Branstad Approval Hits a “Low Point” Following His Unilateral Decision to Shutter Two Mental Health Institutes
Key Point #1: Gov. Terry Branstad’s veto this month of mental health compromise legislation that would have salvaged the hospital facilities in Mt. Pleasant and Clarinda has sent shockwaves through the mental health care field statewide.
Key Point #2: “The shut down of the two facilities is making it really hard. Cherokee has really been downsized, and it is a struggle to find beds for those people who need inpatient services,” Dawn Mentzer, Central Point of Coordination administrator from Buena Vista County told the Pilot-Tribune this week. While Cherokee remains open, there often are no beds available when they are needed.
Read the full story here:
Mental health in crisis
By Dana Larsen, Northwest Iowa Publishing
Gov. Terry Branstad’s veto this month of mental health compromise legislation that would have salvaged the hospital facilities in Mt. Pleasant and Clarinda has sent shockwaves through the mental health care field statewide.
The facilities are being closed, with workers laid off. The move prompted supporters of the facilities to propose a lawsuit against the governor, suggesting that state law requires the state to operate four institutions. The suit is unlikely to change the outcome, but is generating public awareness to a damaged system that serves an often unseen need.
The facility at Cherokee, along with one at Independence, survived the veto. Branstad claims those in need of mental services can get them there, or from private facilities.
“The shut down of the two facilities is making it really hard. Cherokee has really been downsized, and it is a struggle to find beds for those people who need inpatient services,” Dawn Mentzer, Central Point of Coordination administrator from Buena Vista County told the Pilot-Tribune this week. While Cherokee remains open, there often are no beds available when they are needed.
The 15 mental health service regions around the state are scrambling to fill the gap. One thing the local region, seven counties that includes Buena Vista, is doing — developing its own home-based facility. A house is being obtained in Sac City that will be outfitted to serve nine residents as an alternative to the hospitals. The project is slated to open this fall, if a director for the new facility can be found.
Such a facility could be even more effective than the traditional institutions, Mentzer feels. “In a majority of commitments, the individual doesn’t really need a hospital surrounding. And often if they are sent to one of the hospitals, they are just released the next day, and that puts a big burden on our law enforcement to take them back and forth to Independence, Waterloo, and Council Bluffs.”
The crisis home can serve the individuals as long as needed or until another option can be found, and it will have its own transportation service to save on police and sheriff time transporting people.
All of the stakeholders in the seven area counties agree that there is a distinct likelihood that the one home facility being established won’t be enough to meet the need. “We’re starting there, and if we need to expand, it is something we will have to look at,” Mentzer said.
It also won’t be a savings to taxpayers. Medicaid offsets some of the expenses at the mental hospitals, which isn’t expected to be the case at the crisis home, so costs to county taxpayers are expected to actually increase somewhat.
The problem is, the funding isn’t there.
“Funding for mental health care is always short. It is not a high priority in the mind of our legislature. We are trying to make all the changes under a capped budget,” Mentzer explains. In essence, the legislative approach has been to set a levy limit at a mid-range figure. Buena Vista’s rate was fairly low and is basically now frozen, with an appropriation for the first year only to make up lost funds.
The money isn’t going to meet the need, Mentzer warns.
“If we don’t change the way funding is provided, the whole system will fail,” she said. One region has already had to plead for more money from the state to keep their system afloat, and two others are in danger of the same result, she said.
For now, Buena Vista County’s only means of continuing to fund the necessary services is to dip into reserves, but that won’t last for long.
Between the seven area counties, Mentzer estimates that there are around 300 residents actively receiving some form of public mental health care.
This includes mental illness, but also services for those with intellectual disabilities, brain injury, substance abuse.
People often relate mental illness issuers to high profile cases like that of Mark Becker, Waterloo, who in 2009 shot and killed beloved high school coach Ed Thomas. Becker bounced around between mental health institutions in the state, but confidentiality rules may have prevented anyone from putting the entire picture of his mental illness together. He has been found to be suffering from paranoid schizophrenia.
However, many of the cases that need handling are not so acute, and can be addressed with counseling, medication or ongoing assistance in the community.
Unfortunately, most often people who are jailed or committed to an institution may have no one to follow-up or provide support after they return to their community.
The local region is addressing this too, with a newly-developed jail diversion program.
“We are hoping to catch people at the point of intervention, so that when they return home they will have someone following their case and providing support, making sure they are taking prescriptions and going to their services — so we don’t have a revolving door in and out of our hospitals and jails,” Mentzer said.
The program started July 1 as a pilot program in Crawford County, is to be expanded to the others. The sheriff and magistrates there have quickly come on board with the concept. When an inmate is booked, jail staff uses a screening developed by a jail diversion task force. If there are red flags for mental illness, a professional can be called in to do an assessment while the person is still behind bars. Medication can be started while the person is still in jail, and referrals are arranged to mental health providers in advance of release.
“We have people going to jails who really should not be there,” Mentzer said. “When the real problem is substance abuse or mental health issues that are causing people to be trouble for their community, jail is not where they need to be.”
While funding is short, and the loss of two Iowa mental hospitals is already being felt, Mentzer said the local region is in stronger shape than others, and making good progress with finding alternatives to hospital commitments.
“I’ve feeling pretty positive. We’re redefining mental health services within the Rolling Hills region. We have great providers in these counties. They are competitors in a sense, but they realize they need to partner together in various ways to provide the services that are necessary,” she said. “We have everyone coming to the table.”