Guest Columnist

Reynolds must understand Iowa's mental health history

An interview room is empty during an open house at the University of Iowa Hospitals and Clinics’ Crisis Stabilization Unit in Iowa City on Friday, Oct. 12, 2018. The Crisis Stabilization Unit (CSU) is a specialized unit for adults who are having a psychiatric emergency and need immediate care. (Stephen Mally/The Gazette)
An interview room is empty during an open house at the University of Iowa Hospitals and Clinics’ Crisis Stabilization Unit in Iowa City on Friday, Oct. 12, 2018. The Crisis Stabilization Unit (CSU) is a specialized unit for adults who are having a psychiatric emergency and need immediate care. (Stephen Mally/The Gazette)

Gov. Kim Reynold’s children’s mental health board has made its recommendation, including screening all of Iowa’s children for mental health issues.

Director Jerry Foxhoven has lauded the recommendation as an “innovative” step that will attract professionals to the state.

Perhaps this group of experts is envisioning a system that would provide early assessment and identification of problems by checking a child’s health at age appropriate intervals. This type of a program could even include physical, developmental, vision and dental as well as mental health screening. Once problems were identified, diagnostic tests could follow, and treatment could be initiated.

Sounds like a very innovative approach that could benefit all of Iowa’s children. Actually, it’s a decades old federal Medicaid policy called EPSDT or Early Periodic Screening, Diagnosis and Treatment. EPSDT was enacted in 1967 as part of the Medicaid program and all states were required to implement it.

However, as with all public policy, there is a wide gap between policy design and implementation. Many states, including Iowa, never fully implemented EPSDT.

Over the past forty years managed care has slowly dismantled mental health services nationwide. Iowa was an early adopter of managed care. During the late nineties Charles Palmer, Director of the Department of Human Services and Gov. Terry Branstad chose to carve mental health care out of the state’s Medicaid budget and turn it over to a private, for profit managed care company. Over 20 years later the result is what we live with today.

Iowa’s private nonprofit sector does have a rich history of developing effective services for children. Several innovative programs such as psychiatric residential, subacute care, in-home family treatment and treatment foster care were all created by this sector. All, except for a few remaining psychiatric beds are gone. The nonprofit sector in Iowa had been decimated by relentless funding cuts and managed care.

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The reality is that children’s mental health services in Iowa are in their present state due to decades of ill-conceived public policy, continuous efforts to reduce funding and the failure of the private insurance to adopt actual parity. Reynolds needs to understand this history before repeating it.

• George Estle, who is now retired, was CEO of Tanager Place, a children’s human services agency, for 35 years.

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