[NYAPRS Enews] Exciting Changes in Iowa Resemble NY's Experiment in Regional Organizing

[Briana Gilmore]

NYAPRS Note: Regional organization in Iowa may not be at the behest of DSRIP, but the way they are preparing to arrange service capacity across the state closely resembles NY's experiment in regional-based service distribution. Each of Iowa's new service systems emphasizes mental health particularly through crisis response in the community and increasingly educational capacity for mental health professionals.

'Exciting' Changes Happening in Iowa's Mental Health Care
Globe Gazette; Erin Murphy, 9/28/2014


Multiple years in the making, Iowa's new method of delivering mental health services is underway.

The early feedback from officials on the ground is mostly positive and cautiously optimistic. Officials think the transition from services delivered by counties to a collaboration of multiple-county regions will improve mental health care in the state.

But many also caution that significant challenges remain, such as shortages of patient beds and psychiatric physicians and the lack of a statewide system for treating children with mental health issues.

And there is the ever-present concern that the new system may not be sufficiently funded.

The state recently completed a transition to 15 multi-county mental health regions, a process that started roughly three years ago with state legislators who sought to create a statewide balance of available services and spending and create efficiencies by pooling resources.

Now, each region is required to offer a baseline of mental health services, including outpatient therapy, community living support and support for employment, according to the Iowa Department of Human Services

Counties tax residents at the same rate statewide to cover mental health services.

By combining counties into regions, the redesign aimed to create efficiencies and savings that would free up funds to reinvest in services and lower property taxes.

"The regions went into effect July 1, and so far we're hearing positive feedback and excitement about how the redesign may help bring even more new services to the regions in years to come," said Rick Shults, Iowa Human Services' division administrator of mental health and disability services.

In a statement emailed to the Globe Gazette Des Moines Bureau, Shults said, "MHDS Regions are focused on ensuring that defined core services are available to individuals with mental illness or intellectual disabilities. Many MHDS Regions have sufficient funds to expand to (include) comprehensive crisis services and justice-involved services."

Bob Lincoln was on the cutting edge of the state's mental health redesign.

The central point coordinator for Cerro Gordo County led a group that formed a multiple-county partnership in 2008. That model provided the blueprint for the statewide redesign that followed a few years later.

Lincoln now leads a 22-county region - the largest in the state - that includes much of northern Iowa, including Black Hawk County.

"It's just a very rare time in my lifetime that if you're involved in a change process that you don't have to convince your partners that we have to change," Lincoln said.

"Everybody knows these things are changing, everybody's trying to figure out what is the best way to change so it does make the system work," Lincoln said. "It's very exciting. There are a lot of opportunities to fix and address things we always felt were built into the system. So that's been very cool."

Lori Elam, who leads a five-county region of eastern Iowa that includes Scott County, also used the word "exciting" to describe the state's mental health redesign.

"We're taking baby steps here. We have a good group of (county) supervisors that serve on the governing board. It's a very good group, dedicated," Elam said. "It's an exciting time, and I'm excited about the possibility of new services."

But concerns remain, especially over the number of beds available for mental health patients and the number of physicians available to treat them.

"We have a severe shortage of psychiatrists in Iowa, as well as all over the country," Elam said. "There's still a wait time to get in to see a mental health provider.

"So it's frustrating that we don't have any change in providers, we don't have any new doctors, no new beds. That's still an issue for all the regions across the state," she said.

Almost 40 percent of Iowans live in an area underserved by mental health professionals, according to data from the nonprofit Kaiser Family Foundation.

Teresa Bomhoff, president of the National Alliance on Mental Illness of Greater Des Moines, said, "I hope the next legislative session gets devoted to looking at that (workforce shortage) and creating more pathways for people to get into mental health professions, trying to create a means for secondary institutions to create more places where people can go to get the training."

One way regions hope to alleviate some of the pressure from a lack of available beds is by creating crisis intervention teams that will assist individuals experiencing mental health issues.

"Programs could include a crisis hotline or crisis beds at a local hospital where someone can come in and say, 'I'm not feeling good. I'm thinking about committing suicide.' We can get that bed and get them away from what's hurting them," Elam said.

"We hook them up with services. There's a wide variety of things we can help people do. ... There's various levels of crisis services," she said.

Several officials said their chief concern was a steady funding stream.

"I understand everybody wants to control property taxes, but I also understand that you have to decide what your priorities are," said Patty Puttmann, director of social services in Woodbury County.

"If we're being told we have to expand services, we have to expand (patient) populations, we have to make (treatment) community-based, there's no longer going to be institutional funding ... then those things cost more than what we were doing," Puttmann said. "As a state, we have to determine what our priorities are."

Deanna Triplett, CEO of the Iowa Behavioral Health Association, put it even more bluntly.

"There needs to be adequate funding and appropriate funding," Triplett said. "We've had an underfunded system for a long time."

Lincoln said that funding will be critical as the state puts more emphasis on community-based rather than institutional care.

Like Puttmann, Lincoln said what the state chooses to do with savings produced by the new regionalized system will show where its priorities lie.

"I think our biggest challenge is reformulating our institutional process, the civil commitment process," Lincoln said.

"If you talk to law enforcement they will tell you the system is really broken at that level, that we don't have enough inpatient capacity for the patients that are presenting," he said.

"So we have people committing themselves for treatment, sitting in the ER for a day or two days, being transported across the state or even across state lines. So I think now is the time to really look at those people in acute need," Lincoln said.

"We want to keep people in the community, but we don't have the resources yet. So we have to figure out how to build that capacity up. That's where the regions come in," he said.

"We have enough leverage, we have enough dollars. Do we reinvest that savings to fill these gaps? Or do we reduce property tax? Or do we do both?"

Mandatory Services

Under the new statewide mental health care redesign, each region is required to provide core services. Among them are:

* Basic crisis response provisions, including 24-hour access to crisis services.

* Support for community living, such as home health aides and home and vehicle modifications.

* Recovery services including peer and family support.

* Service coordination, including coordinating physical health and primary care.

- Iowa Department of Human Services


http://globegazette.com/news/iowa/exciting-changes-happening-in-iowa-s-mental-health-care/article_0db458a1-b557-5a7a-b476-ecf87eca765e.html
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