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As state funding wanes, local stakeholders left to address mental health needs

The Hawk Eye - 3/12/2017

March 12--State lawmakers have shouted about a crisis. A leader in the Burlington Police Department called it a movement.

Discussion on all sides of the mental health and substance abuse debate have become increasingly tense as state funding wanes. But nearly all parties agree issues facing Iowa's mentally ill and their communities are multi-dimensional: one part positive movement toward change, another part critical lack of funding and resources.

Spurred by the July 2015 closures of state-run Mental Health Institutes in Mount Pleasant and Clarinda, communities across Iowa have been left to shoulder the brunt of the work in providing services to the mentally ill, who often also battle substance abuse addictions.

100+ patients

Mount Pleasant's institute was the only state-run facility in Iowa providing dual-diagnosis inpatient care to people battling addiction and mental illness. Now that the facility is closed, hospitals have been left scrambling to pick up the pieces.

"That's our biggest issue," said Misty Harris, Great River Medical Center's behavioral health director. "Previously, the patients could go to MHI and be treated for both simultaneously. Now, it's if you need treatment for mental illness you have to be treated for your mental illness before you can get treatment for the addictions part of it, or vice-versa. There's no intense concurrent treatment."

Harris has led the hospital's Behavioral Health Assessment Team since it was formed in June 2014. In January 2017 BHAT started working 24/7 with a six-member team of registered nurses with psychiatric experience and a social worker. Fully funded by the Iowa Department of Human Services Southeast Iowa Link, BHAT provides services in Great River'sAcute Care Center, Emergency Department and Intensive Care Unit.

An integrated care clinic was established in 2015 to serve clients from Optimae LifeServices in Des Moines, Henry, Lee and Louisa counties, that provides residential and support services for people with mental illness or developmental disabilities. A partial hospital program was started the same year for patients who don't require inpatient hospitalization but need more help than an outpatient clinic. Services are available part of the day Monday through Friday.

Great River is the only hospital in southeast Iowa providing inpatient mental health services for adults. And its eight-bed facility is always full, Harris said.

"We average over 100 patients a month that are coming in with a behavioral health or substance abuse issue," she said. Sometimes the emergency department will hold five or six patients at a time waiting for a bed to become available at the inpatient Behavioral Health Unit.

Between March 2016 and February 2017, 291 patients were admitted to the inpatient psychiatric unit, with an additional 177 transferred to another inpatient facility in the state.

According to hospital data provided by Harris, 11 percent of mentally ill patients stay in the hospital's emergency department more than 16 hours. Sixty percent stay less than four hours.

Despite the increased demand, Harris applauded Great River for being ahead of many health care providers in the state struggling to provide mental health services.

"Our region is really ahead of some of the other regions throughout the state in developing crisis services," Harris said, citing the crisis homes in Burlington and Fairfield that serve the area's most at-risk patients.

DHS divides the state into service areas known as "regions," to provide "locally delivered services." Southeast Iowa Link serves Keokuk, Jefferson, Van Buren, Washington, Henry, Louisa, Lee and Des Moines counties in an effort to bring together a variety of services and sectors to help the mentally ill and addicted.

Close collaboration with county judges, police departments and jail diversion programs have been a key part of Great River's efforts, Harris explained.

Left with the aftermath

At the Burlington Police Department, Maj. Darren Grimshaw leads the effort to develop a Crisis Intervention Team to train its officers on how to handle mentally ill and addicted people they encounter on the job.

In two weeks one of the department's officers will go to Johnson County to participate in a 40-hour CIT class and eventually train others in the BPD.

Until about four years ago, police officers were only required to complete eight hours of mental health training at the Iowa Law Enforcement Academy. Then the state issued a new law requiring a minimum four hours of training every few years.

But that's not nearly enough, Grimshaw said.

"Law enforcement tends to be kind of the spearhead of interaction," he said. "They're the first ones that are always dealing with these individuals, and what we realized was our law enforcement officers were ill-prepared. They just didn't have the training, the expertise and the knowledge to really deal with it."

About six months ago a group of law enforcement officials in southeast Iowa's eight-county region started meeting monthly with other local stakeholders and mental health providers to determine how a crisis intervention program could be developed for the region.

The goal is to build a specific program for southeast Iowa over the next 12 to 18 months, Grimshaw said.

Initially developed in 1988, the CIT model "seeks to bridge the gap between police response and mental health care by forming a partnership with behavioral health and human services professionals, consumers, their families and law enforcement," according to a CIT International fact sheet.

Police Chief Doug Beaird described it as "critical" for police departments to better train officers in dealing with the mentally ill population.

"The bottom line is, at this point we just don't have any resources," Beaird said.

In a six-month period last year, Beaird said the Burlington Police Department received more than 300 calls related to incidents with mentally ill people.

"We get called back to the same place, the same people over and over again," he said. "And that's I think what we're getting at with this crisis intervention. Somehow we got to intervene and get these people the help they need."

Law enforcement always had difficultly dealing with the mentally ill, Beaird said, but problems have significantly escalated since the area lost Mount Pleasant's MHI.

"After those state facilities closed is when this thing just absolutely spread rapidly. It spread rapidly and it spread fast, and now we're left to deal with the aftermath."

Once fully operational, a CIT is meant to assist law enforcement collaborate with mental health professionals on-site when they respond to incidents.

"Our concern right now is that as people are forced to stay within public jurisdictions and controlled by those areas -- meaning, it's not the state that's going 'we're going to put money into this problem and here's how we're going to help local jurisdictions' -- now it's literally Chief Beaird saying, 'how do I utilize my personnel to deal with the people suffering from mental illness in Burlington?'"

Since most calls responding to mental health-related incidents require two officers, its been taxing on the department's resources, Beaird said. To help ease some of BPD's needs, the city council allocated money in next fiscal year's budget to hire two new police officers.

Revenue estimates coming

Discussions in the Legislature surrounding mental health challenges have persisted since the MHI closures and, most recently, Gov. Terry Branstad'sMedicaid privatization initiative. But little has been done to address the lack of necessary funding and resources.

Iowa ranks behind all 50 states in the number of state psychiatric beds per capita, according to a July 2016 report by the national Treatment Advocacy Center.

In 2016, Iowa had only 64 state hospital beds, down from 149 in 2010. Only two beds are available per 100,000 residents.

State Sen. Rich Taylor, D-Mount Pleasant, was one of the leading legislators in a lawsuit filed against Branstad alleging he violated the state constitution in closing two of the state's four mental health hospitals, and he has continued to be critical of the administration as problems with Medicaid privatization persist.

"It hurts me to see what we're doing to the mentally ill in Iowa," Taylor said at a campaign event last year. "Systematically, red states all over the country are denying health care for the poor, for the elderly and for the mentally ill. And we can't do that, we can't do that in Iowa. Iowans don't treat people like that -- never have, never will, never should. But we've got a governor that has forgotten he's an Iowan."

Rep. Dave Heaton, R-Mount Pleasant, has told constituents he took the Mount Pleasant MHI closure hard as chairman of the heath and human services appropriations subcommittee and representative of an area struggling in the aftermath of the decision.

During a debate in October, Heaton said the MHI closure was "the toughest thing that's happened to me in the last 22 years of being in the Legislature."

"I just want you all to know, I was very hurt by this," he said. "And I'm determined that I will get dual diagnosis and substance abuse to return to our facility. You've got my word."

In February, Heaton co-sponsored a bill requiring state MHIs and hospitals licensed to provide inpatient psychiatric services enroll in a "psychiatric bed tracking system" and report the number of beds available for people with a concurrent mental illness and substance abuse disorder. It did not make it out of the Human Services Committee in time to meet the March 3 "funnel" deadline, likely sidelining it for the rest of the session.

But parts of House File 156 survived funnel week, including provisions to implement the bed-tracking system and create a state work group to develop regional strategies to address the needs of Iowans with mental health, disability and substance abuse disorders.

Legislators are expected to receive updated revenue estimates Tuesday determining how much they can spend on the 2018 fiscal year budget.


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