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How 'access centers' plan to take on Iowa's mental health crisis

Jul 18, 2019 at 6:00 am
    Mike Tiernan, president of the board of NAMI Linn County has breakfast with Steven Miller in Cedar Rapids on Friday, May 17, 2019. Miller developed Schizoaffective disorder in his late teens and battled mental illness for around 20 years before improved medication allowed him to get his life back. (Cliff Jette/The Gazette)

    Steven Miller was 19 when he “started getting really sick.” But for years before that, he’d had a sense that something would go terribly wrong for him.

    “Mental illness and substance abuse run in my family,” he said. “So even at like eight or nine years old, I felt like something was coming.”

    A native Iowan, Miller, now 59, moved to Cedar Rapids when he was four. He struggled silently with symptoms of mental illness through his teen years — at times turning to alcohol, marijuana or other drugs to “manage his symptoms” and numb the pain he was experiencing.

    “People couldn’t tell there was something going on from the outside, but on the inside, I was just an absolute wreck,” he said.

    Finally, after years of silently suffering, Miller reached his breaking point.

    “My symptoms had gotten so bad, they started to scare me,” he said. “I felt like I had bugs crawling on my skin, I was experiencing delusions and feelings of religious grandiosity and I was having auditory hallucinations. It was the auditory hallucinations — the hearing voices — that really scared me.”

    Desperate for help, Miller had his brother take him to the emergency room.

    “Back then, there was really no alternative to the emergency room — there was no other place where people could go to find help,” he recalled.

    And that’s still the case today, said Barb Gay, former executive director of the Area Substance Abuse Council in Cedar Rapids.

    “When life is too much, it’s usually because of the environments around you,” she said. “It could be other people or maybe you’re all alone, and that’s causing some difficult emotional stress, so having a place where you can go is really important. And today, in Iowa we don’t have any place for people to go.”

    That’s why state legislators passed a bill last year that aims to fill a statewide need for short-term crisis care services with the creation of six regional “access” centers.

    24/7 Access to mental health care

    “The idea with an access center is that somebody has a place they can go 24/7 when they are having a behavioral health crisis,” said Kathy Johnson, executive director of the Abbe Mental Health Center, also in Cedar Rapids.

    “And the term ‘crisis’ is really defined by the individual, but generally it is a condition or situation that has a significant impact on your ability to perform day-to-day activities, making it hard to function,” she said. “So a crisis really could just be that something is not going right, and you need someone to help you deal with it.”

    House File 2456, which Gov. Kim Reynolds signed into law in March 2018, requires access centers to provide short-term assistance to Iowans in crisis situations. Those centers would have 16 or fewer beds to provide immediate, short-term assessments for people with serious mental illnesses or substance-abuse disorders who do not need significant support.

    The bill does not say where in Iowa the six centers should be built — only that each one has to provide detox, crisis observation and crisis stabilization services. Some counties, such as Linn and Johnson, also have added sobering units to their projects.

    “The idea in Linn and Johnson counties is to create a one-stop-shop, in which we put all these services under one roof,” explained Diane Brecht, executive director of the Penn Center Care Facility in Cedar Rapids, which offers longer-term and residential care for those with mental illness. “That way, when people come in, we can determine what services they need and immediately connect them with that service.”

    Planning already is underway in eight of the 14 Mental Health Disability Service Regions, according to the most recent Iowa Mental Health and Disability Services Regions Statewide Report, with multiple counties in Eastern Iowa planning projects, including Dubuque, Linn and Johnson.

    Linn and Johnson counties currently have made the most progress, with Linn’s facility projected to open at the end of the year and Johnson’s expected to go online by fall 2020.

    Other counties have also made progress, said Jody Eaton, chief executive officers of Mental Health Disability Service Regions.

    Clarke County has been planning its access center since before the legislation was passed, but the project remains in the development stage. In Dallas County, a crisis stabilization unit already has been created and is up and running. Eaton said she believes county officials plan to build on what they’ve already started.

    There are no plans to build a brick-and-mortar facility in Pottawattamie County, Eaton said. Instead the county has decided to build an “access network” in which there would be a lead agency doing client assessments and then connecting that client with services.

    And in Wapello County, there are plans to develop an access center, likely in the Ottumwa area.

    Other counties and regions, Eaton said, are still in the discussion phase — looking at what the best options are for their communities, whether it be a single physical facility like Linn County’s or a network of services dispersed throughout the region.

    Each county is taking a different approach to meeting the state access center requirements, Eaton said, and it’s possible that other counties and districts also are having conversations about access centers and what their communities might need.

    Mental health in Iowa by the numbers

    Nearly one in five — or roughly 46.6 million — adults in the United States live with a mental illness, according to the National Institute of Mental Health, and, of those, approximately 19.8 million were able to access mental health services. In addition, roughly one in 25 adults experience a serious mental illness that substantially interferes with major life activities.

    In Iowa, approximately 123,000 residents are afflicted with a mental illness, according to the Iowa chapter of the National Alliance on Mental Illness. That means one in four adults will experience a mental health issue and one in 17 will develop a serious mental illness.

    The National Institute of Mental Health says approximately 20 percent of state prisoners and 21 percent of local jail prisoners have “a recent history” of a mental health condition. Federal figures from 2015 showed more than half the people in local jails in the United States suffer from substance abuse disorders, and nearly half suffer from chronic mental health problems.

    And information provided by the Linn County Jail, for example, shows that 39 percent of inmates in jail are on psychiatric medication.

    Mental health care in Iowa’s jails and hospitals

    “Most mental health inmates come to the jail with no medications,” Linn County Jail Administrator Pete Wilson said. “And it could take several days for an inmate to be seen by a psychiatric nurse to get the medication restarted.”

    And because mentally ill inmates can pose a higher risk, Wilson said, jail staff has to be cognizant of where these inmates are housed, as they could be a threat to themselves or others.

    “There are no real treatment options for inmates other than medication,” he said. “There are no group or individual therapy options available to them. Plus, there is a huge liability for the jail in dealing with mental health inmates as their thoughts or actions can rapidly change, and oftentimes staff are not aware of these ever changing events.”

    Hospitals and emergency rooms also struggle to meet the demands of patients with mental illness, Gay, formerly with the Area Substance Abuse Council, said.

    “And there is a lot of research that because the system is overburdened, the interpretation from patients who are in the hospital for mental health or substance abuse situations is that hospital staff is not particularly warm and welcoming and supportive,” she said. “But that is completely understandable because the hospital staff are already overburdened and they are trying to deal physical crises.”

    However, despite the fact that emergency rooms and jails are not the appropriate places to take people in crisis, first responders’ hands often are tied.

    No place for people with mental illness to go

    A police officer since 2005, Cedar Rapids Sgt. Chris Bieber said first responders are dealing more and more with calls regarding people in crisis, either due to mental illness or substance abuse.

    “I’d venture to say on average that at least half of our daily calls have something to do with a mental health issue,” he said. “Some are situations that officers can de-escalate, or connect that person to a mobile crisis unit, and others are situations where the people need more help and end up either at the hospital or in jail.”

    Neither facility is ideal, Bieber said, but when dealing with such cases, officers have limited resources.

    “It’s frustrating,” said Sgt. Brad Kunkel of the Johnson County Sheriff’s Office.

    “Oftentimes, the problem is those two options — jail or the emergency room — don’t really fit every situation,” he continued. “Then we are kind of stuck in this situation where we have to tell a parent or a spouse or a caregiver, ‘Sorry, there is really nothing we can do right now.’ And that is really frustrating because when people call the police, they expect some sort of help.”

    Stepping in

    “That’s really what these access centers are about,” said Linn County Supervisor Ben Rogers, who is shepherding the Linn County project. “It’s closing that gap between a person who is having a mental health crisis — where the hospital and jail are not warranted — and those immediate services that can step in, calm the situation and then address the underlying issues.”

    “Jail is one of the biggest housers of mental health patients,” said Matthew Miller, project manager for the access center in Johnson County.

    “It’s always that or emergency rooms, and that’s what we want to avoid,” he said. “We want to avoid overburdening those systems, as well as over-criminalizing and over-medicalizing these situations, especially since statistically 70 percent of folks who are struggling with a mental health crisis don’t actually need a high level of care. They just need a safe place to go where they can connect with services.”

    Though this is new territory for Iowa, Rogers said he is excited about the future.

    “For the first time law enforcement will be able to divert from jails and hospitals and take people to the access center instead,” he said. “And that’s exciting. This is all new so we don’t necessarily know yet if we’ve right-sized the project — we may end up adding more — but the exciting thing is that we’re even having these conversations.”

    But even if it’s not enough to address every person’s problem with mental health, it’s at least a step toward better mental health care access.

    “I don’t know if it is going to be enough, but it is definitely a step in the right direction,” said Elley Gould, the jail alternatives administrator for the Johnson County Sheriff’s Office. “I’m optimistic. I think these centers will help address needs in the community, and I think it will relieve some of the pressure on our law enforcement agencies, jails and emergency rooms.”

    Today, roughly 40 years since that day his brother took him to the emergency room, Steven Miller said he’s stable and able to live a mostly normal life, thanks to the proper care and the right medications.

    It’s difficult to say whether having an access center when he was sick would have changed his experience coping with mental illness. But, Miller said, it wouldn’t have hurt.

    “I’m sure it’s going to make a big difference for a lot of people,” he said. “I’m very positive about the future — and not just for the access center, but for the people who will be using it. There are just a lot of good things I think are going to come out of it.”

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