If someone were to walk into a room with a broken arm, they would be told to get treatment and brought to the nearest hospital, but when someone walks into a room with a mental health issue, the same treatment isn’t given, said gubernatorial candidate Jake Porter at a mental Health Forum.

Candidates Fred Hubbell, Kim Reynolds and Jake Porter all attended this forum on Iowa’s mental health system which has become a growing issue on voter’s minds.

The forum was moderated by the Des Moines Register’s Opinion Editor, Kathie Obradovich, as well as Lisa Streyffeler, Des Moines University assistant professor of behavioral medicine, bioethics and medical humanities. The candidates spoke separately.

Republican Kim Reynolds

“Mental health has been and will continue to be at the forefront of my administration,” Gov. Reynolds said. “As I said in January in my condition of the state address no parent, child, friend or neighbor should suffer in silence when it comes to mental health.”

Recognizing the issue as complex, Reynolds said her administration has been making steps to address the problem. Standardizing and expanding access to healthcare resources, investment in new programs, collaboration between patients and providers and new healthcare related bills were some of the steps Reynolds said had been made.

While there was a bill passed that overhauled the mental healthcare system in Iowa, the bill did not fund that system. This has drawn criticism to the bill and was the first question asked by either moderator as the privatized medicaid system in Iowa does not cover some of the expanded services.

“Part of the legislation that we signed last year also put a working group together that will answer that exact question on how we will be able to sustain and fund the comprehensive mental healthcare.”

Part of the renegotiations with managed care organizations (MCO), the groups that oversee care in the privatized Medicaid system, will include talks on funding the system, Reynolds said.

Reynolds also talked about future goals for her administration to help treat mental health in the state. One goal of hers was to focus on early treatment and intervention to identify and treat young people with mental health issues before they develop further.

Part of the mental health problem in the state Reynolds said she has helped reduce was related to addiction and substance abuse. During Reynolds time in office, a bipartisan opioid bill was passed to reduce the number of opioids prescribed and reduce the practice of “doctor shopping.”

Reynolds mentioned her own relation to addiction, saying she was celebrating 18 years of sobriety.

“I can tell you that I would not have been able to do it on my own without the support of a family, my community and the services that I was afforded through PAL (Parents of Addicted Loved Ones),” Reynolds said. “So I do know life can be better, and I do know it is going to take all of us working collectively together to make that happen.”

Last year, Reynolds approved the sale of health benefit plans that are unregulated by state and federal insurance laws. As a result, these plans don’t have to cover mental health care and can sometimes cost more if a patient wants these services covered.

Reynolds responded to this by saying she is proud to have passed bipartisan reforms that reduced the cost of healthcare in the state.

When pressed on the issue and asked whether plans would be able to choose not to cover pre-existing mental health conditions, Reynolds said patients would have multiple options and some of these people would not have coverage at all if not for the plans that don’t cover mental health.

Democrat Fred Hubbell

Mental healthcare is something Hubbell said has always been a pursuit of his. In recent years, he has helped different groups expand services.

“Make no mistake, we face a serious mental health crisis in our state,” Hubbell said. “And whether it is you, your friend or a neighbor: everybody is affected by the lack of critical mental health services.”

Hubbell then voiced his support for the work he and his running mate, state Sen. Rita Hart, have made over the last 18 months. Earlier this year, Hubbell went on a “mental health tour” across Iowa.

On this tour, Hubbell mainly visited jails and listened to law enforcement who are oftentimes the first care providers for individuals with mental health as there has been a shortage of services and beds in Iowa.

“Rather than sitting in a jail cell, they need to get the care they deserve,” Hubbell said.

Another issue Hubbell brought up was mental health concerns among farmers, who he said experience mental health issues at a higher rate.

“’How did we get here?’” Hubbell said. “For several years the Branstad-Reynolds administration has systematically undermined and underfunded programs and facilities designed to help those who are battling a range of mental health issues.”

Hubbell said recent issues in Iowa’s mental healthcare systems have been due to the managed care organizations in addition to the decision from the Branstad and Reynolds administration’s decision to close down two mental health facilities last year.

When the state outsources its healthcare coverage to private companies, Hubbell said it puts care in the hands of people whose responsibility is to make a profit, not to provide the best care to Iowa citizens.

“We need to reverse privatized Medicaid, we are having the wrong people do the services,” Hubbell said. “In many cases they are getting people out of treatment much faster than they need to be … They make money either way, they don’t care about that.”

Hubbell also cited reports from the National Alliance on Mental Illness who has given Iowa a rating of D or F for the last 20 years on issues regarding mental health.

One thing Hubbell has found during his tours is that people have been denied the resources they need for their mental illness.

“People are denied services because there aren’t enough beds or available doctors and need to drive hours for treatment,” Hubbell said.

Hubbell said he would support county flexibility when it comes to allowing counties to raise their taxes to pay for mental health services, but he would first like to focus on prevention of mental health crises and funding for care facilities which could prevent individuals from going to the emergency room or jail cells — the most expensive place to treat patients.

“Let’s let local communities figure out what they need for mental health services,” Hubbell said. “They need flexibility, if they want to adjust the levy which is set at 1996 levels, then they should be given that kind of flexibility.”

Libertarian Jake Porter

“[Mental health] has been ignored for far too long,” Porter said. “I am happy to see people coming out and talking about these very important issues.”

As suicides are “soaring” and overdoses are happening frequently, Porter said this shows that the issues of mental healthcare is one that needs to be addressed.

“If they are suicidal, depressed, are we going to know what warning signs to look for?” Porter said. “What happens if they are a drug addict, how are we going to go over there and help?”

The first step in addressing these is recognizing there is a problem and breaking down the stigma, Porter said. Budget priorities, criminal justice reform and Medicaid privatization are some of the things Porter said he hears contribute to this when traveling the state.

For Porter, addressing these things is not about attacking his opponents, because mental healthcare is something that people “need to work together on.” Instead, Porter said he would focus on policy solutions.

“We need to look at these issues as mental health issues and not as criminal issues,” Porter said.

People in Iowa can sometimes be afraid to come forward with their illness, Porter said. Some people are afraid to say they have an addiction as their kids could be taken away, they might lose their jobs and they could lose economic opportunities for the rest of their lives, he said.

“These are the very real questions some people have to ask,” Porter said.

When it comes to funding the healthcare reforms in the state, Porter said if it was passed it should have been funded as well. Porter blamed this on the focus on being a Democrat or a Republican in the state rather than working together to accomplish what the people “actually want.”

Porter also said the governor should not have unilaterally privatized Medicaid without much discussion between the legislature. His solution to this would be rolling Medicaid back into the state’s control, prioritizing funding to the programs passed by the state and involving all people in a discussion on how to make Medicaid better. This would include a discussion with everyone with a plan under Medicaid as well as different healthcare boards.

When asked if funding would come in an increase to taxes, Porter said he was not a fan of the sales tax as a whole as it disproportionately affects the poorest Iowans. He would support localities setting their property taxes to a higher rate in order to fund healthcare.