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.

DHS Director Charles Krogmeier has recommended the state close the Mental Health Institute (MHI) in Mount Pleasant and shift its responsibility to a facility in Independence, more than 100 miles away in Buchanan County.

“What we have tried to say in our report, and I know the task force hit on this fairly hard in their report, is that this discussion or this decision needs to be made in the context of ‘What should the overall mental health delivery system in Iowa look like? What are the needs? Where are the services? What are the gaps? And, how do the [mental health institutes] fit into that overall discussion?’ I think they are part of it, but how much they are a part of it is the question,” Krogmeier said on a conference call with reporters.

Former Democratic state Rep. Ro Foege served as chairman of a 12-member task force that evaluated, toured and held public meetings in each of the four communities with a mental health facility — Mount Pleasant, Independence, Clarinda and Cherokee. Following deliberations, the task force concluded that none of the facilities should be immediately closed. Instead, the members of the task force have advocated the four should remain open until the state has fully explored the existing system — the people it serves, public safety, total costs and best practices.

“I think the task force took a very sincere and hard look at this and decided that it just couldn’t recommend closing one of these facilities at this point,” Foege said in an interview with The Iowa Independent. “We need to make sure there are services available.

“The part that is very important is that the state, I believe, needs to provide a safety net, and that is what these four mental health institutes have been. We need to make sure that the safety net remains in place.”

Had it not been for the mandate, which was included in the Human Services appropriations bill last year, Krogmeier said closing Mount Pleasant would not be a position he would take. Outside of presenting the plan, he also does not plan to advocate the closing to members of the legislature.

“The cost of any of these services is predominately staff, drugs and feeding and housing the population. If you keep the population the same, and you provide all the same services, your costs are going to be about the same,” he said. “There are some marginal cost savings … but it is not huge.”

If the legislature elects to move forward on closing Mount Pleasant, the cost savings achieved will depend if existing personnel are consolidated into a facility in Independence, due to collective bargaining agreements that provide for relocation reimbursements. The Department of Human Services also shares administrative and support costs with the Iowa Department of Corrections, which operates a medium-security correctional facility on the Mount Pleasant campus. The shared costs associated with the DOC in fiscal year 2011 are estimated to be $1.4 million. Presumably, much of that cost would be reabsorbed by the Department of Corrections.

The department’s recommendation also anticipates that the Department of Corrections would begin to utilize the space vacated in Mount Pleasant following the move. Because the task force found that collaborative efforts and communication should continue between the state departments of Human Services, Corrections and Education and the Judicial Branch, Foege is hopeful that some of the existing personnel at the mental health institute could be utilized within the expanded correctional facilities.

Both men also point to community-based delivery changes that have been made in Minnesota as possible opportunities that Iowa should explore. Switching to smaller facilities would also allow the state to gain federal appropriations for the care it provides.

“[What we were asked to do] is quite different than looking at the overall system and the kinds of care that need to be provided, and how best we provide those,” Krogmeier said. “That’s where we would like to see the policy-makers go. We would like to seriously have that discussion and move the state in that direction. Whether we physically have four or three MHIs in that whole discussion is a relatively small issue — although it is very important to those communities, and very important to our employees at those locations. But when you frame this in terms of what should the mental health system look like, [the MHIs] are just one piece.”

The Mount Pleasant facility is the oldest of the four state-run facilities that serve individuals affected by mental illness. (Photo courtesy of the IAGenWeb Project.)

The legislature mandated that DHS recommend which of Iowa’s four mental health institutes should be closed without loss of services.

A 12-member task force, however, was also tasked with reviewing the four institutes. That report, which recommends that the state not close any facility until existing services can be maintained, isn’t expected to be released until late Monday.

“The quality of service at the [Mental Health Institute] in Mount Pleasant is beyond question and I want everyone to know that this recommendation is no reflection whatsoever on the dedication and expertise of our staff, which is outstanding,” said Charles Krogmeier, director of the Department of Human Services.

The department’s recommendation to close the Mount Pleasant facility, which shares its grounds with the medium-security Mount Pleasant Correctional Facility, appears to be primarily steeped in economic reasoning.

Krogmeier said he decided to recommend the closure that would cause the least economic fallout for staff and the community, the least disruption for families of patients, and the most opportunities for improving the mental health system. The exact impact on the state budget will depend on how legislators decide to close the facility, as well as how existing services are continued.

Ro Foege, who served as chairman of the task force, remains hopeful that some of the employees current in Mount Pleasant could continue their work within the correctional facility, which is not slated for closure. Mental health professionals in Mount Pleasant provide the only dual-diagnosis program — psychiatric and substance abuse — run by the state. Although substance abuse patients throughout the state come to Mount Pleasant for treatment, it’s primary service area is limited to 15 counties in southeast Iowa.

Krogmeier has indicated that such services could be moved to the mental health institute in Independence. Since the Mount Pleasant facility takes a wealth of cases from Polk and Linn counties, primarily through the correctional system, it remains unclear how much cost savings can be achieved in the realm of travel and time if such cases are moved to Independence in Buchanan County.

Both the DHS recommendation on closure and the task force were mandated by the legislature in May 2009.

According to a memo to the Iowa Council on Human Services by DHS director Charles Krogmeier, the agency’s nine divisions would be reduced to five, its eight services areas would be reduced to five and 78 currently vacant positions would be eliminated. The agency would also utilize more part-time offices.

Hussman reports that Krogmeier said Gov. Chet Culver’s recent 10 percent across-the-board budget cuts, coupled with a projected budget shortfall in 2011, “makes these changes no longer a choice but an imperative to align ourselves in the best way to provide the services Iowans need from DHS.”

The changes are expected to occur between January and April, if the plan is approved.

Carlos Tzirin-Rodriguez, who was not originally detained in the May 12 immigration raid at the plant, was convicted of possessing a resident alien card that was not issued to him and knowingly possessing the identification of another person. The documents, according to court records, were used to gain employment at Agriprocessors, a kosher meatpacking plant in Postville and the site of the nation’s largest single-site immigration raid.

Tim Counts, midwest spokesperson for Immigration and Customs Enforcement, said that Tzirin-Rodriguez was detained on April 15. Because Tzirin-Rodriquez remains in the custody of the U.S. Marshal pending sentencing, Counts declined further comment in relation to the case.

In a plea agreement, Tzirin-Rodriguez admitted that he possessed a falsified resident alien card and used the identification of another person without consent. He also admitted to entering the United States on about April 1, 2006, at or near San Ysidro, Calif., with the aid of a smuggler.

Sentencing before U.S. District Court Chief Judge Linda R. Reade will be set after a presentence report is prepared. Tzirin-Rodriguez faces up to 10 years in prison and a mandatory consecutive penalty of two years in prison for the charge of using the identification of another person. He also faces $200 in special assessments, and up to three years of supervised release following any prison term.

Roughly one month after Tzirin-Rodriguez was detained, federal agents stormed the Agriprocessors plant in Postville. A total of 389 workers were detained as a part of the immigration raid on May 12. Of those detained, 300 have made plea agreements on criminal charges and most are serving prison time before their ultimate deportation.

Two members of Agriprocessors middle management have been charged with aiding and abetting illegal workers, and have entered a “not guilty” plea. A third indictment for another plant supervisor remains sealed, pending that person’s arrest.