The Iowa Legislature this year moved the mental health funding care of a county levy to state tax dollars.
It was just the latest in a long line of laws over the past 11 years aimed at fixing Iowa’s failing mental health system.
âIt has been a lifelong change for us,â said Ryanne Wood, Lee County Community and Disability Services Coordinator.
The Iowa mental health system came under intense scrutiny in June 2009, when a 24-year-old schizophrenic named Mark Becker walked into a high school weight room. and shot famous Aplington-Parkersburg football coach Ed Thomas, who later died in a hospital.
During his interview with the police, Becker spoke about angels, demons and a plot to harm the children of Parkersburg. In court, his defense attorneys said he suffered from paranoid schizophrenia and should not be held responsible for his actions, although a jury disagreed and he was sentenced to death. life imprisonment without the possibility of parole in 2010.
Becker’s mental health issues were known to law enforcement officials. He had been jailed three times in the 10 months before Thomas’ death, including a hospitalization that ended less than 18 hours before the shooting.
Wood, who has worked in mental health for 15 years, said there were still discussions that Iowa’s 99 counties meant there were 99 mental health systems. Something had to be done, but the question remained: what?
âFrom a state perspective, there has been a big push to be more consistent across all counties,â Wood said.
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When Thomas was killed, Wood said everyone thought it was time to make some changes. Wood, who is now the President and CEO of the Southeast Iowa Link Mental Health Region, said discussions on how to make Iowa’s mental health system more efficient began immediately. A mental health bill was passed in 2010 to ensure law enforcement knows when crime suspects are released from mental hospitals. But the big changes didn’t come for several years.
Years of talks culminated in the passage of Senate File 440. This bill regionalized Iowa’s mental health system. Regions meant that counties could pool their resources in an attempt to provide better care.
To form regions, counties had to prove that they had access to a number of services. One of the services the SEIL region needed to prove it had was access to mental health beds. It wasn’t difficult initially: one of four mental health facilities in Iowa was located in the middle of the region.
But the Mount Pleasant Institute of Mental Health didn’t stay long. It was closed by the government of the day. Terry Branstad in 2015. That meant the SEIL region ended up with eight mental health beds, all on the West Burlington campus of the Southeast Iowa Regional Medical Center. The SEIL region has around 160,000 inhabitants.
“He didn’t have to ask the legislature (to shut down the hospital),” said Sen. Tom Courtney (D-Burlington), who represented the 44th Senate District when the Regions Act was passed.
Courtney said the legislature decided to fund the state’s four mental health facilities, but Branstad decided he would close the hospitals anyway,
Wood said there was a bit of nervousness in the surrounding areas in the first place. What would happen if the money ran out? Would that mean that some areas of the region would be better served than others for lack of money?
Wood argued that this is the sort of thing that can happen when services are regionalized.
âThere was a fear that the local access points would disappear,â said Wood.
But in many ways the regions have improved. Each county continues to have its own Disability Mental Health Services Coordinator and, because resources are pooled, regions can deliver more services with less money than they would have if each county. county had to provide the service itself. It’s not about Lee or Monks Countys, said Wood, these are the eight counties in the SEIL region.
Having a regionalised mental health system also means that employees in the regions can spend more time learning about their respective issues. Wood doesn’t need to know every detail of financing or drafting contracts, she has someone in her area who can handle it. As CEO, Wood performs administrative functions and oversees the region.
Mental health regions continue to bear a greater burden with less funding
However, the regions are not the end of the story. Since the creation of regions in 2013, legislators have continued to add more rules, more services to fund and less capacity to fund those services. The state handed over the children’s mental health system to the regions and increased the number of services that were to be offered by the regions, all without state money or without the authority of the county governments to raise taxes. .
Wood said all of the changes were made with the center of the state in mind. She said there had been good intentions all around, but that was not enough to capture the reality of the challenges of delivering mental health care in the more rural areas of the state.
One of the best examples is the challenge currently facing the SEIL region: the new state funding program for mental health. The program has billed itself as an increase in funding for mental health, and it is on paper. The fixed regions must obtain millions of dollars in new funding.
But the reality is that, without further changes, the bill represents a permanent reduction in funding for the SEIL region. Currently, SEIL is funded at around $ 43 per resident, but the new legislation will not allow SEIL to be funded at this level for the next five years.
It is without taking into account the growth. Even if the system were to grow at a cost of just 1.5% per year, the SEIL region would need $ 46 per capita by the time its funding was restored in fiscal 2026.
Beyond that, the legislature has only allowed growth of up to 1.5% per year, and that growth is based on changing sales tax collections, not increasing sales. cost of services. If the state sees no change in its sales tax collections, regions will see no change in their funding.
Courtney hopes the change will help the mental health system, but he doubts lawmakers will keep their promise to fund the state’s mental health system. He thinks it’s only a matter of time before the state decides it needs the money for something else, like tax cuts.
A state senator is successful, but not during his tenure
But not all of the changes to the mental health system have involved the regions, and not all have been inspired by what happened in Parkersburg.
Tom Greene worked as a pharmacist before becoming a state senator. Working as a pharmacist, he realized that there are a handful of people with mental health issues who take medication but don’t really need the attention of a psychiatrist every two months to refill. their prescription.
âThere were so many patients who said ‘has the doctor ever called? “” he said of his inspiration to draft the bill.
When Greene graduated, pharmacists only needed four years of study. Now pharmacists receive as much education as doctors, except that their education is specifically about drugs used to treat a variety of illnesses.
Greene saw an opportunity. What if pharmacists could get permission from physicians to manage prescriptions for those with mental illness who are stable on their medications? Greene introduced this bill to the Legislature, becoming one of his signature pieces of legislation.
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Sadly, Greene said he had failed to convince Democrats to support his bill and that it did not pass in his four years as a senator. He said lobbyists for doctors in Iowa opposed the bill, believing the bill was a way to replace doctors.
But Greene said his bill was not about reducing the need for psychiatrists, it was recognition Iowa had too few of them. The bill was about a partnership so that someone who just needed an interview appointment with a psychiatrist could meet with a pharmacist instead. Greene hoped this would free the psychiatrist to meet more urgent cases.
This spring, Governor Kim Reynolds was successful in pushing the bill through and she invited Greene to the signing ceremony.
âI just think it’s a win, a win, a win. I really mean it,â said Greene.