����������

With Mental Health Institutes Closed, Patients Served Elsewhere in Iowa

Erin Murphy Sioux City Journal�� July 12, 2015

��

In January, there were 62 patients at Iowa’s state-run mental health institutions in Clarinda and Mount Pleasant.

��

By the time those two institutions closed six months later, all 62 patients had completed their treatment or were transferred to private facilities, community-based programs or the state’s remaining two facilities in Cherokee and Independence, a state official said.

��

The state’s declared goal by closing the two mental health institutions is to provide better services in a more modern setting. The state is projected to save $15.5 million next year as a result of the move.

��

It’s a move many other states are making as they move away from institutional to community-based mental health care.

��

Amy McCoy, a spokeswoman for the state Department of Human Services, said of the 62 patients hospitalized in Mount Pleasant (38) and Clarinda (24) in late January, 54 were connected with “appropriate community-based services or placements.” All remained in Iowa, McCoy said.

��

Of the remaining eight patients, six were transferred to Independence and two to Cherokee.

��

“The majority of patients were able to complete their inpatient treatment programs at the MHIs, and will continue receiving outpatient treatment or services in community based facilities as needed,” McCoy said in an email. “DHS regularly does discharge planning at all state facilities, so the process has been well-established — keeping in mind that the goal nationwide is to effectively serve as many people in the community as possible, not in aging institutions.”

��

McCoy noted the number of patients at the facilities was fluid throughout the past six months, as some patients experience short stays. Mount Pleasant, for example, has 30-day programs, and some patients at Clarinda stay for only about a week.

��

TEAM PLANNED TRANSITION

Gov. Terry Branstad in January declared his intention to close the mental health institutions in Clarinda and Mount Pleasant by halting funding for the fiscal year that started July 1. That gave the state health department roughly six months to attend to the futures of the 62 patients in the facilities.

��

McCoy said in addition to its normal discharging process, the health department worked with a team that included representatives of multiple agencies that advocate for transitioning mental health patients.

��

“Through this effort — which also included input from guardians — state government and advocacy partners coordinated to ensure quality placements with a focus on individuals in the geropsychiatric program,” McCoy said. “Discharge planning for the MHIs included a thoughtful, systematic plan that took place over several months, and our partners on the facilities team oversaw these efforts to ensure quality.”

��

Not everyone was eager to accept the change. Chief among those voicing concerns were patients’ family members, the labor union that represented many of the facilities’ workers and state lawmakers who represent the districts containing the facilities or politically oppose the governor’s administration.

��

At a legislative committee hearing in May at the Iowa Capitol, one family member of a patient at Clarinda said she was concerned her sister was being forced to leave “her home.”

��

“She feels like it’s her home. She refers to it as her home,” Janice Scalise, whose sister Carol was a patient in Clarinda, said at that May hearing. “Right now, she feels very safe, very secure. All the staff, the nurse, everyone knows her. And she knows them. She has people around her that live there. So she’s in a familiar situation. To take her out of that would be, I know, very stressful for her, and put her somewhere that she doesn’t know who they are or what they’re doing. She has a tendency to get upset about stuff like that. And I don’t blame her. I would, too.”

��

NATIONAL TREND

In the 1950s, the United States had more than 300 state-run mental health hospitals serving an average of 560,000 people daily, according to Dr. Ron Manderscheid, executive director of the National Association of County Behavioral Health and Developmental Disability Directors in Washington, D.C., and a native of Lansing, Iowa.

��

Now, Manderscheid said, fewer than 50,000 Americans daily receive mental health care in a mental health institution.

��

Branstad and his health department have opted to join that trend. Branstad said he thinks treating patients in hospital settings is outdated.

��

“We’re going to continue to look at how we cannot continue the 18th century approach that was approved by the Legislature back before the turn of the century,” Branstad said last week. “Instead look at what is the best way and looking at how we best deliver the services not where we deliver the services.”

��

Manderscheid agrees with Iowa’s new approach to mental health care. He said states can develop community-based care systems that can deliver in the community services just as well as a hospital, without the institutionalization of the patient.

��

“The overarching logic of why it’s better is because it normalizes life for that person. We use the word mainstream: It mainstreams life for that person to be a member of that community, to participate in the community. … Those are all very positive things,” Manderscheid said. “And the normalization is very important because if I remove you from the community and I leave you removed from the community, not only is the community going to stigmatize you, but you’re going to stigmatize yourself.”

��

Harvey Rosenthal, executive director of the ���������� Association of Psychiatric Rehabilitation Services, agreed and added states are trying to find ways to get more bang for their mental health care buck. Rosenthal, who suffers from a form of bipolar disorder, said mental health care systems have reached a “perfect storm” of government looking for more cost-efficient methods of delivery and laws and regulations that promote preventative services to reduce hospital visits.

��

“We’re moving toward value-based payment, (treatment) based on outcomes, not based on how many times (a patient is hospitalized),” Rosenthal said. “The money wants recovery, and the biggest factor of all in determining services is money.”

��

Rosenthal added one caveat about the move to community-based mental health care services.

��

“But it requires an investment,” he said.

��

CHANGE IN CARE

McCoy said Iowa has invested in its mental health care redesign, which shifted care from each of the state’s 99 counties to 18 multiple-county regions. The transition, which was completed in 2014, was designed to pool counties’ resources in order to provide more consistent services to patients across the state, particularly in lower-populous, rural counties.

��

McCoy said services being offered by the regions include preventative measures with the goal of reducing hospitalizations.

��

“That’s going very well. The regions have ending balances of more than $100 million for operations, and they’re investing in new services,” McCoy said. “There’s a lot happening on the ground out there with programs preventing the need for acute care.”

��

Even while expressing her concerns at that legislative hearing, Scalise said she was open to the possibility her sister may find equal or better service outside the walls in Clarinda.

��

“I’m not saying there isn’t another place out there. I’m not saying that at all,” Scalise said. “If there is, I’d like to see it.”

��

��