Opinion: Despite Criticism, Iowa’s Mental Health System Now Ranks 6th In the Nation

by: Department of Human Services Director Jerry Foxhoven

There’s an old adage that if you repeat something often enough, people will believe it’s true. You’ve likely heard that Iowa has a failing mental health system many times, but no matter how many times people repeat that, it simply isn’t true. However, we know we can do better, and we are working to do just that.

Iowa has ranked in the top 10 among states in mental health for the past 3 years and we have continued to improve even before the implementation of new reforms. In 2016, we were ranked 8th; in 2017, we were ranked 7th; and in 2018 we now rank 6th, according to “The State of Mental Health in America 2018” report published by Mental Health America.

The transition from a county-based system to the Mental Health and Disability Services (MHDS) Regions has been a huge improvement and it is becoming more and more of a success. The one measure where we are at, or near, the bottom is in the number of inpatient psychiatric hospital beds operated by the state. However, if you look at total inpatient beds (public and private) the State of Iowa is actually near the middle – before the new 172 beds currently being built have come on line.

Even so, no mental health advocate or expert thinks that it would be a good thing to go back to the massive use of institutions like we had 75-100 years ago. Most advocates and mental health professionals would agree that being at the top of the list for having the most institutional beds would not be a positive indicator.

There is a stereotype that mental illness only includes people with serious acute conditions requiring inpatient services or those suffering from mild depression – nothing in between. The truth is that mental illness encompasses a wide range of complex conditions requiring a full array of treatment modalities.

However, we know there is work to do, and are creating an entirely new set of required mental health services that are now being developed and rolled out. I believe the new mental health services, based on legislation passed last year, will make us the envy of every other state once fully implemented.

Another thing that is often repeated is that the new mental health legislation has not been funded. Yet, millions of dollars have been included in the new Managed Care Organization (MCO) contracts in order to fund the beginning of the rollout of the new mental health services as they come on line. However, this is not a Medicaid problem, and will not be solved or funded by Medicaid alone. Creating a state of the art mental health system throughout the state requires collaboration with many partners and payers. These include the MHDS Regions, private payers, the Iowa Medicaid MCOs, mental health providers and educators.

Similarly, we are also in the early stages of creating a children’s mental health system (Children’s System). The Children’s System State Board (Children’s Board) recently held its first meeting, which was well attended and very action focused. The Children’s Board serves an important role in establishing a statewide mental health system to improve children’s well-being, build healthy and resilient children, provide for educational growth, and coordinate medical and mental health care for Iowa’s youth in need. Currently, without a system in place, our ranking among states for youth is number 8 according to the report published by Mental Health America.

We are not at, or near, the bottom of the states with our mental health system. In fact, we are in the top ten. However, we will not be content until we are as good as we can be, and we are steadily moving in that direction.