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Melissa Walker, Mental Health Cuts Would Hit Thousands

Editorial, Direct Adequate Funds to Mental Health

[Note: This material is copyright by the Des Moines Register, and is reproduced here as a matter of "fair use" for non-commercial, educational purposes only. Any other use may require the prior approval of the Des Moines Register.]

At the least, something is dreadfully different than it used to be, and Iowa is a lesser place because of it.

The change isn't immediately apparent. It has occurred so gradually that nothing out of the ordinary seemed to be happening.

Perhaps that's the way it is with profound change. Everything seems normal until you look back over the decades and realize how different things are.

So it is with the way we keep putting more and more of our fellow Iowans behind bars for major portions of their lives. A look back reveals how out of character that is for Iowa.

Consider that Iowa's total population has remained basically unchanged for 100 years. It has grown slightly, but has remained under 3 million through all the decades.

Through most of the last century, the number of Iowans in prison stayed about the same, too. The number spiked a little during the Great Depression, but generally around 2,000 or fewer Iowans were in prison at any given time.

It makes sense that if your total population isn't growing, the number of people in prison shouldn't grow much, either.

But the number did grow, beginning in the 1980s. Iowa's population actually declined in that decade, but the number of Iowans incarcerated began to shoot up. By the mid-1990s, more than 6,000 Iowans were behind bars - triple the historical number.

The number keeps growing. Now, nearly 9,000 Iowans are in prison. In another 10 years, it's estimated the prison population will top 11,000, at a time when the total population of the state will grow only slightly.

Think of 11,000 Iowans in prison. That would be more than five times greater than the historic rate of incarceration in Iowa.

It is hard to believe that Iowa children are growing up to be criminals at five times the rate they were a few generations ago, but that seems to be the case.

That surely is evidence of a fundamental deterioration in the social fabric of the state.

It is little consolation that Iowa imprisons a smaller proportion of its population than most other states.

That doesn't change the fact that a fivefold increase in the number of Iowans behind bars is a symptom of something deeply wrong.

Through most of the 20th century, Iowa got along fine with just three prisons - Fort Madison and Anamosa for men and Rockwell City for women. Now there are new prisons at Mount Pleasant, Clarinda, Fort Dodge and Newton. Rockwell City was turned into a men's prison, with women moved to Mitchellville. A major prison medical and screening facility operates at Oakdale.

A state with a population of 2.8 million that needed three prisons in 1970 shouldn't have needed eight prisons to protect a population of 2.9 million by 2000.

Moreover, Iowa's population is aging, which, if anything, should mean less crime. It doesn't compute.

It is revealing that two of the new prisons are at sites of mental-health institutes. Until the 1960s, each of the state's four mental-health institutes - at Mount Pleasant, Clarinda, Cherokee and Independence - housed from 1,500 to 2,000 patients. Now they're down to fewer than 100 each.

It's no coincidence that the prison population went up as commitments to mental institutions went down. The unintended consequence of deinstitutionalization of mentally ill people turned prisons into warehouses for criminals with mental problems. It is a national scandal.

Then there are the drug-related crimes that scarcely existed 50 years ago. Society decided to define drug using and selling as criminal behavior, and lawmakers decided to conduct dual wars on drugs and on crime by toughening the criminal codes, making sentences longer, often mandatory.

Those are the usual reasons cited for the prison population explosion. There might be societal reasons as well, including the possibility that greater numbers of Iowa kids simply are growing up troubled and alienated - essentially being inadvertently reared to become drug users or criminals.

That possibility is almost too disturbing to contemplate, but it needs to be examined. Rather than testing kids in reading and math, perhaps we should be evaluating children in the context of their whole lives, in and out of school, to point everyone away from a future in prison.

Any child who ends up an adult in prison has really been left behind.

And any state that must imprison more and more of its people every year has something deeply amiss.
_______________
RICHARD DOAK is a retired Register columnist.

Sara Voigt of Creative Community Options helps Angela Hutton, 37, of Des Moines run errands. More than 1,000 Polk County residents rely on such services to remain independent. A lack of money is forcing the county to make deep cuts in mental health care, putting services in jeopardy.
 

Thousands of Iowa's poorest residents could be without mental health counselors, home-delivered meals and rides to work or medical appointments come July.

Cash-strapped county officials, who have three weeks to certify spending plans for the budget year that begins July 1, say they must extract more money from state government, raise local taxes or order service cuts for people such as Angela Hutton and the 45,000 other Iowans who cannot afford mental health and disability care.

Hutton, 37, of Des Moines is blind and uses a wheelchair because of a childhood head injury that left her unable to walk or drive. Employees from Creative Community Options, an agency that gets money from Polk County, help her bathe, shop and do things around the house.

Without the services, "I would lose my independence and my ability to handle my own life," Hutton said.

Disparity in care concerns lawmakers

The state contributed $142.6 million this year to counties for mental health and disability services. However, state lawmakers since 1997 have placed limits on the amount of tax money counties can collect for those services and have cut millions of dollars intended for county budgets. The moves have forced many counties to pay for services from reserve budgets, which have dwindled in many cases to dangerously low levels or have been completely depleted, county leaders say.

The issue is now in the hands of state lawmakers, some of whom say counties' requests for more money or to eliminate the tax cap have little support. Legislators are more worried about what they say is a fragmented system that produces disparity in the level of care from one county to another.

In Northeast Iowa, mental-health clients in Winneshiek County receive community support services where workers visit their houses, help them manage their illness and assist them when they suffer a crisis and need someone with whom to talk. Those services are not available to residents who live in neighboring Fayette County.

"We're not different counties here; we're one state," said Sen. Jack Hatch, a Des Moines Democrat who was on a legislative committee formed to study mental health services. "We should acknowledge this is a statewide problem, that a citizen in Cherokee should get the same services as a citizen in Polk County."

A bill that examines state payments based in part on each county's general fund balance has been introduced. Hearings on the mental health system began last week.

Counties urge haste in spending decisions

County leaders say that they appreciate the talk of reform, but that they have a March 15 deadline to set spending limits and tax rates for the next budget year. That's why many of them will consider mental health service cuts, some for the first time.

Polk County residents could be among those hit the hardest. Almost 1,000 mentally and physically disabled residents would lose some or all of their government-paid services under a series of budget cuts set to take effect July 1. The cuts will affect their transportation to doctor appointments, delivery of their meals, and how they pay their bills.

In some cases, "it may be the straw that breaks the camel's back and they end up in the hospital," said Lynn Ferrell, executive director of health services in Polk County, where officials will cut $6.5 million from various mental health programs.

Polk County is not alone:

- The mental health budget in Dallas County could increase 19 percent to $5.1 million next year. Officials will consider a number of changes that will affect 700 mental health patients. Supervisors could also reduce payments to the company that operates the county-owned care facility where 80 disabled people live.

- Scott County officials warn that 5,000 to 10,000 people could be affected by proposed program eliminations or partial cuts in service. A jail diversion program, day treatment, crisis line and job training are all on the chopping block.

"It's kind of devastating, truly," supervisor Jim Hancock said. "It's been a trying process, but it's something we're going to have to do."

- Linn County's mental health budget faces almost a $1 million deficit next year, supervisor Lu Barron said. Officials have not yet decided on cuts, Barron said, because "you just don't need to get people all excited about it, especially if it's needless. This really affects people's lives, so we do go about it a little more cautiously."

In 2002, Linn County officials made across-the-board cuts that, among other things, created longer waiting lists for services.

- Woodbury County in January was sued for more than $1 million for failure to pay a Sioux City hospital for residents' mental health services.

"It's really a crisis, because the money is not there to pay for the service demand," said John Easter, intergovernmental affairs director for the Iowa State Association of Counties.

Cuts, caps leave counties in bind

The problems, county officials say, can be traced to 1997, when lawmakers capped the amount counties can tax their residents for mental health services. The state promised to pick up the rest. Instead, lawmakers just five years later cut nearly $18 million from the amount that went to counties. Now 64 counties have reached the limit on what they can levy. Wapello County is the highest at $2.49 per $1,000 of taxable value; Dickinson County is the lowest at 29 cents per $1,000.

County governments, by law, are required to pay for mental health care when residents are too poor and cannot get help elsewhere. That's why counties have dipped into their rainy-day funds frequently since the state made cuts.

Sen. James Seymour, a Woodbine Republican, said he could support giving more money to counties for mental health services if there was a way to only help those that truly need the money. He pointed to the fact that Iowa's 99 counties have a combined $500 million in their reserves.

"Some of these reserves are pretty substantial, and some of these counties are the ones that are saying we need more for mental health," said Seymour, who also served on the mental health services committee. "If we can arrive at a solution that has some fairness in it, yes I could" support more money for counties.

Counties spent a combined $123.9 million on mental health and disabilities in 2004-05. Statewide, the $1.1 billion spent, which includes money from all payment sources, including federal aid and client participation, was almost three times what the Iowa Department of Transportation spent on road construction last year.

Advocates say trims put patients at risk

Linda Hinton, a lawyer for the counties association, said 2007 has been a watershed year for elected officials who have realized they are in a financial bind. Cuts could focus on programs such as "mobile crisis teams" of mental health professionals that help law enforcement officers deal with mentally ill people who run afoul of the law. But some county leaders say the ax could also fall on meal and crisis-prevention programs for people who are independent but need help daily.

"These are individuals who can get into trouble, not realize that they're doing something wrong and end up in the judicial system," said Marcy Davis, head of Creative Community Options in Ankeny. "It is much more cost effective to do the preventive work, because if we don't, they're eventually going to deteriorate to the point where they require more expensive services."

Lori Elam, community services director for Scott County, predicted that other people with mental disorders will lose jobs or disconnect from counseling groups.

"Some of them won't get mental health treatment," she said. "They won't have the services available to get the medication or the people who touch base with them on a daily basis to get the support they need. They'll be out there floundering on their own."

An estimated 26.2 percent of Americans 18 and older - about 57.7 million people - suffer from mental disorders, according to the National Institute of Mental Health. In Iowa, counties pick up the tab for 45,000 patients who cannot afford care.

Mental health advocates say many people will fall through the cracks unless the system receives more money from the state.

But no matter how much money is spent, a problem will remain: Iowa's system of county control provides no way to determine how well patients are cared for from one county to the next.

Nearly all of Iowa's 99 counties provide their own mental health services with very little state oversight of what services are provided. As a result, residents can easily receive varying levels of service.

"The mental health system here is horribly fragmented," said Patrick Smith, executive director of Northeast Iowa Behavioral Health in Decorah. "We live in a state where it really depends on where you live for what kind of services you get."

Dr. Michael Flaum, a psychiatrist and director of the Iowa Consortium for Mental Health, which serves as a liaison for various aspects of the public mental health system, calls the issue a "critical concern."

"A county really can sort of chintz on services," he said.
_______________
Staff writer Jeff Eckhoff contributed to this article.

In Iowa, counties are responsible for managing and partially funding services for mentally ill and mentally disabled adults. That means this state has 99 different mental-health systems. Someone living in one county may get help with medications, living independently or bathing. The person in a neighboring county may not.

A county-based mental-health system is unfair. Compounding that problem: Some counties have run out of money to pay for mental-health services. That means cuts that could leave thousands of Iowans without needed help.

In the short-term, state lawmakers should appropriate money to ensure all Iowans, in all counties, have access to services. After all, lawmakers have been part of the problem.

In 1997, lawmakers capped the amount of money that counties can tax residents for mental-health services. Though the state promised to pick up the rest of the cost, lawmakers cut money to counties a few years later. Now, 64 counties have reached the limit they can levy.

Longer term, lawmakers need to rethink Iowa's county-based system. It doesn't make sense. Beyond the equity question, is such a system the best way to use tax dollars efficiently? And why should mental health be the responsibility of counties in the first place?

After all, counties aren't expected to treat people with cancer or provide medication to diabetics. Mental illness and mental disabilities are legitimate health problems. It makes no more sense to use property taxes in 99 different counties to fund mental-health services than it would to fund services for people with any other medical condition.

John Winkleman is the executive director of the Howard Center Inc. in Sac City, which has contracts for mental-health services in 16 counties.

In a letter to Kevin Concannan, director of the Iowa Department of Human Services, Winkleman wrote: "Providers are finding it increasingly difficult to work with 99 bosses and 99 different county plans with varying and waning budgets. Aside from trying to please everyone, lobbying for system change is almost impossible. ... If you have a child with a disability, you would be wise to move to a richer county."

Winkleman is pursuing legislation that would appropriate $23 million "to save as many services statewide as we can this year" and then move Iowa toward a statewide mental-health system.

Iowa should have a single, uniform system administered through DHS, which already has several offices throughout the state.

According to Sen. Jack Hatch, a Des Moines Democrat, the Legislature is exploring changes to the county-based system.

"We have to find a better way to provide the services that are needed," he said. "We have a county-based system that is mostly being funded with state dollars. It's a disjointed system of service, treatment and funding."

Disjointed and unfair.

Live in one county and get what you need. Live in another and you don't. All Iowans should have equal access to services, which would be best delivered by a statewide system. And those services should be adequate, which means lawmakers will have to find the dollars to pay for them.

Published February 25, 2007

State must fund vital mental health services
 

Melissa Walker's article about mental-health budget cuts only skims the surface of this issue ("Mental Health Cuts Would Hit Thousands," Feb. 18).

Mental-health services aren't just medications for low-income residents. They include transportation for wheelchair-bound students to go to Iowa's universities; hot meals to elderly residents who aren't able to cook for themselves; and programs to help the mentally ill avoid victimization.

If the state of Iowa doesn't follow through with their promises of financial help for mental-health services, the economic results will be devastating. Not only will mentally ill residents in every county be forced to fend for themselves, but social service agencies in every county will have their funding cut, forcing the small-town agencies to cut jobs.

Iowa's mental-health services are vital to our economy, our sense of worth and most importantly, they are life-changing to those who receive the services. We need our state government to stand up and do what is right to keep thousands of other Iowans on the path to self-sufficiency.

- Travis Robinson,

Des Moines.

Published February 25, 2007

Repeated lockups costly
 

Regarding Richard Doak's Feb. 18 column ("Surge in Prison Population Shows all Is not Well in Iowa"): The growth in the Iowa prison population has not been uniform. Between 1970 and 1972 it decreased from 1,808 inmates to 1,406 and the current prison population is below what was projected several years ago.

There is no one-size-fit-all solution to managing prison population growth. The most serious obstacle to proper prison management is the practice of legislators accusing each other of being soft on crime.

As a consequence, we have offenders serving short prison sentences for nonperson crimes who cycle from prison to parole to prison, etc. They average 1.6 returns to prison at about $70,000 per return; this costs us many millions of dollars per year.

Will the members of the Legislature confront this problem, or will they say they can't because if we change anything we will be called soft on crime?

- John Neff,

Iowa City.

Published February 25, 2007

Mental health money should all go in one pot
 

The reasons why Iowa's mental-health system is in disarray are very complex. However, the basic problem is the continued insistence on keeping a system that has 100 separate funding and service plans. Each of the 99 counties has its own funding and service plan, and the state has a funding and service plan and, as the editorial points out, they vary significantly.

Is it any wonder that the Legislature has a problem trying to sort out a sensible response to the problems described? Until the Legislature decides to get 100 funders and planners out of the mix, the Register will be writing articles about Iowa's mental-health system's problems every year at this time.

The article talks about county funding, but most of the funding is now state and state-managed federal funds. Given that reality, it makes sense to pull all the funding into one state-level pot and clearly place future funding responsibility with the state.

There also needs to be one statewide plan of services that will develop equality of services across the state. The services then need to be managed by a limited regional system of agencies. It is time to put the persons in need of service first, and not an archaic system that no longer represents reality.

- Harold Templeman,

former state administrator for mental health and developmental disabilities,

West Des Moines.

Published February 25, 2007

Move could jeopardize all Iowa counties' health funds
 

I read with interest the Feb. 20 editorial, "Direct Adequate Funds to Mental Health." It failed to take into account the rampant fluctuations in funding of mental health by the Legislature. What is adequately funded this year is completely cut next year.

While state control and funding sounds like the answer, I would remind those who believe this to be a panacea of the closing of Mount Pleasant's CDC unit two years ago during a budget crisis and the crisis created by a lack of funding to the Medical Classification Unit at Oakdale.

While having a shortfall in several of the 99 counties is problematic, it certainly is better than having all 99 counties shut down, which would be the case should the state cut back on its commitment to mental health.

- Daniel L. Flaherty,
Des Moines.
 

Published February 25, 2007

Iowa prison spending is misallocated
 

Your Feb. 18 opinion page highlights problems existing within Iowa's criminal justice system. Richard Doak pointed out that in the past 30 years, Iowa's prison population has shown a sharp and unexplained increase ("Surge in Prison Population Shows all is not Well in Iowa"). With a population that has increased only slightly and has grown older, we now are imprisoning almost seven times as many of our citizens.

Next to Doak's column is one by David Yepsen, who points out that it is good politics to be against crime and criminals ("Dems Pushing Foolish Issues"). There is no question that it is good politics to run against murders, rapes and robberies. Many politicians have also found that it is good politics to suggest, as Yepsen does, that anyone who questions the wisdom of our inflated response to crime is actually supporting the criminal acts.

The Iowa Department of Corrections Web site discloses that in mid-2005, 31 percent of male inmates and 60 percent of all female inmates were classified as mentally ill, and that, during the same period, while 26.9 percent of inmates were being held on drug-related charges, 90 percent actually had a history of substance abuse.

If prison is a dumping ground for the mentally ill and addicted, let us consider reallocating some corrections money to sectors established to treat the mentally ill and addicted. It is a sad situation if the only way we can get tax dollars to deal with mentally ill and addicted citizens is to label them as criminals and place them in our corrections system.

I reject Yepsen's suggestion that the fact that Iowa spends less per capita on corrections than many other states indicates that we are not paying enough. Iowa is different from other states; that is why many of us chose to live here. We don't have the problems of abject poverty, urban alienation and crime that exist in many other states. We should recognize that and allocate public funds accordingly.

If we build more jails and prisons and employ more police and prosecutors, we will find people to lock up. Before doing that, however, we should ask ourselves what we are trying to accomplish by locking up more people, and whether this is an effective means to make Iowa a better place to live.

- John J. Wolfe,
Clinton.

Published February 25, 2007

Costs of not imprisoning ignored
 

Your Feb. 15 editorial claims there are less costly and more effective methods of providing for public safety than incarceration ("Let's not be 'Leader' in Prison Growth"). However, the only figure provided was for the $23,367 annual cost of prison. It seems obvious that you do not want to point out the cost of drug treatment, or the very low percentage of persons who refrain from drug use after treatment. You encourage community-based alternatives, but again fail to identify the cost of these programs.

An additional factor that should be considered is the cost to the public of having criminals at large.

A study presented at a Northwestern University conference in Chicago some years back claimed that career criminals cost the public more than $150,000 per year when they were at large. That included general property theft, auto theft, property damage during criminal activities and personal injury damages.

- L.L. Snyder,
Pleasant Hill.

 By Scott Dochterman
 The Gazette

February 25, 2007
 

  CORALVILLE — At a conference Saturday, Dr. Nancy Andreasen offered new data showing remission is more likely for schizophrenics through changes in recent diagnosis.
  Andreasen, the director of University Hospitals’ mental health clinical research center, spoke about recovering from mental illness at the Choices in Recovery conference at the Coralville Marriott Hotel and Conference Center.
  In 2005, Andreasen chaired an internationally renowned committee to define remission, and the committee returned with seven symptoms. The positive symptoms include delusion, hallucinations, disorganized speech and disorganized behavior. The negative symptoms include alogia (lack of speech), affective flattening (lack of emotion) and avolition (lack of motivation).
  Using those symptoms to diagnose remission, Andreasen said 51 percent of schizophrenics achieved remission in six months. Forty-two percent of all schizophrenics achieved remission for one year, and 34 percent achieved remission for two years.
  ‘‘The picture is not as grim as it appears,’’ Andreasen said.
  Andreasen, who earned the President’s National Medal of Science in 2000, said she is seeking a pioneer grant to discover a potential link between creativity and mental illness. She cited three of science’s most important discoveries — Isaac Newton’s mechanics and theory of gravity, Albert Einstein’s theory of relativity and James Watson’s co-discovery of DNA structure — that were performed by people with connections to mental illness or schizophrenia. She also cited several other historical figures, including Abraham Lincoln, Winston Churchill and Ludwig von Beethoven, as people afflicted with mental illness.
  ‘‘I think what she is showing (Saturday) is really important data. I think especially the fact that there’s a huge change in how often remission is being seen as opposed to a number of years ago,’’ said Nancy Hale, research assistant in the University of Iowa’s Department of Psychiatry Research. ‘‘ I thought her data on what the i n d i v i d u a l s looked like from a clinical and a research standpoint, that was very interesting. The pictures that she painted of people that now classically do extremely well, it’s not the death sentence it used to be for someone.
  ‘‘That is extremely exciting for people who have been ill, who have seen this in their family, to have that creativity component acknowledged.’’
  Andreasen said the concept of remission was validated by schizophrenics who have longer periods of symptomatic improvements and 89 percent are employed.
  Dave Wagner, jail administrator for the Johnson County Sheriff’s Office, said diagnosing schizophrenia early could slow recidivism in jails and prisons, which he called ‘‘a vicious cycle.’’
  ‘‘I think awareness dealing with issues dealing with mental illness and early diversion could help those people and people . . . who work in jails, maybe keep those people out of jail,’’ Wagner said.