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Experts Discuss Iowa's Broken Mental Health System

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CEDAR RAPIDS, Iowa - The state's mental health population is being undeserved because of a broken system, an expert panel said Wednesday.

Panel members included Jackie Smith Duggan,vice president of the National Alliance for Mental Illness Linn County; Kent Jackson, director of children's specialty services at UnityPoint Health St. Luke's; State Sen. Jack Hatch; State. Sen. Liz Mathis; Ben Rogers, Linn County supervisor; Renee Schulte, former Iowa legislator and Department of Human Services consultant; Dan Strellner, president of Abbe Inc.; and Al Whitters, medical director of Mercy Behavioral Health.

Panelists pointed to complicated funding mechanisms as well as state and federal budget cuts as some of the biggest problems contributing to the state's shortfall in services. This broken system couldn't be more clearly highlighted than in the closure of the Abbe Center for Community Care on Sept. 30, several panelists said.

The Abbe Center, which provided long-term care to about 75 adults, was forced to close due to county funding problems and uncertainty from the state's redesign of the mental health system. The redesign's purpose is to transition Iowa from a county-based system to a statewide system that is regionally administered with the hope to more adequately treat rural and urban communities.

Part of the Abbe Center's problem was that it was too big to receive federal funding, Whitters said, because Medicaid dollars can only be used to fund smaller 15-people homes. So instead it had to rely on county funding, which comes from property taxes.

This made for a perfect storm, Strellner, director of the center, said.

"You don't downsize a 75-bed facility in 60 days, and you don't do it without significant infrastructural cost," he said. Theses smaller facilities cost more, need additional staff and sometimes aren't safe enough for some patients.

After the center's closure, the majority of its patients were placed in other residential facilities around the state. However, eight patients left against medical advice, Strellner said.

This lack of funding translates into a lack of beds to keep patients. Emergency rooms have become pseudo-psychiatric wards, so much so that hospitals are developing plans to deal with these patients in their emergency departments, St. Luke's Jackson said.

"This creates a system jam," he said.

State lawmakers sitting on the panel said that they hope the redesign will begin to mend some of these problems. The legislator has appropriated millions of dollars to support the system and implemented a way to collect consistent data from Iowa's 99 counties and to share that data.

"We have a backward way of treating people," Hatch said. "Part of the problem was politicians did not understand the system itself."

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