Government

Iowa's mental health reform needs key ingredient: money

Legislators to debate providing help for adults and children

An artistic representation of what mental illness feels like is displayed in the lobby at the Cedar Rapids Public Library marking Mental Health Awareness week at the library in southeast Cedar Rapids, Iowa, on Wednesday, Oct. 10, 2018. (Jim Slosiarek/The Gazette)
An artistic representation of what mental illness feels like is displayed in the lobby at the Cedar Rapids Public Library marking Mental Health Awareness week at the library in southeast Cedar Rapids, Iowa, on Wednesday, Oct. 10, 2018. (Jim Slosiarek/The Gazette)
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DES MOINES — Advocates applauded a massive overhaul last year of Iowa’s mental health care delivery system — but that was just a start.

The 2018 reforms called for critical access centers for people experiencing an immediate mental health crisis, established a statewide crisis hotline, removed a cap on the number of beds a health care facility can house, expanded the use of teams of community-based professionals who can offer comprehensive treatment for people with serious and persistent mental illness and established services for those patients.

But more significant work remains ahead this year for lawmakers — including finding a reliable funding stream to pay for the legislation and creating a mental health care system for children.

Gov. Kim Reynolds appointed a task force to research children’s mental health care and make recommendations. The group delivered its plan last year and Reynolds said she and lawmakers will consider them.

She plans Tuesday during her Condition of the State address to highlight the need of creating a children’s system.

“We don’t have one. They’ve been talking about it for years and now it’s time that we do something,” she said.

It will take time, the governor said, noting how recent reforms to the adult system were spread out over several years with a redesign to the state’s mental heath regions in 2014 and the latest overhaul in 2018.

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House Speaker Linda Upmeyer, a Republican from Clear Lake, said Rep. Joel Fry, R-Osceola, and Shannon Lundgren, R-Peosta, are working on the issue and reviewing the recommendations.

“But where do we start? How do we get moving down this path? What are the things that are possible? And what do we need to do first to sort of set up the infrastructure base for accomplishing some of these things?” Upmeyer said. “I think that will be something we’ll want to work on and I’m hoping that that’s something we can do in a very bipartisan way. We worked together to do that last year. I think that’s important to do.”

House Minority Leader Todd Prichard, a Democratic from Charles City, had similar hope.

“There’s definitely room with mental health to find bipartisan support to solve Iowa’s mental health crisis,” he said.

For all the praise the 2018 reforms to the adult system received, many supporters noted it lacked a funding plan.

The current system is funded largely by local property taxes, which are capped by state law. Some counties have asked for the cap to be raised or eliminated, so property taxes can be increased to create more funding for local mental health care services.

Legislators may debate whether the state government should pick up the whole tab.

An ongoing push from water quality advocates to pass a three-eighths of a cent sales tax for natural resources funding has spurred a new debate: legislators could pass a full 1-cent sales tax increase, use three-eighths for water quality funding and debate over how to spend the remaining five-eighths. Such a debate could include using it for mental health care funding.

Legislative leaders’ opinions on such a proposal are mixed.

“One thing our caucus is interested in is lowering taxes, especially property taxes,” said Senate Majority Leader Jack Whitver, a Republican from Ankeny. “If there are ideas or options to remove (mental health care funding) from the property tax rolls, we’re willing to look at it. ... That’s part of a larger discussion.”

Reynolds and Upmeyer said they believe mental health care funding should be generated at the local level because that keeps funding in the hands of the government closest to the citizens.

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Upmeyer said it used to be funded at the state level but she finds the current county-level funding system better.

“It was a state program and it really didn’t work that well because it wasn’t in touch with people,” Upmeyer said. “Especially when you’re dealing with mental health issues, I think we are absolutely committed that the best way to do this is in a much more local way.”

Another potential state-versus-local trade-off could involve the funding called backfill — money the state sends local governments to compensate for lost revenue as a result of property tax cuts passed by the Legislature in 2013. Republican leaders now are considering ending it.

Such a trade-off was not palatable to Senate Minority Leader Janet Petersen, a Democrat from Des Moines.

“I would hope they would fix our mental health funding structure without some type of hostage-type of package deal that puts local leaders in a bad position,” Petersen said. “If they get rid of the backfill, it will come down on local property owners and I don’t think people around the state want to see property taxes go up. ... I think Iowans are looking for stable, ongoing funding for our mental health system.”

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