"There you go again." Remember that famous line President Ronald Reagan made in one of his many debates? Well, in Iowa it perfectly describes Governor-for-life Terry Branstad and his annual cutting of mental health funding.
Over the course of the past four years, the mental health system in Iowa has undergone a redesign premised on the idea that there had to be a better way to fund and deliver services to people suffering the ravages of mental illness and intellectual disabilities. This idea led to the creation of 15 regions across the state that allow Iowa's 99 counties to work together to provide better services. Our region is the Sioux Rivers Region, which brings Woodbury, Plymouth and Sioux counties together under one regional administrator.
Three weeks ago I attended the Region Advisory Committee in the morning. The focus was on the priorities of developing and expanding community-based employment opportunities for individuals with intellectual disabilities and crisis stabilization programs for individuals with a mental illness. It was the consensus of all present that for the first time in years, as a result of the redesign, a stable funding resource existed to confidently plan the development and implementation of these initiatives, while at the same time continuing all the locally based county programs.
In the afternoon the region's governing body, which consists of two county supervisors from each of the three counties, met. The regional administrator stated that much of what I just described and the relatively secure funding base required to make it all work had suddenly been seriously and negatively altered. Why, you ask? In between the two meetings, Gov. Branstad had delivered his State of the State address and once again had proposed drastically reducing the funding necessary to do what needs to be done for people with mental illness and intellectual disabilities. This, even though the agreement arrived at last year with the Legislature guaranteed at least one more year of funding while the redesign was being implemented.
The good governor does this just about every year. Two years ago he used his powerful line-item veto to prevent the much-needed expansion of the waiver programs that serve thousands of disabled Iowans. Then he resisted Medicaid expansion until the legislators crafted a compromise that he accepted. It is a mystery to all why he now continues to undermine the redesign of services supported by his own administration over the past four years. Also, in the same State of the State address, he even goes one step further by proposing to close two of the four state hospitals in Iowa. One is Clarinda and the other Mount Pleasant, which is the only state institution that provides treatment for co-occurring disorders (people suffering from mental illness and substance abuse).
All of this despite the fact that 6 percent of Iowa's population (about 180,000 people) suffers from severe mental illness. There are only 762 in-patient beds for psychiatric care in Iowa and that will decrease to 700 if these two institutions are closed. It will be much more difficult for families to access in-patient care in southern Iowa, forcing sheriff's departments to transport people 50 or more miles further for in-patient care or, worse still, the patients will have to be held in county jails.
These cuts are proposed even though Iowa ranks 47th in the number of psychiatric beds, based on populations, 47th in the number of psychiatrists, and 48th in Mental Health Courts (Woodbury County has the only remaining Mental Health Court in all of Iowa). Furthermore, there are only 10 designated psychiatric VA beds available for all of Iowa, and they are all located in Des Moines.
The governor and his staff claim that the two state institutions are too costly and that cuts to the regions will be offset by Medicaid expansion. These claims do not justify the chaos that will be engendered. Without at least one more year of the agreed-upon funding for the new regional approach, the startup funding necessary to produce meaningful change will disappear. The closing of two state institutions without any reasonable alternatives will generate the same chaos for patients and their families experienced when the governor unilaterally closed the home for girls at Toledo last year.
Please consider doing whatever you can to help overcome the governor’s projected cuts. Letters and calls to our state legislators will help greatly, but communication with the governor is best because he can choose to line-item veto whatever the Legislature does. Thank you for whatever you can do to help.
Next week: Jim Wharton
A Sioux City resident, Jim Rixner is executive director of the Siouxland Mental Health Center and is a former member of the City Council. He and his wife, Bernadette, are the parents of three adult sons and the grandparents of five.