Recently, The Journal's editorial board identified its top ten priorities for the 2018 Iowa legislative session. I certainly agree with some of those priorities, but I was disappointed that, unlike in other media outlets across the state such as the Des Moines Register and the Associated Press, mental health services were not mentioned. Yes, the opioid crisis was in the top ten, but any specific mention of mental health was left out. Being left out of conversations and detailed legislative initiatives has characterized mental health care for all too long, and it is one of many reasons why Iowa continues to languish in the bottom five states for those services.
There are at least four major issues in 2018 affecting individuals and families experiencing the effects of mental illness. First, is the ongoing struggle to hold managed care organizations accountable for their persistent denial of services and timely payments to providers. The chaos resulting from one of the three companies leaving Iowa, and the associated confusion for families, has compounded an already distressing indifference to the needs of Medicaid recipients. This is especially true for the mentally ill and intellectually disabled in our state. The state Legislature should act to restore these Medicaid services to state operation and control. The resulting accountability will enhance services and payment procedures. Quality, not profit, will guide the process and all will benefit.
Second, the Legislature needs to finally write into Iowa Code that mental health services for children are to be provided statewide. Under current law, only adults are actually covered for mental health services. This is a glaring gap and needs to be changed. We are fortunate that for years previous Woodbury County supervisors had the compassion to extend services to children, and those services were sustained by the Sioux Rivers Region (one more reason to stay in that region). However, until the code is changed, comprehensive mental health services for children are unavailable for any child not covered by Medicaid in most of Iowa’s 15 mental health regions. As I have stated in previous columns, the only real prevention of a mental illness disease is early intervention; covering children assures that intervention.
Third, it is time legislative action be directed toward further enhancing crisis services across the state. Progress has been made over the past two years, but more needs to be done. For example, the Sioux Rivers Crisis Stabilization Center here in Sioux City is a successful example of what needs to be done. However, much more needs to be done. Transitional programs to house and treat individuals who are no longer hospitalized but still need a safe place to live are necessary. Also, quality residential programs for individuals with a mental illness need to be expanded. On the front end of any crisis situation, the police need additional support to adequately help mentally ill people in crisis. Our police officers do an excellent job when they encounter a mentally ill individual experiencing a crisis, but they need the support of licensed therapists and nurses to help resolve the situation. Not everyone needs to go to the hospital, the crisis center or, as a last resort, jail. Coordinated intervention can lead to an adequate safety plan and assure followup engagements in treatment. Here in Sioux City, we have begun those conversations and the region and state need to play their part through funding and support.
Finally, the governor and the Legislature need to step up and develop and fund the development of the necessary workforce to deliver any and all of these services. Much of what I have described above can only be accomplished with the necessary professionals to provide these services.
The lack of psychiatrists, registered nurse practitioners and physician assistants across the state is one of the main reasons the Iowa mental health system is failing. The establishment of a psychiatry residency program by a Broadlawns Hospital/Unity Pointe collaboration in Des Moines is a major step forward. But it is only a beginning to overcoming this problem. Incentives need to be put in place to attract mental health professionals and assure they remain in Iowa. These would include: loan forgiveness programs, retention grants to keep educated staff in the state, grants for tuition, internships across the state, especially in rural areas, and the expansion of telemedicine sites.
I hope that all these issues become priorities for our legislators. You can help make this happen by speaking up at forums and e-mailing or calling legislators. Please do.
Next week: Jim Wharton
A Sioux City resident, Jim Rixner is the retired executive director of the Siouxland Mental Health Center and a former member of the City Council. He and his wife, Bernadette, are the parents of three adult sons and the grandparents of seven.