‘A huge gap between the treatment’: Iowa lawmakers hope to address mental health care rift

DES MOINES — Bettendorf Police Chief Doug Scott has seen the impacts the lack of short-term mental health support is having on the city up close.

Local law enforcement utilizes tools to support people experiencing mental health crises, he said, including mental health professionals who join first responders during mental-health-related calls.

But, he said, that’s not enough to prevent repeat offenders struggling with their mental health from going out and committing more low-level crimes. Local law enforcement has two options in those cases: bring them to jail, where they will receive limited mental health care, or to a hospital, where they may exhibit behavior that is too violent for staff to handle.

“Nobody wants to see somebody moving in and out of jail on a regular basis,” Scott said. “The overarching concern right now is, how do we stop this cycle and improve the outcomes of this group of individuals that's really struggling long term to help them get back on their feet?”

It's an issue he hopes the state legislature will address this session, following years of Iowa counties and local law enforcement expressing concern over short-term treatment options for repeat offenders struggling with their mental health.

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Iowa state Rep. Gary Mohr, a Republican from Bettendorf who plans on spearheading efforts to improve subacute mental health treatment options in Iowa during the 2026 Iowa legislative session, said a coalition of Quad Cities law enforcement officials’ stark warning on the severity of the issue caught his attention.

Last year, during a meeting with law enforcement officials from Scott County, Davenport and Bettendorf, Mohr said local sheriffs and police highlighted a group of fewer than two dozen low-level offenders struggling with their mental health who cycle between hospitals and jails due to the lack of support options between the two.

They told Mohr that investing in subacute mental health care in Iowa communities would improve public safety, save local governments money and help provide impactful relief and help for those caught in the vicious cycle.

“What surprised me was the unanimity of that group on the need for subacute mental health care services in Iowa,” Mohr said during an Iowa legislative subcommittee hearing on the issue in January. “This isn't just a police issue or a sheriff's issue. This is a fairness issue to people with mental health conditions.”

Subacute mental health care is short-term, intensive treatment to resolve the presence of acute or crisis mental health symptoms. Facilities that specialize in subacute mental health provide care at a level just under full hospitalization. The treatment is less intensive than inpatient psychiatric care but is more structured than outpatient therapy.

Mohr told the Gazette-Lee Des Moines Bureau he plans to introduce legislation targeting the “low-hanging fruit” within the issue this legislative session.

“I can't guarantee you we will solve this problem in 60 days, but I can guarantee you there's a huge interest around this,” Mohr said during the subcommittee. “I prefer we look at the need. What ideally is the need out there and how ideally would we solve that need? Then we'll worry about money. But I don't want us to devise a system based on pennies and nickels.”

A ‘huge gap’ in treatment options

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According to a report from the Scott County Mental Health Alliance, the Davenport Police Department saw a 292 percent increase in mental health calls for service between 2020 and 2024.

Between 2020 and 2025, Scott County spent more than $7 million on 17 individuals who are frequently involved in mental health incidents or are users of expensive emergency and community social services, according to the report. This boils down to $84,234 per person, per year.

“Funds spent over the past five years have produced minimal positive outcomes — one individual died in 2023 and another awaits prison time for committing a heinous crime,” the report states.

Scott County Sheriff Tim Lane said the report focused on those who could have been treated in former state-run subacute mental health care facilities that have closed over the last decade due to budgetary constraints.

He said these types of state-run facilities need to reopen to provide adequate support for those in need of subacute mental health treatment.

“The taxpayer is paying for this problem, regardless of the fact that the state has closed their facilities to save money,” Lane said. “There is no facility that exists at this point in the state that has the ability to handle the amount of this problem that exists. What we end up with is this huge gap between the treatment.”

Potential code changes

During the Subacute Mental Health Care Services Interim Study Committee on Jan. 6, co-chaired by Mohr, state lawmakers heard from representatives from the Iowa Department of Inspections, Appeals and Licensing and the Iowa Department of Health and Human Services who noted potential barriers to reestablishing more subacute mental health treatment facilities in the state.

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Corey Turner, director of the State-Operated Specialty Care Division for the Department of Health and Human Services, said this form of short-term care faced challenges with funding and reimbursements. He added that subacute facilities have stricter hiring requirements than crisis facilities and can only treat a limited number of patients at a time, which makes it more costly for these providers to operate.

There are currently 30 available beds in six different facilities across the state that provide this type of treatment, including in Waterloo, Cedar Rapids, Ottumwa, Ames and Sioux City, according to Iowa HHS. However, Turner said he has heard from at least one provider who said they are often underutilized.

Another concern brought up in the meeting is a section in Iowa code stating that subacute mental health care services “shall be limited to a period not to exceed 10 calendar days or another time period determined in accordance with rules adopted by the department.”

Turner said while this section is not intended to limit subacute mental health care services, it is often misinterpreted by providers across the state who view it as a hard cap and stop treatment at the 10-day mark.

“It's a reassessment every 10 days. It's not a fault of the rules or HHS at the time. It’s just the way in which it’s written and the way in which it’s interpreted, providers see it as a detriment,” Turner said.

“It doesn't ensure that there's viability in the business model. If you have a 10-day limit on someone, and that 10th day comes and goes … the individual may already be discharged by the time they receive payment, or they may not be paying for services at all,” he continued.

Mohr told the Gazette-Lee Des Moines Bureau that he plans to include a revision in his proposed legislation that would expand the 10-day window.

Calls for more state support

Scott, Lane and other Quad Cities law enforcement and mental health service providers say state support is needed to address the lack of subacute mental health care services.

The Scott County Mental Health Alliance report calls for using existing mental health program funds more “efficiently,” revising Iowa code to clarify language around subacute care treatment that is misinterpreted by different providers and rewriting the State Medicaid Plan to include the current non-billable support services like Intensive Case Management.

“When we see a person out on the street, we cannot just force them to start taking medication that they need in order to help,” Lane said. “There needs to be a facility. It needs to be operated by the state, because the people who need it can't afford the service, but it needs to deal with both the risk of violence and the need for the mental health services.”