A system in dire need of reform

By The Gazette Editorial Board

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Ask just about anyone who's experienced Iowa's mental health care system. They'll quickly tell you it's broken, fragmented, uncoordinated.

Too many patients falling through too many cracks. Hundreds on waiting lists. Few if any psychiatrists available in most counties, and many of those aren't willing to take on more cases. County sheriff's deputies transporting patients long distances to find services.

“We don't even have good data telling us how many people need these services in our state,” Assistant House Majority Leader Renee Schulte, R-Cedar Rapids, told us.

The situation has worsened in the past decade. Services have become concentrated in metro areas, such as Polk and Linn, while they are scarce elsewhere.

Iowa must do better for our most vulnerable citizens.

Iowa Hospital Association President Kirk Norris acknowledges that payment for services remains part of the problem. Many patients are in the Medicaid program, where provider reimbursement rates are increasingly inadequate to cover expenses, say many in the field.

However, Norris and hospital CEOs Ted Townsend, St. Luke's, and Tim Charles, Mercy, all say the lack of uniformity in the delivery system is at least as much to blame. They say the system needs major reform.

Schulte is among those legislators trying to kick-start reform. She'll help introduce a mental health bill this week - a “shell” beginning what she says will take several years and phases to complete. The goal is to create one coordinated system of care, regardless of age.

“If someone has mental illness as a child, they likely still have it when they become an adult ... but there are lots of gaps in service when they turn 18,” Schulte said.

Counties are charged with overseeing mental health care services. But since 1995, property taxes to support programs have been frozen and the state hasn't kept up its share of funding. Meanwhile, providers such as St. Luke's, which treated mental health patients from 67 counties last year, have to deal with different rules in each county.

Schulte and others propose rooting out inefficiencies in the system, then setting aside the savings in a fund toward building more capacity, especially for follow-up care once acute treatment is done. A state task force recently found that “subacute care” is critical and in short supply in Iowa.

The hospital leaders say they're more optimistic that legislators will make progress on the issue this session. They point to the Republican House majority's HF45 bill that called for cuts in dozens of programs - but included a $25 million appropriation to shore up mental health programs - as a sign that legislators are getting serious about this problem.

They should. The problem is serious and will only get worse without major reform.

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