Unintended Consequences Of Cutting Mental Health Services In Iowa
I took this picture a couple of years ago during a trip to Iowa. This is the old Clarinda Asylum for the Insane. The name was changed for obvious reasons a long time ago to the Clarinda Treatment Complex. I grew up in Iowa, so let me tell you a few things about my home state. Among other things, Iowans grow corn, raise hogs, and sometimes elect people to the Iowa State House who need a little schooling about mental illness and the needs of the mentally ill.
Iowa currently has four state hospitals for the mentally ill. Now that number is being cut down to three. Iowa State Legislators, who have no clue about what they’re doing, ordered the head of the Department of Human Services, Charles Krogmeier, to shut down one of the state’s mental hospitals. The Clarinda facility and three other hospitals were put on the chopping block. Krogmeier didn’t want to shut down any of the hospitals. He said that the move wouldn’t save money or improve patient care, but the politicians gave him no choice. Mr. Krogmeier suggested the elimination of the Mount Pleasant Mental Health Institute.
Bravo, Iowa State Legislators. You and Governor Chet Culver are gutting Iowa’s mental health system by ignoring the big picture. State hospitals treat patients who don’t have insurance and cannot pay for private care, and those that no one else will take. You know what I mean. I’m talking about violent patients. They hurt themselves or others, and engage in inappropriate sexual behavior or start fires. Mental health patients without insurance, or those who exhibit dangerous behaviors, can wait many days in a hospital emergency room for a state hospital bed to open up. The consulting firm that Governor Culver hired suggested that the state close down the geropsych beds at Clarinda and the drug treatment center at the Mount Pleasant Mental Health Institute. They told Governor Culver that the geropsych patients could go into area nursing homes, and that the drug treatment patients could pay out of pocket, or find money elsewhere, for treatment in private facilities. Shows you what the “experts” know about the mental health system. Nursing homes won’t touch geropsych patients because of rules concerning chemical and physical restraints, and drug treatment patients wouldn’t be in state beds if they could pay for their treatment in the first place.
The Iowa State Legislature and Governor Culver need to take Mr. Krogmeier’s advice. He is advising the governor to open up a series of small 16 bed mental health centers throughout the state before closing a single hospital. This would facilitate revenue via Medicaid, and allow patients to be closer to home. Of course, opening centers takes time, and the clock is ticking. I hope the politicians can work things out, but judging by their track record, I don’t give it much hope. Shuffling patients to other hospitals and limiting beds isn’t going to solve the problem. It’s going to make things worse.
*This blog post was originally published at Nurse Ratched's Place*
The irony of this story coming after the earlier blog on whether Americans are too cold-hearted to appreciate the need for health care reform is quite sharp. Callous politicians who don’t feel the consequences of casting out the mentally ill onto the streets is not uncommon. I still remember the funding cuts instituted by Ronald Reagan’s administration that were part of an overall attempt to alter the political economy to be more profitable for business. Fewer and fewer beds became available and the homeless problem grew worse. Alexander Thomas wrote on this in his 1998 article (http://www.sociology.org/content/vol003.004/thomas.html).
Our generation can hang our collective heads in shame to allow this sort of tactic anywhere in the country. To the good folks of Iowa, have a happy holiday.