Mental health providers and advocates praised the governor's plan to overhaul the state's behavioral health system during Thursday's subcommittee meeting, but provisions regarding disability services and inpatient care address specific concerns. Some said they expected it to happen.
Lawmakers gave House Research Bill 653 initial approval by a 2-1 vote. This bill is one of Iowa Governor Kim Reynolds' priorities for the 2024 legislative session, and is one of Iowa Governor Kim Reynolds' priorities for the 2024 legislative session, which will transition current mental health services while providing support for mental health, substance abuse, and other addiction recovery services. It proposes establishing an Iowa Behavioral Health Services System (BHSS) to provide services. Incorporating the Health and Disabilities Services (MHDS) system into the advisory role.
The behavioral health system will divide the state into seven districts, taking over 13 existing mental health regions and 19 substance abuse regions designated to provide care, with the Iowa Department of Health and Human Services overseeing BHSS. He will be in charge of contract negotiations. We will collaborate with nursing care service providers in each district. Disability services currently provided by MHDS will also be transferred to the Iowa Department of Health Services' Disability and Aging Services Division.
Iowa Department of Health and Human Services Director Kelly Garcia told lawmakers that the bill's proposed changes are based on a four-year evaluation of how best to address problems in the state's mental health care system, the agency's collaborative work, and the He said it was born out of feedback from the local community.
“What we're seeing today is a broken system,” Garcia said. “It's broken and it's not serving the people of Iowa. So we're taking a very important step to really solve this problem, and we're doing it in a thoughtful and methodical way. But with clear direction and accountability, we are beginning to shore up the gaps we see.”
Multiple lobbyists representing care providers and mental health advocacy groups credit Iowa State's Kim Reynolds for advancing a plan to address the state's mental and behavioral health needs and existing gaps in available care. He expressed his gratitude to the Governor and Iowa Health Services.
A January Treatment Advocacy Center report ranked Iowa last in the nation in the number of state-managed inpatient psychiatric beds available for adult treatment. Iowa has 64 state hospital beds available for adults with severe mental illness, or a rate of 2 beds per 100,000 residents. The mental health advocacy group said 50 beds per 100,000 residents is needed to “provide minimally adequate treatment for individuals with severe mental illness.”
Leslie Carpenter of the Iowa Mental Health Advocates said she supports the overall goal of the project and the integration of mental health and substance abuse services. But she said the bill would focus on “emergency patient services, long-term services provided within large facilities, and community-based services that avoid, divert, or offset the need for law enforcement involvement and incarceration.” criticized the wording.
Carpenter said he supports measures to avoid law enforcement involvement and incarceration, but said it should not hamper acute inpatient services. Inpatient and hospital treatment can often help people in the early stages of mental illness and prevent mental illness from progressing into more serious problems, such as involvement in the criminal legal system, she said. Ta.
“Healing inpatient and long-term permanent supportive housing rather than warehousing is far preferable to homelessness, incarceration, and graves,” she said. “Hospital treatment is not inherently bad. It may be possible to provide this treatment with far less trauma, but for those with the most serious illnesses, this is the only part of the continuum of care. is an important part of saving lives and must be continuously available.”
Others questioned other specific elements of the bill, such as the transition period outlined for the system changes. Under this bill, BHSS districts would be fully operational and ready by July 1, 2025, and the current system would remain in operation until that date.
Amy Campbell, speaking on behalf of the Iowa Association of Area Agencies on Aging, the Polk County Board of Supervisors and several health care groups, thanked HHS and the governor's office for their transparency in the proposed changes, but raised some questions. said it has not yet been answered. For example, Campbell said he doesn't expect the transition schedule to be a problem for behavioral health services, but it could pose a problem for disability services currently provided through the MHDS system.
“I think there's a lot of concern about transferring disability services (to HHS), but there's not a lot of detail in the bill to plan for that,” Campbell said. “And when it comes to job assistance and employment assistance that they can receive for employment, this is a significant number of people. We don't want to create problems there.”
Mr Campbell also said future funding for mental and behavioral health remains uncertain as that amount is deducted from the system currently allocated to disability services.
State Rep. Beth Wessel Croschel, R-Dahms, said the proposal had many positive changes, but she refused to approve it because there were several unanswered questions. Rep. Joel Frey and Rep. Ann Meyer voted in favor of moving the bill forward.
Rep. Frey, an Osceola Republican, said the bill is the next step in a multi-year effort to improve mental health care in Iowa.
“I’m proud of where we are today,” Frye said. “I think we're doing a good job. There's room for improvement and we have a lot of opportunities coming our way, but in general we're listening to what Iowans need and we're doing a good job with this.” I look forward to seeing how the bill will help complement the next steps in the mental health and disability services system.”
