DES MOINES --- It is an issue, a question that has driven Iowans to public events and town halls by the hundreds.
How can the state improve its mental health care system?
So I asked the governor and state?s top state lawmakers that very question this week, just days before the Iowa Legislature convenes for its 2018 session.
Iowa has worked on its mental health care delivery system for years. In 2013, the state shifted from a county to regional delivery system. Instead of all 99 counties having their own mental health care system, most counties grouped into regions to share resources and deliver services.
Advocates say it was a step in the right direction, although there have been bumps in the road. Multiple regions are experiencing disharmony among the counties.
More importantly, Iowans with mental health needs are sometimes still falling through the cracks.
The stories are personal, heartbreaking and horrifying, and they have driven Iowans by the hundreds to speak out about the various issues with and needs in the system.
On Monday, state lawmakers will convene for the 2018 session, during which they have the opportunity to improve existing programs, create new ones and examine the potential need for more funding.
What are their plans? What do Iowa?s top elected leaders plan to do to address the state?s mental health care system?
Here?s what they said this week.
Gov. Kim Reynolds touted the 2013 redesign and said the state since then has increased mental health funding by 34 percent. She also said more can be done, and said a systemic approach is needed, one that includes mental health care, opioid addiction treatment, and privately managed Medicaid.
?We need to make sure that its coordinated its accountable and that were strategic in how were really meeting the needs of Iowans that are vulnerable or suffering,? Reynolds said.
Reynolds said a state task force has made recommendations to her administration, and that she believes there are some opportunities to improve the state?s mental health care system. She said she plans to talk about the issue during her condition of the state address to the Legislature on Tuesday.
Bill Dix, the Republican leader in the Senate, said he hears from mental health care providers that, in some cases, services exist, and that perhaps the opportunity is to better coordinate those services to ensure people who need them receive them.
Dix said he expects a group of GOP senators to meet during the session and make recommendations.
?There are a number of Republican senators who view this as one of the must-do things this session,? Dix said. ?I anticipate that they?ll be working to build broad consensus on a proposal to accomplish just that.?
Linda Upmeyer, the Republican House Speaker, also noted the state has been working on its mental health care system for many years, yet acknowledged more needs to be done. She said services must be available to help individuals who are going into a mental health crisis, as well as for those emerging from a crisis and trying to become stable.
?I think we can all agree that what we need now is more services in our communities,? Upmeyer said.
Mark Smith, the Democratic leader in the House, said his primary goal is to increase the number of mental health care professionals --- psychiatrists, psychologists, counselors, social workers, nurse practitioners --- working in Iowa, particularly in rural areas.
?We are short on professionals. That needs to be fixed by more programs that help people with getting educations and moving into rural areas,? Smith said.
Smith also said the Medicaid reimbursement system is causing issues in mental health care. He said providers are struggling because of low or untimely reimbursement from Medicaid.
Janet Peterson, leader of the Senate Democrats, said the state erred in closing two state-run mental health institutions in 2014 without having adequate community-based services ready for patients who had been treated in those facilities.
She also cited concern with the state?s funding system, which is generated in part through local property taxes. She noted Polk County, the state?s most populous, has been locked into the same funding level since 1996 even though the population of the county has grown by 100,000 people.
?We have fewer dollars to serve more people and more needs. And some areas of the state that are seeing growth are having those same problems we?re having in Polk County. Whereas other communities, where they?re losing population, aren?t having those problems,? Petersen said. ?But I do believe we can come together to work on that. And we must come together and work on that.?