Governor's bill moves forward to restructure mental health, substance abuse care in Iowa

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Governor's bill moves forward to restructure mental health, substance abuse care in Iowa

Mental health providers and advocates praised the governor’s plan to reform the state’s behavioral health system during a subcommittee meeting Thursday, though some said he needs to address specific concerns with provisions on disability services and patient care. are supposed to.

Lawmakers gave preliminary approval to House Study Bill 653 in a 2-1 vote. The legislation, one of Iowa Gov. Kim Reynolds’ priorities for the 2024 legislative session, would create a Behavioral Health Services System (BHSS) in Iowa to provide mental health, substance abuse and other addiction recovery services, while furthering the current state of ) proposes to establish. Health and Disability Services (MHDS) system in an advisory role.

The behavioral health system will divide the state into seven districts that will take over the existing 13 mental health and 19 substance abuse areas designated to provide care, with the Iowa Department of Health and Human Services in charge of overseeing BHSS and negotiating contracts. . With care providers in each district. Disability services currently provided by MHDS will also transfer to the Division of Disability and Aging Services of Iowa HHS.

Iowa HHS Director Kelly Garcia told lawmakers the proposed changes to the law came from a four-year assessment, agency alignment work and feedback from Iowa communities on how to best address problems in the state’s mental health care system.

“What we see today is a system that is broken,” Garcia said. “It’s broken, it’s not serving Iowans. And so we’re really taking a significant step forward in fixing that issue, and doing it in a thoughtful and systematic way, but with some clear direction and accountability that begins to address the shortcomings that we lets see.

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Several lobbyists representing care providers and mental health advocacy organizations thanked Iowa Gov. Kim Reynolds and Iowa HHS for coming up with a plan to address the state’s mental and behavioral health needs and the current shortfall in available care.

In a January Treatment Advocacy Center report, Iowa ranked last in the nation in terms of inpatient psychiatric beds available to treat adults managed by the state. There are 64 state hospital beds available in Iowa for adults with serious mental illnesses – a rate of two beds per 100,000 residents. The mental health care advocacy group said 50 beds per 100,000 residents is the lower limit needed to “provide minimally adequate treatment for persons with serious mental illness.”

Leslie Carpenter of Iowa Mental Health Advocacy said she supports the overall goal of the project and the merger of mental health and substance abuse services. But he criticized the language in the bill for focusing on community-based services that “avoid, distract, or offset the acute need for in-patient services, long-term services provided in large institutional settings, law enforcement involvement, and incarceration.” Do it.”

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While she said she supports law enforcement involvement and measures to avoid incarceration, Carpenter said acute inpatient services should not be discouraged. Inpatient and hospital treatment can often help people in the early stages of psychosis, he said, and prevent mental illnesses from progressing into more serious problems that would involve the criminal legal system.

“Inpatient and long-term permanent supportive housing that heals, not storage, is far better than homelessness, incarceration and graves,” she said. “Inpatient care is not inherently bad. We can do this with very little trauma, but for those with the most serious diseases, it is a vital life-saving part of the continuum of care and must continue to be available.

Others questioned other specific components of the bill, such as the transition period outlined for changes to the system. Under the bill, BHSS districts would be fully operational and ready by July 1, 2025, with the existing system continuing in place until that date.

Amy Campbell, representing the Iowa Association of Area Agencies on Aging and the Polk County Board of Supervisors and several health care groups, thanked HHS and the governor’s office for transparency in the proposed changes, but said some questions remain unanswered. For example, Campbell said he doesn’t think the timeline of the transition will be an issue for behavioral health services, but could create problems for disability services currently provided through the MHDS system.

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“I think there’s a lot of concern about moving disability services (to HHS), and the plan for that is not well outlined in the bill,” Campbell said. “And this is an important population when you talk about job supports and the work supports they get for employment. You don’t want to have any hiccups there.”

Campbell also said that funding for mental and behavioral health going forward remains unclear, as funds are being taken out of the system that are currently allocated for disability services.

Representative Beth Wessel-Kroschel, D-Ames, said the proposal had many positive changes, but she declined to sign on because she had some unanswered questions. Representatives Joel Fry and Ann Meyer voted to advance the bill.

Fry, R-Osceola, said the bill is the next step in a years-long effort to reform mental health care in Iowa.

“I’m proud of where we are today,” Fry said. “I think we are doing well. There are improvements to be made and many opportunities remain, but overall, we are listening to what Iowans need and we look forward to how this bill will help us deliver the next phase of our mental health and disability service system.

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