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Follow us on TwitterA small item included within Iowa’s 2009 Health and Human Services budget requesting the agency submit a legislative proposal to close one state mental health facility was mostly overlooked or ignored at time of its passage. But now that the agency has created a task force and the governor’s office has populated it, at least four Iowa communities that will be directly impacted by the decision are standing up and taking notice.
The four mental health institutions that serve Iowa each have specific geographic regions of the state from which they draw general adults in need of care. In addition, each facility has a specialized area of care that serves patients in an even larger area.
“The people who have been named to this task force: None of them are current legislators,” said Ro Foege, a former state representative from Mt. Vernon with deep roots in social services who has been chosen to serve as the group’s chairman. “They are all just people, and they are all stakeholders in mental health services in Iowa. … I think the make-up of the group was very thoughtfully done.”
Iowa currently has four state-run mental health institutions, one basically in each geographic quadrant of the state in or near the communities of Mount Pleasant, Independence, Clarinda and Cherokee. The task force, which has already begun meeting, will soon tour each of the facilities and accept comment from their neighboring communities.
The task force and the Department of Human Services, as charged by the legislature, is to submit a proposal on closing one of the facilities and consolidating the services provided at other state mental health institutions. Such consolidation, however, must, according to the legislature, provide the same level of services and the same number of beds as currently exists between the four locations.
“My interest is that maybe we need to look at not just the numbers of beds, but the level of service,” Foege said, making clear that he was speaking for himself and not as the chairman of the task force. “We may in fact, eventually, just as been done throughout the history of mental health service, reduce the number of beds, but actually increase availability and access to mental health services.”
As an example, Foege speculated that the dual-diagnosis program, which provides treatment for individuals who are afflicted with both mental illness and substance abuse, might be moved to a more community-based option that would be located in the communities that provide the largest segments of that population at the facility.
Ro Foege was named chairman of the 12-member task force
“Again, this is just speculation, and I don’t know the answers yet,” Foege, who has worked at least two of the state institutions, said. “Is there something or a program that could be implemented on a county level that would provide services to that population rather than having them go to Mount Pleasant and into an institutionalized setting?”
The task is made especially difficult because each of the institutions have developed their own niche specialties within the mental health field. While Mount Pleasant provides the dual-diagnosis program, Clarinda is touted as a leader in providing psychiatric treatment to geriatric patients, and services the entire state in that area. Independence and Cherokee are both known for their work with adolescents and children, with each taking half of the state in terms of service area. In each of the specialty areas potential patients, often those whose illness is too complex and severe for care in-home or in other community-based facilities, are placed on waiting lists due to an already lacking amount of space.
Each facility also provides services to large geographic sections — ranging from 15 to 41 counties — as their specific service area for generalized adult illnesses. And, within those geographic regions, public-private partnerships have been formed, often with staff at the state facilities providing training and outreach to providers, who in turn provide mental health services in underserved communities throughout the state. From that perspective, the closing of any one of the state institutions would have consequences on a much larger scale than the individual communities where the facilities reside.
“We have a very serious responsibility to consumers, to members of the staff at the facilities and to the communities,” Foege said. “I don’t think anyone on the committee is taking this lightly.”
Because of the mix of individuals, many of whom have had direct and personal experiences with persons with mental illnesses, Foege said the task force is not only well positioned to look at the problem from a clinical and economic aspect, but to consider it “with a heart” to those individuals and families who will ultimately be directly impacted by the decisions that will be made.
“Just speaking for myself again,” he said, “I can envision going about its work and then passing on a recommendation not only that closing a facility isn’t appropriate or effective, but recommending the expansion of services.”
With full realization of the state’s economic realities and concern for job losses, however, communities aren’t taking any chances. Coalitions of organizations, ranging from concerned citizens to local chambers of commerce to county officials, are developing strategies to protect and defend their state-run facility.
“Cherokee … admits more patients than any other [mental health institute] facility in Iowa,” wrote Woodbury County supervisors in a letter to Foege and the task force “and the length of stay is less than average.”
The task force, according to Foege, plans to continue to meet from now until mid-November. During that time members will visit each site and speak with local stakeholders. November will be reserved for writing out the evaluation and presenting it to the Department of Human Services. It will be up to the department to select the facility and develop the plan as mandated by lawmakers. That report should be given to the legislature in mid- or late-December, weeks before the 2010 session begins.
