Iowa’s mental health system in dismal shape, officials and advocates say
Underfunded, understaffed and riddled with gaps, Iowa’s mental health system is broken. Such is the dismal assessment of advocates, state and county officials and families who have sought care.
Counties and state institutions have faced limited funding for years, and legislators are now beginning to draft plans to overhaul the system.
Like policymakers across the nation, Iowa struggles to distribute limited revenue without jeopardizing care for the 34,985 residents who rely on the state’s system, according to study by the Iowa Center for Public Affairs Journalism that was part of a national examination by the Center for Public Integrity.
“Our people with mental illnesses are in worse shape today, than when I started 30 years ago,” said June Judge, a family education teacher with National Alliance on Mental Illness of Johnson County.
Unlike many other states, Iowa’s mental health system places a large financial burden on counties. Only Ohio and Wisconsin require local governments to foot a larger portion of the bill. Revenue shapes the services a county can provide, creating drastic inequality across the state.
In 2009, Shelby County spent an average of $81.12 on mental health for each resident, while Muscatine County spent just $3.33. Average county spending was $36.35.
“What services you get, is basically dependent on where you live,” said Roger Munns, Department of Human Services spokesman.
Iowa also faces a widely-acknowledged shortage of mental health physicians, and the state ranks near the bottom of the nation in psychiatric beds per capita.
This leaves some families unable to get the care they need.
Becker case: A ‘vivid example of how the system is not working’
In 2009, the fatal shooting of football coach Ed Thomas raised questions about a system that failed to protect and care for the community.
Image has not been found. URL: http://images.americanindependent.com/88ced6e58000x182.jpg.jpg Joan Becker, Mark Becker and David Becker, Joan's husband and Mark's father, pose for a photo during Thanksgiving 2010. It was the first time the family had been together since Christmas 2008. – Courtesy of the Becker family
On June 24 that year, Mark Becker stole a .22-caliber pistol from his father’s gun cabinet, drove 10 miles to his old high school’s weight room and repeatedly shot Thomas in front of 22 Applington-Parkersburg High School students.
As Thomas lay on the ground, Becker stomped and cursed him before instructing the students present to “be free.”
The incident may have been prevented had Becker, a diagnosed paranoid schizophrenic, received proper care, said Joan Becker, his mother. Her account of the months leading up to the shooting is the story of a system that failed her son at every turn, and left her family in danger.
“There was no accountability in my son’s case,” she said in a recent interview. “We felt like no one cared.”
On June 23, Becker was released from a three-day stay in the psychiatric ward of a Waterloo Hospital – the ninth institution he visited in less than a year. The next day, he shot Thomas.
Becker had just a day’s worth of medication in him at the time of the shooting, and, though he had been diagnosed in April, he was still weeks away from receiving his prescription, his mother said.
Schizophrenia requires long-term treatment, according to fact sheets from the College of Psychiatric and Neurologic Pharmacists. Once in jail, Becker received steady treatment, and his mother said it took three to six months for his hallucinations to subside.
Emily Piper, lobbyist for the Iowa Psychiatric Society, called the case a “vivid example of how the system is not working” that underscores Iowa’s need for long-term care. She added, however, there was no proof such sub-acute care could have prevented Thomas’ death.
A lack of long-term care is one of many issues that plague the system.
“We do not have enough psychiatrists – that’s a very big problem,” said Deb Niehof, executive director, National Alliance on Mental Illness of Central Iowa.
Iowa ranks 47th nationally in psychiatrists per capita, according to the most recent review from the Health Resources and Services Administration and is short 157 mental health physicians. The worst shortages are in rural communities, which make up nearly half the state’s population and 89 of its 99 counties.
Due to state belt-tightening and limited county funds, even residents of urban, physician-filled counties may face service cuts.
Cash-strapped counties bear large burden
Counties rely on property taxes to finance mental health care programs, but an unchanged 1996 law froze those levees, essentially capping how much money counties could raise. As a result, counties became increasingly dependent upon state funding to serve the mentally ill.
Making matters worse, state funding for mental health has decreased since 2008, a trend officials expect to continue through 2012. In recent years some counties used federal stimulus funds to plug that gap, but that money has since dried up.
Over the past year, shrinking budgets have led seven counties to adopt waiting lists for mental health services. If the state does not increase funding, more counties will likely follow suit.
Johnson County, which includes Iowa City, may be among them, said Kristen Artley, director of its Mental Health and Disability Services.
The county recently held an emergency meeting of its mental health and disabilities planning council to discuss how to handle an unprecedented $2.5 million shortfall for 2011.
Along with instituting waiting lists, Johnson County may also make cuts to several non-mandated services, Artley said at the meeting.
Cuts to one of those services listed, a home care program**,** could prove devastating for Carol Spaziani and her son – a 49-year old diagnosed schizophrenic, who has relied on the program for 31 years.
“He would not make it on his own if it weren’t for that kind of service. He would be under the bridges or in jail some place,” she told the planning council.