Iowa’s latest mental health bill — called a “milestone” by Gov. Kim Reynolds when she signed it into law Thursday — aims to fill a statewide need for short-term crisis care services with the creation of six regional “access” centers.
Officials in Linn and Johnson counties — where similar work already has been underway — are left wondering if the state plan meshes with or clashes with their efforts to create local facilities to help people in need of detoxification, sobering or crisis intervention — services that would divert people in need from jail cells and psych beds.
“We are in the initial stages of planning, so whatever the state requires for an access center, we will build that in. We’re just really going to wait to see what an access center requires us to provide so we are able to do that,” Linn County Supervisor Ben Rogers said. “Clearly there are a lot of questions out there. I think Linn is going to move forward because this is something that is desperately needed in our community.”
Officials in Linn and Johnson are looking to hire project managers to help bring the local projects to fruition.
Rogers has requested using county mental health fund reserves to hire a project manager. Johnson County officials, who have been working toward an access center for years, are drafting a contract with plans of hiring someone — possibly with the University of Iowa — this month.
“We really are looking at needing someone prior to getting up and running, to have subject-area expertise. So not just a general project manager but somebody that knows the particulars and deliverables with crisis intervention behavioral health,” Johnson County Supervisor Lisa Green-Douglass said.
Project managers will help make sure their respective access centers adhere to any rules and requirements set forth under the new state law.
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“Whatever the rules are, we will look at and make sure we are complying with them,” Rogers said.
According to House File 2456, which was signed Thursday, access centers must 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 and who do not need significant support.
Iowa Department of Human Services spokesman Matt Highland said the department will begin developing requirements — such as building or service specifics — for the access centers in the coming months.
“There’s going to be a number of things we have to do on our end to get this up and running,” Highland said.
The bill does not say where in Iowa the six centers are to be built.
While the state begins creating requirements, local officials hope for flexibility. Some in Johnson County worry the state approach may be limited and not include amenities considered locally, such as overnight stays for sobering or crisis stabilization.
“What I don’t know that the Legislature’s worked through is this idea of what a community like Johnson County, with a large state-of-the-art hospital like (University of Iowa Hospitals and Clinics), would need is going to be very different than what a community in rural western Iowa with no inpatient psych beds nearby” would need, said Johnson County Jail Alternatives Coordinator Jessica Peckover.
In the end, local officials say they hope for latitude so that the centers provide a lower-cost option to psychiatric hospital units often already at capacity, or give law enforcement an alternative to jail when dealing with certain individuals.
“I think the more the merrier, with access centers, but also give regions the flexibility to design their access centers to the population they serve, not just a one-size-fits-all. That approach does not work well in mental health,” Rogers said.
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Sen. Mark Chelgren, R-Ottumwa, floor manager of the legislation, said the bill should give some discretion to the state’s 14 Mental Health and Disability Services Regions.
“The bill itself is designed to have maximum flexibility with the regions themselves and allow them to determine needs,” he said.
As far as county efforts, both Linn and Johnson counties plan to build out a center in an existing facility. Neither county has identified a specific location yet.
The other big question to be answered is where the six access centers will be located and whether centers proposed in Linn and Johnson counties will be considered a part of that network. Linn and Johnson are in the same mental health taxing region — along with Benton, Bremer, Buchanan, Delaware, Dubuque, Iowa and Jones counties — meaning that plans are being paid to build two multimillion facilities in one district.
“That’s something that the regions, they’ll have to come together and determine strategically where those locations should be,” Highland said. “They’ll really need to be strategic about the placement, development and size of the programs.”
Regions will fund the centers through individual county tax levies, with Medicaid covering services for eligible patients, Highland said.
Chelgren added, if necessary, the state could see more than six centers.
“There’s nothing to say there can’t be more than six,” Chelgren said.
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