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Southwest Iowa mental health service lacks capacity for high-need patients

The Daily Nonpareil - 2/8/2017

Editor's note: This is the first part of a series.

The abrupt closure of two of Iowa's mental health institutes on July 1, 2016, along with limited community residential programs have left the state without the capacity to serve all of its high-need patients, local officials said last week.

"I think we knew this was coming," said Suzanne Watson, the CEO of the Southwest Iowa Mental Health and Disabilities Region. "The community providers, we don't have the capacity now in Iowa to serve the real high-need people."

Group homes lack the expertise, design and revenue to serve them, she said.

"Right now what's happening is that the rate from the (Medicaid managed care organizations) ... hasn't been done in a way that makes it feasible for a community provider to do that," Watson said. "We've got a couple hundred folks who need these services."

As a result, patients are being held in hospitals and jails ? some for months at a time ? until beds become available at the state's remaining facilities, Watson said.

The situation is awkward for hospitals with psychiatric beds, said Denise McNitt, chief nurse executive at CHI Health Mercy Hospital in Council Bluffs.

"One of our biggest issues this past year has been inability to find proper placement of patients," she said. "We had a patient that was with us for 13 months."

The patient, who had come from a group home, was intellectually challenged, as well as mentally ill, and had behavior issues, McNitt said.

"There was just no place that was willing to accept him ? including the group home he came from," McNitt said. "We had another patient here at about the same time that was here for 9 months, and she ended up getting placed pretty far away" in another state.

Both were Medicaid patients, and their managed care organizations cut off funding after a short time, McNitt said.

"They were denied after the MCO decided they no longer met the criteria for inpatient acute care ? which they didn't, but we weren't going to throw them out without a safe place to send them to," she said. "There's a need out there in the community for (a place for) these patients who need a little higher level of care."

The shortage of capacity for high-need patients is statewide, McNitt said.

"We have patients that come here from all over the state of Iowa," she said, including Davenport, Cedar Rapids and other eastern Iowa cities that would have sent patients to Mount Pleasant before that mental health institute closed.

The patients who are hardest to place are the ones that have behavior issues and can become aggressive, said Steve Baumert, president and CEO of Methodist Jennie Edmundson Hospital in Council Bluffs.

"Really, the acute care setting in a hospital is not the appropriate place for them," he said. "We sometimes will keep them for a very long time because there isn't a place to accept them."

These patients tie up beds that could be used by more suitable patients ? and tie up staff as well, because the patients require constant supervision and care, Baumert said.

"The state facilities that (were) closed have created a lack of available space for chronically mentally ill patients," he said.

Sometimes, the patient is an elderly person with advanced dementia who is agitated, Baumert said.

"There's not a lot of facilities that specialize in the care of that kind of patient," he said. "The family can't take care of them. That's a growing area of concern. I don't think the state of Iowa has the answer for that yet."

Some are sent to state mental health institutes in Cherokee or Independence, but space isn't always available, Baumert said.

Closing the state's other two institutes was in keeping with the long-term push to care for patients in the least restrictive environment possible ? but the state's mental health system wasn't ready for the sudden transition, Watson said.

"I think, on paper, it makes the state look good because we closed some institutions," Watson said. "But I don't think we've fully served the clients who need the assistance ? the higher level of care."