Legislators Struggle to Reform Statewide Mental Health Program that Still has Gaps

By Lynn Campbell
Iowapolitics.com

Lawmakers are struggling with how to transform Iowa’s 99-county system for providing mental health services into a more uniform, statewide network. 

In the meantime, the underfunded system leaves thousands waiting for services.
 
“Those are the people probably suffering the most right now,” said Margaret Stout, who for 25 years was executive director of Iowa’s chapter of National Alliance on Mental Illness, a nonprofit that provides mental health education, advocacy and support.

An example of that suffering came about a year ago.

Jeffrey Alan Krier, 53, of rural Sigourney, in April 2011 fatally shot Keokuk County Sheriff’s Deputy Eric Stein. Krier, who battled bipolar disorder for three decades, was then shot and killed by members of the Iowa State Patrol Tactical Unit after a three-hour standoff.

“I’m deeply concerned about situations such as the one that occurred in Sigourney,” Stout said. “There was a gentleman that needed to access care very quickly, and that certainly didn’t happen. Reading the outcome of that, there were serious holes within the treatment system.”

Iowa’s adult mental health system provided services to 52,059 people last fiscal year, according to the Iowa State Association of Counties, which represents officials in the state's 99 counties.

Underfunding leaves thousands more without much needed services. The system has an anticipated $51.4 million shortfall in fiscal 2013, according to the state's Legislative Services Agency.

When lawmakers began tackling the issue last year, they focused on eliminating the list of Iowans waiting for mental health services. They provided a one-time appropriation of $20 million.

But the money wasn’t enough. Eleven Iowa counties still have waiting lists, according to the Iowa Department of Human Services. Those lists include about 4,000 people, said Teresa Bomhoff, vice president of NAMI Greater Des Moines.

“The longer an illness goes on, the more trouble a person can get into,” said Stout, who said she once suffered from a bout of depression. “I know that good treatment works. It’s just that access to good treatment has not happened for everybody.”

Federal stimulus money exacerbated the problem. Counties used $40 million of this money for mental health services, but that money is gone.

State money to address shortfalls in the system is expected to be in the human services budget, which the Legislature has yet to address.

House plan would have state pay for county's share 

Meanwhile, a plan advanced Thursday by House Republicans aims to create statewide equity in the $1.3 billion mental health system, and provide $125.8 million in property tax relief. This would happen by leaving the entire bill up to the state and federal government. 

A House version of Senate File 2315 would, on July 1, 2013, end a county mental health levy — which ranges from 20 cents per $1,000 of assessed valuation in Plymouth County, to $97 per $1,000 of assessed valuation in Audubon County — and replace it with money from the state’s general fund over five years. The bill would amount to $145.8 million after inflation.

“We don’t truly believe that property taxes are the best way to pay for this,” said state Rep. Renee Schulte, R-Cedar Rapids, the bill's House floor manager. “Your general fund — consisting of income taxes, sales taxes and all that — is just a more fair and equitable way to levy funds for this particular service.”

But Bomhoff said having the state buyout the county’s share in the mental health delivery system “makes people really, really nervous, based on past performance.”

State lawmakers shorted Iowa counties about $7 million for mental health services last year — $81 million instead of $88 million — leaving county taxpayers to pay higher property-tax levies.

“Counties have dealt with the Legislature making promises that they haven’t fulfilled in the past,” said Linda Hinton, government relations manager for the Iowa State Association of Counties.

Hatch: House plan has 'no support' in Senate 

Even as Schulte, via a 19-6 vote, moved that plan through a House Appropriations Committee on Thursday, state Sen. Jack Hatch, D-Des Moines, said the plan has “absolutely no support” in the Democratic-led Senate.

“We are gaining nowhere in funding mental health. We’re just replacing state dollars for county dollars,” Hatch said of the House plan. “Mental health has always been underfunded. So why would we continue to underfund it ... while we are trying to redesign the system?”

Hatch said in addition to the $125.8 million paid by counties, an additional $150 million will be needed to pay for mental health services in the next five years. He said the state should focus its resources on that growth, rather than replacing county dollars with state dollars.

State Rep. Dave Heaton, R-Mount Pleasant, said if the state doesn’t live up to its promise to fund the mental-health service system, it would still lead to an increase in property taxes at the local level.

Schulte said no one wants property taxes to grow.

“The state will be much more motivated to prioritize this funding, knowing that it’s going to be a property tax increase if they don’t,” she said.

Stout said the success of mental-health reform will be judged on whether the money is there for needed services.

“Any changes that may come forward may be a step in the right direction, but if the money isn’t there, we’re still in the same boat,” Stout said. “The system really would not have changed unless the dollar follows. That’s the main concern.”