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Watch as candidates for governor answer questions about the state of mental health in Iowa during the Register’s mental health forum at Des Moines University.
Iowa’s crisis in mental health care is getting overdue attention, due to recent tragedies and events organized in response. But it’s clear that the candidates for governor — and state leaders as a whole — have a lot to learn about how to reform the system.
At a forum Tuesday sponsored by the Register, Des Moines University and the Iowa Hospital Association, 12 candidates answered questions on how to improve mental health care in Iowa. A 13th, Gov. Kim Reynolds, had a scheduling conflict and provided a pre-recorded video statement.
The postmortem: The event included a dose of denial (thanks to the governor), a dearth of details and plenty of delusions. But advocates saw signs of hope from the discussion.
“There were platitudes, sure, but there were also sharp observations and specific suggestions. It was not all political talking points,” said Peggy Huppert, executive director for NAMI Iowa. “Honestly, when I compare their performance at the forum to what they had to say to me in July and August, the progress is remarkable.”
The candidates present — Democrats, Republicans, Libertarians and an independent —were nearly united in their criticism of privatized Medicaid management under Reynolds and her predecessor, Terry Branstad. Our editorial board, of course, agrees that it has been a disaster. Private managed care organizations have pulled the plug on care for some mental health patients and reduced payments for providers. An innovative crisis-stabilization program in Centerville was forced to close because state officials failed to write rules to allow Medicaid payment for such services.
Iowa’s problems go much deeper than Medicaid privatization, however. The state had barriers to care, a shortage of psychiatrists and funding issues long before the new system launched April 1, 2016.
“They all criticized Medicaid managed care, but none of them addressed the big question on that — how would they contain costs if it went back to the state?” Huppert noted.
In fact, none of the candidates had any realistic answers on how to pay for improving mental health care. Manage the state budget better than Reynolds and Branstad have? OK, how? Establish programs to divert mentally ill Iowans from jail or psychiatric hospitals? Great – that should save money in the long run, but it still requires upfront investment. Pass single-payer health care and legalize cannabis? That might be a realistic solution in another state or nation.
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Prompted by a question, some candidates agreed that the state should lift a state law that caps the amount of property taxes that counties can collect to pay for mental-health services. The cap is stuck at 1996 levels, even though some counties have seen large population increases since then. But none of the candidates addressed how to overcome the primary barrier to lifting the cap: The Iowa Farm Bureau Federation, which opposed any changes last legislative session.
Other candidates, such as Democrat Jon Neiderbach and Libertarian Marco Battaglia, questioned why Iowa ties mental-health funding to property taxes. It’s a great question, and it’s worth re-examining Iowa’s regional system that is governed by county supervisors.
A few candidates took the easy answer: reopen the Mental Health Institutes in Clarinda and Mount Pleasant. But other candidates — including Republican Ron Corbett and Democrats Fred Hubbell, Andy McGuire and John Norris — recognized that the state doesn’t necessarily need to reopen the institutes, but create more community-based approaches that include several types of beds: acute, transitional and long-term.
A separate event could be organized just to address the night’s final question, on creating a mental health system that serves children. Iowans should demand answers from all elected leaders on how we can intervene earlier to treat children.
But sometimes it’s just better for candidates to keep their mouths closed. Independent candidate Brent Roske said it’s an “obvious correlation” that Iowa has seen an increase in violent crime and that it ranks last in its proportion of mental health beds. This comment perpetuates the unfounded stereotype that mentally ill people are violent.
Candidates and public officials have come a long way, but they must spend more time with Iowans to solve this issue — people like Leslie and Scott Carpenter of Iowa City, who were in the audience of about 400 people at DMU. In 2008, their then-16-year-old son was first hospitalized for suicidal thoughts. He’s since been diagnosed with schizo-affective disorder and other illnesses. They’ve struggled with long waits for a bed; privacy laws that prevent them from even talking with their son’s doctors without a release; a lack of continuity of care between rotating doctors and community agencies; and other holes in the system.
Their solutions include opening more psychiatric beds in regional medical centers and more efforts to recruit more psychiatrists, social workers, nurses and other care providers.
The Carpenters suggested the next event should include parents, medical professionals and others living the crisis every day. We agree. All of us must be involved in the solutions, from patients to whoever will be the next governor.
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