This story was produced by Iowa Center for Public Affairs Journalism-IowaWatch.org, a non-profit, online news Website that collaborates with Iowa news organizations to produce explanatory and investigative reporting.

No set criteria exist yet to gauge whether or not a redesign of how Iowa delivers mental health treatment, which included the controversial closing of two mental health institutes June 30, will be as beneficial to Iowans as hoped, Gov. Terry Branstad said in an IowaWatch interview.

Branstad said he will continue to review a four-year plan for re-designing how Iowa provides mental health care. The redesign plan, implemented in 2012, is to bring mental health care services from being delivered at the county level to being delivered in a regional level containing multiple counties. Fifteen mental health regions exist in Iowa.

Mental health care advocates in Iowa have not embraced the changes, and Branstad is well aware of that.

“People hate change but they love progress,” he said in the interview, conducted earlier this week at the Statehouse in Des Moines. “We have to overcome that resistance to change, and we need to show people we can really deliver better services to people. My goal is to provide the best services to the patients that we’re serving.”

Though Iowa is in the third year of that phased redesign, Branstad said administrators in the 15 regions still are putting together a network they hope will be more effective when providing patients with mental health services than when Iowa used the county-based system.

“As we go forward and we look at how the mental health program is instituted, we need to constantly re-evaluate and look at: where do we and how do we provide the best services for people?” Branstad said.

Branstad said no timeline exists for determining criteria and the eventual review. Benchmarks to determine success should come from the experts in mental health, such as the Iowa Department of Human Services and its director, Chuck Palmer, and mental health care interest groups; and the state’s Department of Corrections and Department of Economic Development.

“We really need to get, probably, outside expertise to come in and review and give us a report on where we are and what adjustments or changes need to be made,” Branstad said.

Two of Iowa’s four state mental health institutes going into this year — one in Mount Pleasant and one in Clarinda – closed on June 30. On July 2, the governor vetoed proposed funding that would have kept keep the Mount Pleasant Mental Health institute running under the state and the Clarinda Mental Health institute operating under the state until it could be phased into private ownership.

The Clarinda geriatric facility served elderly mental illness patients with behavioral issues. The Mount Pleasant facility served people who have substance abuse issues while also treating them for mental illnesses.

Branstad hinted that the state could consider whether or not to close the remaining two state-run mental health institutes in Independence and Cherokee. He said he has no plans to do so but said Minnesota and Wisconsin downsized to one or two large institutes in what he said was were successful redesigns.

CRITICS HAVE CONCERNS

Teresa Bomhoff, president of Des Moines’ branch of the National Alliance on Mental Illness, said having no review in place is a problem.

“People are still reeling. I think it’s going to be a struggle, especially for the people in southern Iowa,” Bomhoff told IowaWatch in a reference to the remaining two mental health institutes being located in northern Iowa.

Closing the Mount Pleasant and Clarinda facilities already has had a negative impact on patients, Bomhoff said. She cited a Des Moines Register report on two people who have died since being moved from the Clarinda Mental Health institute to private nursing homes. Family members of the patients blame the deaths on moving patients out of their acute care facility.

“Those two individuals needed specialized care,” Bomhoff said. “You don’t automatically find that in the private sector. Private business is not an automatic solution to everything. Had the mental health institutes stayed open, that specialized care could have continued for those two individuals.

“They might still be alive today.”

Bomhoff said Iowa needs a balance between state and regional facilities.

Rep. Dave Heaton, R-Mount Pleasant, who helped draft SF 505, the bill allotting more funding for the two institutes, said he does not believe the regional facilities can replace the institutes.

Though Heaton said he is a fan of regional health care systems that let Iowans seek care close to home, regional systems will not provide a unique service the two closed facilities provided: acute care at a place of last resort for Iowans who could not be rehabilitated in other state mental health programs, or who were refused care from private businesses.

State Sen. Rich Taylor, D-Mount Pleasant

State Sen. Rich Taylor, D-Mount Pleasant

Sen. Rich Taylor, D-Mount Pleasant, who was as vocal as Heaton in his opposition to closing the two institutes, said those facilities provided a necessary state service for Iowans. The regional facilities only provide adequate intermediate care, Taylor said.

“He (Branstad) says there’s better care out there in the private sector. That’s just simply a lie. There are no facilities that can take care of these very, very hard to place individuals,” Taylor said.

Branstad said regional institutions will provide an array of services Iowans need. The two mental health institutes that closed June 30 were not critical to that system, he said.

“We want to make sure the services are designed to meet the needs of the patient, not to take care of the facility or the employees in the facilities,” Branstad said.

“If you’re a legislator from a community that’s got an institution, you don’t want to see that institution close. As governor I want to look out for the needs of the people of Iowa and have an array of services available.”

DEALING WITH THE NUMBERS

In 2013, the Iowa Department of Public Health reported in the most recently available statistical state report available that 2.8 percent of Iowans have a serious mental illness. An Iowa Office of Person’s with Disabilities 2015 report showed that 4.5 percent of Iowans over 5 years old, or one in 22, suffer from a mental or emotional illness serious enough that they feel it interferes with their daily activities.

Iowa has 726 acute care beds for those 128,309 people the Iowa Office of Person’s with Disabilities identified as having a serious mental illness. The two remaining mental health institutes share 96 of those beds.

The Department of Human Services is trying to cut down on the time patients wait to find an acute care bed. In the past, hospital and emergency room staff would have to call as many as 30 hospitals to find an open bed, said Amy McCoy, of the Iowa Department of Human Services, said.

A bed-tracking service will be launched at 27 hospitals across the state so health professionals can check an online system to see where acute mental health care beds are available, she said.

State Rep. David Heaton, R-Mount Pleasnat

State Rep. David Heaton, R-Mount Pleasant

Heaton said he does not want to see the waiting time for regional mental health facilities grow.

“When you say waiting list, you’re talking about a person in crisis. You’re talking about a person who needs to be in a secure, safe setting,” Heaton said.

Heaton said some Iowans might not be accepted into the regional facilities and will have no access to care, he said.

Taylor said mentally ill patients with substance abuse problems could end up in emergency rooms, or jail cells. “Eventually, a lot of them will be held in the prison system,” he said.

FINDING DOCTORS IS DIFFICULT

Branstad said he tried to expand the number of acute care beds in the Independence Mental Health institute, but legislators did not support it. How to create more beds in Iowa will be an issue to tackle in the coming years, he said.

For certain, the future will need to include attracting more qualified doctors to Iowa, he said.

“We educate enough doctors in Iowa. We don’t have enough doctors in Iowa because a lot of them do their residencies out of the state,” Branstad said. “If we can have a residency program in Iowa, we’re likely to keep more doctors.”

Broadlawns Medical Center, of Des Moines, will receive a $5 million state appropriation over the next two years and is working to secure $5 million in matching funds for a psychiatric residency program that could train more psychiatrists in Iowa, said Jimmy Centers, Branstad’s spokesman.

Bomhoff agreed that Iowa does not have enough qualified professionals for what she calls an under-addressed problem. Iowa needs to invest in care, she said.

One of Branstad’s arguments for closing the two institutes was that each institute lacked qualified doctors after one had retired and another was nearing retirement. Taylor said he doubts Iowa can attract doctors to regional facilities.

The reason, he said, is that the state has not actively recruited them for the larger institutes. Iowa will have trouble attracting qualified professionals to smaller regional facilities if it cannot attract them to the larger state institutes, he said.