The fact that “mental health” remains a separate category of healthcare demonstrates how far we still have go to. Mental health is part and parcel of – integral to – overall health. It should be a normal part of healthcare, period, but we’re not there. Iowa is doing poorly on the basis of state-run psychiatric beds per 100,000 people, but that is not the only measure of beds or quality of care. Where Iowa (and most states) fall short is on the treatment of the seriously mentally ill. These patients are the most difficult and costly to treat.
We all know someone who deals with mental health issues every day, be it anxiety, depression, or one of a series of much more serious disorders. Mental health is a huge topic that deserves a laser focus and considerable detail. This is an outline of overarching topics and issues that must be addressed:
- Leadership is needed: We need leadership, in the form of a serious, multi-disciplinary, independent task force mandated by the governor. It should include DHS; mental health professionals; representatives from all levels of government; law enforcement; NAMI; family members and patients; and must be mandated to come up with a series of recommendations. It must consist of those with direct knowledge of, and experience with, mental health issues and Iowa’s current system, with a clear mandate to produce a series of recommendations to improve Iowa’s mental health care system from the bottom up. The plan, which they will be given one year to develop, should be detailed and include estimated costs. Budget experts can work concurrently to establish the costs of these recommendations.
- Mental health care must be accessible: With a population of 3.1 million, and given that serious mental illness typically occurs in those above the age of 15 (about 85% of Iowa’s population) and assuming an incidence of serious mental illness of approximately 4.2%, some 112,000 Iowans will suffer from a serious mental illness at some point in their lifetime. We have nowhere near the beds or mental healthcare professionals needed, and there are deserts within the state where people have to travel hours to get help. In brief, mental health care must be accessible to all Iowans. (See: Components of a Mental Health Care Plan for Iowa – The Musings of a Concerned Parent, Scott Carpenter, link)
Most urgent is access and adequate care for the most seriously ill – those who truly need full time care, but end up back in the community either because no appropriate facility is available, or because professionals are unwilling to recognize that, given the severity of the illness, the community is not an appropriate place for that person at that time. Giving these most seriously ill access to the type and duration of care/facilities they need also opens the acute care beds at hospitals for people with all levels of illnesses who are in crisis, at the time they need that access.
- We must provide all levels of care: Not everyone who deals with mental health challenges or suffers from a serious mental health illness needs an acute care psychiatric bed, but we absolutely need a continuum of care that is accessible to all – from acute care, to sub-acute, mid-term, long-term residential care, and assisted outpatient treatment, to the availability of health care professionals for regular therapy. In particular, if we appropriately move patients from acute care beds to a different level of care, we can open up a large percentage of acute care beds. Assisted Outpatient Treatment will greatly reduce the bed shortage and lower overall costs.
We need the new access centers all around the state so patients do not end up in jails and Emergency Rooms for lack of a better option. We need professionals who can deal with dual diagnosis in all age groups (mental health and addiction issues combined) as well. We need professionals who can help with mental health issues in schools too. Regular, accessible treatment also tends to lower costs and improve outcomes.
- Attracting and retaining mental health care professionals. There is currently a critical lack of mental health care professionals and some areas of the state are bereft of any form of mental health care. We may need to put incentives – educational, cost, retention – in place. That will be up to the task force to recommend, but without the professionals, we cannot adequately treat our mentally ill.
- Reduce barriers to treatment: Lack of access is a barrier to treatment. Limitations placed by insurance companies constitute barriers to treatment. Allowing agencies and psychiatric providers to refuse to treat the most seriously ill patients – or forcing patients out of an acute care setting before they are stabilized – constitutes a huge barrier to treatment. Discharging patients (to family and the community) who are not stabilized is dangerous and inhumane. Recidivism rates and costs soar. Parity laws exist; mandating that insurance companies obey these laws is one of the many missing pieces.
As a friend of mine repeats daily as her mantra: We can do better, we should do better, we must do better. If elected, I will work hard so that we can truly say, “We will do better.” And then, “Finally, we are doing better.”
I worked on this policy after consulting with local advocates, Scott and Leslie Carpenter, who have a son with a serious mental illness that has evolved over the past 11 years. Leslie serves on the NAMI Johnson County Board of Directors, teaches Family to Family classes, and is an active member of the Advocacy and Outreach Committee.