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Palmer: Momentum Building for Mental Health Reform

DES MOINES, Iowa – Department of Human Services Director Chuck Palmer said that preliminary recommendations delivered to lawmakers Monday prove that momentum is building for sweeping changes in the way Iowa delivers mental health services.

“I’m deeply grateful for the thoughtful input from such a wide spectrum of providers, local officials, advocates, and especially from mental health consumers and their families, all of whom made huge contributions to the recommendations in our report,” Palmer said.

“Our job now is to sharpen and prioritize these recommendations, and to recommend a transition plan and identify funding mechanisms that will allow us to gradually transform Iowa into a best-practice state.”

Dozens of preliminary recommendations were prepared by numerous workgroups over the last several months. A compilation of the recommendations was presented to legislators Monday. The recommendations include:

• Development of a crisis intervention system to bring immediate evaluation and assistance to people in crisis situations. The intervention would prevent inappropriate criminal charges or unnecessary and expensive institutional commitments.

• Development of peer-to-peer services that provide a more effective bond between the person and provider, and creates employment opportunities for some people with mental health or disability needs.

• Development of a “system of care” for children with serious mental health needs. Pilot projects have been successful in providing effective service at home or in the child’s community.

• Details on how counties should group themselves to form fewer regional administrative bodies to more efficiently oversee local services for people with mental health and disability needs.

Last spring the Iowa Legislature and Gov. Branstad directed the DHS to appoint and lead work groups to recommend methods for implementing legislation to replace Iowa’s current mental health delivery system by the summer of 2013.

In addition to the workgroup process, DHS conducted nine regional forums to provide input
from consumers and their families. Palmer attended most of the forums, which drew large crowds.

“We have insisted on casting a wide net for opinions and knowledge,” he said. “We have found great energy for reform. We have much work remaining, including the issue of how to use limited funds to gradually develop services to fill identified gaps. I am pleased at the progress so far.”

Critics have long said the current county-based system leads to inequity and inconsistency for people who need mental health or disability services and are eligible for government help. About $1.3 billion is spent annually on these services, with property taxes accounting for about 10 percent. The rest comes from mostly federal and state sources.

The legislation requires a regional administrative system to deliver a core set of services.

Under recommendations from one of the work groups, counties would form five to 15 regional administrative groups, each with at least three counties representing populations of 200,000 to 700,000 people.

Ideally, Palmer said, the counties would form groups themselves rather than have a state created map.

Palmer said the next six weeks will be spent developing implementation plans for the work groups’ recommendations, with a final report due to legislators by mid December.

Palmer said the change to a regional system will provide equitable and consistent services across the state in an effective and efficient manner.

He added, “There will be changes and some will be difficult, but we start with a base of respect for existing services, existing providers, and existing administrators, and we insist on principals outlined in the U.S. Supreme Court’s Olmstead decision, which declares that people with disabilities must have meaningful choices on where and how to live in community settings.”

The Technical Assistance Collaborative Inc., of Boston, a national nonprofit consultant specializing in developing mental health programs for vulnerable low-income people, was retained to assist the work groups to prepare their recommendations. A lengthy report by TAC was presented to legislators Monday.

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