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Even though the Iowa Department of Human Services fulfilled a legislative mandate to provide a plan for closing one of the state’s four existing mental health institutions, there are larger issues that remain unresolved, the DHS’s director and the leader of an in-depth evaluation of Iowa’s mental health services said Monday.
The four mental health institutions that serve Iowa each have specific geographic regions of the state from which they draw general adults in need of care. In addition, each facility has a specialized area of care that serves patients in an even larger area.
DHS Director Charles Krogmeier has recommended the state close the Mental Health Institute (MHI) in Mount Pleasant and shift its responsibility to a facility in Independence, more than 100 miles away in Buchanan County.
“What we have tried to say in our report, and I know the task force hit on this fairly hard in their report, is that this discussion or this decision needs to be made in the context of ‘What should the overall mental health delivery system in Iowa look like? What are the needs? Where are the services? What are the gaps? And, how do the [mental health institutes] fit into that overall discussion?’ I think they are part of it, but how much they are a part of it is the question,” Krogmeier said on a conference call with reporters.
Former Democratic state Rep. Ro Foege served as chairman of a 12-member task force that evaluated, toured and held public meetings in each of the four communities with a mental health facility — Mount Pleasant, Independence, Clarinda and Cherokee. Following deliberations, the task force concluded that none of the facilities should be immediately closed. Instead, the members of the task force have advocated the four should remain open until the state has fully explored the existing system — the people it serves, public safety, total costs and best practices.
“I think the task force took a very sincere and hard look at this and decided that it just couldn’t recommend closing one of these facilities at this point,” Foege said in an interview with The Iowa Independent. “We need to make sure there are services available.
“The part that is very important is that the state, I believe, needs to provide a safety net, and that is what these four mental health institutes have been. We need to make sure that the safety net remains in place.”
Had it not been for the mandate, which was included in the Human Services appropriations bill last year, Krogmeier said closing Mount Pleasant would not be a position he would take. Outside of presenting the plan, he also does not plan to advocate the closing to members of the legislature.
“The cost of any of these services is predominately staff, drugs and feeding and housing the population. If you keep the population the same, and you provide all the same services, your costs are going to be about the same,” he said. “There are some marginal cost savings … but it is not huge.”
If the legislature elects to move forward on closing Mount Pleasant, the cost savings achieved will depend if existing personnel are consolidated into a facility in Independence, due to collective bargaining agreements that provide for relocation reimbursements. The Department of Human Services also shares administrative and support costs with the Iowa Department of Corrections, which operates a medium-security correctional facility on the Mount Pleasant campus. The shared costs associated with the DOC in fiscal year 2011 are estimated to be $1.4 million. Presumably, much of that cost would be reabsorbed by the Department of Corrections.
The department’s recommendation also anticipates that the Department of Corrections would begin to utilize the space vacated in Mount Pleasant following the move. Because the task force found that collaborative efforts and communication should continue between the state departments of Human Services, Corrections and Education and the Judicial Branch, Foege is hopeful that some of the existing personnel at the mental health institute could be utilized within the expanded correctional facilities.
Both men also point to community-based delivery changes that have been made in Minnesota as possible opportunities that Iowa should explore. Switching to smaller facilities would also allow the state to gain federal appropriations for the care it provides.
“[What we were asked to do] is quite different than looking at the overall system and the kinds of care that need to be provided, and how best we provide those,” Krogmeier said. “That’s where we would like to see the policy-makers go. We would like to seriously have that discussion and move the state in that direction. Whether we physically have four or three MHIs in that whole discussion is a relatively small issue — although it is very important to those communities, and very important to our employees at those locations. But when you frame this in terms of what should the mental health system look like, [the MHIs] are just one piece.”
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