Iowa’s mental illness treatment system is not fixed yet, especially for children

mental health puzzle piece - 1

As the third week of the Iowa legislative session winds down, it seems that the urgency of the past few sessions to address mental health care in Iowa has faded. Many policymakers seem to feel that much work has been done in this space, and they are ready to move on to other priorities.

In fairness, the Iowa Legislature and Gov. Kim Reynolds have passed a lot of legislation to improve mental health care including, but not limited to, passing the Complex Needs Mental Health Law in 2018, the Children’s Mental Health Law in 2019, and moving the funding stream from property taxes to the state budget. This took coordination, dedication, and collaboration, and it is appreciated.

Has Iowa made strides in building mental health resources? Yes, absolutely. The difficult reality, however, is that the need for mental health services — particularly among young people — has blown past the progress we have made. As a mental-health advocate, I continue to hear from Iowa families desperately searching for mental-health services for their loved ones and being unable to find them in our state.

Just because legislation was passed does not mean it is working on the ground and improving actual outcomes for Iowans. We are still lacking staffed hospital beds in both private hospitals and at our two remaining state psychiatric hospitals in Independence and Cherokee. Iowa is ranked 51st in the country – last in the nation – by the Treatment Advocacy Center, with only 2 beds per 100,000 people, when the recommended amount is 50 beds per 100,000 people.

Based upon Iowa’s population, we should have 1,205 beds for adults. However, we have 566 staffed beds. The current numbers as of November 2022, according to the Iowa Department of Health and Human Services are: (64 state beds; 502 staffed private beds). For children, we should have 416 beds; we currently have 125 staffed beds (28 staffed state beds and 97 staffed private beds).

Mental health care at all levels is challenged by Iowa’s workforce shortage. We fully support efforts this session both by legislators and the governor to address this shortage. However, part of the reason for the shortage is that it is difficult to work in a system that is broken and not serving the needs of the patients as well as the health care workers themselves.

We must take a multifaceted approach:

• Increase reimbursement rates to allow for salaries more commensurate with the highly skilled services these professionals are providing;

• Increase access along the continuum of care, from the access centers to the hospitals to true #HousingThatHeals in the community.

• We need to be able to serve patients with the most serious mental illnesses like schizophrenia who also have complex needs with co-occurring substance use disorders and other medical conditions as well.

The policies that could make this happen are in place, but the implementation is not. There are good people at the Department of Health and Human Services who are working diligently to improve the system. We appreciate their efforts and recognize that they need support through the additional funding, staffing, and technology necessary to complete this needed work and oversight.

I also urge hospitals and mental health care providers to expand services to those who desperately need treatment all along the continuum. I hope they fully utilize the new tiered rates which should allow them to serve more inpatients with intensive psychiatric needs. I hope they increase the number of Intensive Residential Service Homes (IRSH) for people living with chronic mental illnesses and complex needs.

Iowa must find a balance. The Department of Justice rightly determined that Iowa must do a better job of integrating people with disabilities into the community, partly because of the atrocities that occurred at the Glenwood Resource Center. However, as this occurs, we must remember that there remains a need for long-term residential treatment options for people living with serious mental illnesses.

Too often, without a treatment-focused setting, these individuals end up in jails, prisons, and emergency departments, where they do not get the help they deserve. No Iowan should be criminalized because they are ill and unable to receive medical treatment. But that’s what is happening in Iowa as a result of the severe lack of long-term supportive housing, acute care hospital beds, and state psychiatric hospital beds.

This is a complex and nuanced issue, and careful solutions are needed at all levels, from the federal government to the local policymakers. To truly fix the mental illness treatment system, we need collaboration and accountability.

I hope every Iowan reading this will take the time to write to your legislators and the governor to remind them of the ongoing need and urge their continued attention to this crisis that is still leaving too many to suffer and die. Together, we can make a difference!


Leslie Carpenter is co-founder of Iowa Mental Health

Advocacy, Iowa City, and a longtime advocate for people with serious brain disorders.


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