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OTHER VOICES: Progress continues on redesign of Iowa's mental health system

Sioux City Journal - 12/3/2016

There's been much discussion recently about Iowa's mental health system. Unfortunately, this discussion often centers on one type of intensive care - inpatient psychiatric beds - instead of pushing us forward, collectively, on developing a full array of mental health services which can effectively serve individuals with all acuities of mental illness closer to home.

In a recently released, comprehensive report, my agency calls for expanding the work that policymakers, service regions, advocates, providers and families have begun through the state's Mental Health and Disability Services (MHDS) redesign, which launched in 2014.

Under the redesign and other recent state efforts:

? 14 MHDS regions have nearly tripled residential crisis beds, almost quadrupled mobile crisis services and, now, five times as many counties have jail diversion programs.

? The governor's office has provided $4 million in grants to establish three new medical residency programs in Iowa that will help train more psychiatrists amid a national shortage of mental health experts.

? By expanding Medicaid services through the bipartisan Iowa Health and Wellness Plan, more Iowans than ever before - nearly 150,000 of them - have gained access to funding for quality mental health services.

? New care-coordination resources are available through managed care organizations (MCOs) which began providing health coverage for the majority of Iowa'sMedicaid population on April 1.

A few weeks ago, Mental Health America released its annual report which ranks Iowa seventh in the nation, up from 13th, based on a comprehensive analysis of national data that looks at access to mental health services. We can all agree that work must continue, but Iowa is headed in the right direction with a focus on expanding access to quality services across our communities.

So, why does discussion so often focus on inpatient psychiatric beds and what are we doing to address concerns?

Having acute inpatient psychiatric beds available is important for a small number of people experiencing the most acute symptoms of mental illness to stabilize their condition. The need for inpatient psychiatric beds has decreased over decades as better treatments, new medications and intensive support services become available, and as services diversify and expand into more communities. Relying too heavily on inpatient hospital treatment, instead of developing a comprehensive array of intensive mental health services, comes at a large price to our health care system and at a steep personal price for the individuals who spend their time within the walls of an institution instead of living successfully closer to home.

One tool we use when we talk about acute inpatient psychiatric bed availability in Iowa is the state's new inpatient psychiatric bed-tracking system. It shows that approximately 10 percent of the more than 740 inpatient psychiatric beds, or between about 60 to 100 beds, are available on any given day in Iowa. For the majority of patients who require hospital treatment to stabilize their condition, there are beds that can meet their needs.

But improvement is needed so that Iowans have quicker access to care so that they can receive successful and effective treatment closer to home. We believe our best path is to continue the work of the redesign and build a comprehensive array of community mental health services. This array must include intensive residential services for multiple complex needs, including co-occurring substance use disorders, to diminish the inappropriate demand on acute psychiatric beds.

To that end, my agency is convening a group of key stakeholders to identify effective services for individuals with severe, multiple, complex needs, and to make specific recommendations for the provision of services. This new effort will complement the continuing work of regions to expand availability of all levels of quality mental health services across Iowa's communities.

I invite you to review the progress report here: http://dhs.iowa.gov/sites/default/files/MHDS_Redesign_Update_Report_Final_SFY17.pdf

We look forward to continuing to work with legislators, MHDS regions, MCOs, providers and advocates in building on the work of the redesign, incorporating better care coordination and further expanding a comprehensive array of intensive services to successfully serve individuals with the most serious mental illnesses closer to home.

Charles M. Palmer is Iowa Department of Human Services director.