down the waiting list for a Medicaid program that covers children with serious mental illnesses, regardless of income.
My family lives in Des Moines, among the very best resourced places in the state. We know the limits of services even there. We've waited for an appointment with a mental-health provider who can prescribe meds, waited in the ER for an inpatient bed to open up, and waited for nurses and therapists to pass along important information to psychiatrists who are so swamped they don't speak directly with families.
We are happy to see lawmakers take action. But we celebrate cautiously because their actions represent just a small start. There's more to do:
• Actually fund the children's system lawmakers established. It's essential infrastructure so families know where to turn for help and can access the same array of core services — from prevention to crisis services — wherever they live and when they need it.
• Catch mental-health concerns early, when intervention is most effective, by making sure every child gets developmental screenings. An Iowa Poll earlier this year found that more than three in four Iowans support universal screening with an opt-out option for parents.
• Protect our Medicaid program from an array of punitive proposals that would put up barriers to enrollment and expand the number of Iowans without insurance — and without access to mental health care at all.
• Raise Medicaid reimbursement rates. Not-for-profit children's mental health providers will tell you they are reaching the outer limits of what they can fundraise to fill in the gap between what Medicaid pays and the real cost of care — and to add insult to injury, some still are having to tap lines of credit to manage slow reimbursement from managed-care organizations. Providers who can fill their appointment calendars without seeing patients on Medicaid have incentives not to.
• Continue to infuse mental health services into our K-12 and early learning systems. There are some exciting small-scale efforts that should grow, such as making mental-health consultants available to child care providers and preschools.
There's also a conversation to be had that goes far beyond our health system. I get to talk to a lot of parents and folks who work with children. You don't talk too long before you hear about the stress families feel, and children themselves feel. The idea that our communities are stronger when everyone thrives seems to have gotten lost. Families have received the message they are mostly on their own to figure it all out.
Some kinds of stress are normal — and essential for development. Every family faces moments of adversity. But stress turns toxic when a child experiences frequent adversity without good support. Prolonged activation of the body's stress response systems disrupts the architecture of the growing brain. That kind of disruption is a significant risk factor for mental-health problems down the road.
We could do so much better helping families avoid the stress that derails healthy development if we wanted to.
Families are positioned to thrive, not stress, when parents have a job that pays a living wage, quality child care while at work and concrete supports when setbacks happen. They are better positioned to thrive when we send a message that they are part of a community that cares for them and to which they can contribute.
So let's establish a strong behavioral health system in our state. Let's also take the bigger view, help families thrive, their children fulfill their potential and make our communities stronger.
Anne Discher is executive director of the Child and Family Policy Center in Des Moines.