Mental Health

EDITOR’S NOTE: This is the third of a five-part series examining the challenges facing mental health services in Eastern Iowa.

Last summer, a couple brought their teenage foster daughter to a Fort Dodge hospital because of fears that she might harm herself. 

The couple and the teenager sat in a waiting room for 47 hours, according to a news report by KCCI-TV in Des Moines.

Emergency room staff reportedly called around the state every few hours hoping to locate an open psychiatric bed. 

Eventually a bed was found. It was not clear whether they found an open bed in Iowa or in a neighboring state.

Peggy Huppert, with the National Alliance on Mental Illness, hears stories like that all the time.

“In a lot of cases what happens is they sit in an emergency department for two or three or four days,” Huppert told KCCI. “Often in a hallway or behind a screen. And after that amount of time, it essentially acts as an informal crisis observation, and finally everyone agrees, ‘Well, (he or she) seems OK, let’s just send (him or her) home.’”

Lori Elam, CEO of Eastern Iowa Mental Health Region, said the frustration that stems from a dearth of inpatient care doesn’t end there.

“Kids are sent as far away as Sioux City or Council Bluffs,” she said. “Can you imagine your child going there, and you can’t get there because you don’t have a car or you have a job?”

The National Alliance of Mental Illness (NAMI) recently summed up Iowa’s mental health resources as compared to the other states. Iowa ranks:

51st (including the District of Columbia) in the ratio of state psychiatric beds to residents;

47th in psychiatrists;

44th in mental health workforce availability.

Shortage of psychiatric beds

The Treatment Advocacy Center also ranks Iowa last among all states in terms of psychiatric bed availability, with just 1.2 beds per 100,000 adults — one-tenth the national average of about 12 beds per 100,000 adults.

To illustrate the point closer to home, the number of psychiatric beds in Clinton County, which has a population of about 47,000, stands at seven. 

A complicating factor is that those beds are intended to accommodate both adults and children, according to Todd Noack, executive director of Life Connections peer-recovery services, which operates Rhonda’s House in DeWitt, the first peer-to-peer respite house in the state. 

“Right now, some of (the seven beds) are being occupied by kids,” Noack said late Friday afternoon. “One of the things that has been a problem in the past is mixing kids with adults. That’s just not right. There’s been a concerted effort to not having kids sharing those beds with adults.”

A recent trend among psychiatrists also is shaking up the overall dynamics. Over the past decade, experts say, psychiatrists increasingly are eschewing work in inpatient facilities, preferring an outpatient setting.

Actions from the state government also have made mental health services more difficult to access in certain areas. For example, in 2015, the state closed two of its four mental hospitals, significantly reducing the number of psychiatric beds for Iowans.

And still other factors fuel the shortage. Mental health providers frequently are reimbursed less than physical health providers, leaving institutions sometimes struggling to cover salaries. 

Shortage of psychiatrists

The shortage of psychiatrists has been escalating because of a retirement drain. There are roughly 30,000 psychiatrists in active patient care in the U.S., and 60% of them are older than 55, with many on the verge of retirement.

And how does the state woo new psychiatrists to the heartland? 

Psychiatrists are in demand everywhere, said Jim Irwin, a member of the Clinton County Board of Supervisors and vice chairman of the Eastern Iowa Mental Health Region board of directors. “I can go to Florida, to California, to Colorado, to New York, to Arizona. Why would I want to come to Iowa?”

A National Council for Behavioral Health report indicates there is a national shortage of psychiatrists that is about to spiral out of control, with 77% of U.S. counties reporting a severe psychiatrist shortage. 

Primary care physicians have been put into a position of trying to address the burgeoning demand for mental health services, but a report by the Commonwealth Fund indicates that just 16% of doctors said their offices had the capacity to care for those with serious mental illnesses.

An “all-hands-on-deck” climate is further illustrated by a law passed in Iowa in 2018 that requires teachers to receive suicide-prevention training when they renew their teaching licenses.

“The state gave us some monies for our teachers to take some suicide-prevention training,” said Chris Hoover, superintendent of Maquoketa Community School District. “However, I don’t feel that a one-hour online course certifies any of my teachers to be able to recognize and treat or take care of a suicidal student. 

“Good intentions,” he continued, “but it’s a much bigger problem than a one-hour class.”

Workforce availability shortage

Richard Whitaker, CEO of Vera French Community Mental Health Center in Davenport, sounded a concern that might have been flying under the radar.

“Everyone talks about the psychiatrist and the nurse practitioner shortages,” he said. “But I don’t think everyone realizes that there also are shortages due to the inability to compete with those lower-end wages. We’re talking about those folks that we try to hire for our direct-support level.

“We have people that are reporting 30 percent vacancies,” Whitaker continued. “They are running on a 70% staffing level because those direct-support level providers are very difficult to find. Statewide, we are asking for a 10% increase in the rates that fund those services.”

He said many facilities have struggled to hire direct-level personnel since the unemployment rate hit historic lows. Whitaker said that job-placement agencies also are aware that Medicaid hasn’t boosted its rate of compensation for more than a decade. 

The problem is exacerbated for communities that are close to the state border. For example, Illinois has just passed legislation that eventually will boost the minimum wage to $15 per hour.

Whitaker said that is going to have an impact on places like residential facilities that heavily rely on those types of employees.

“Now we’re competing against McDonald’s, Target, and others for those same people,” he said. “That’s going to be a problem for us in Iowa.”