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COMPLEX NEEDS REPORT URGES ACTION

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In response to legislation passed in 2017, the Iowa Department of Human Services put together a work group to look at the services and supports available now for Iowans with complex mental health, disability, and substance use disorders, and make recommendations to fill the gaps and better serve these Iowans.  These recommendations include:

  • Expanding and improving Iowa’s mental health and substance use disorder services array to fill gaps for individuals with the most complex service needs by developing and implementing in strategic locations throughout Iowa:
    • Six access centers.
    • 22 Assertive Community Treatment teams.
    • A full array of mental health crisis response and subacute residential services.
    • Intensive residential service homes (nicknamed IRiSH homes) to serve a minimum of 120 individuals.
    • Tertiary care psychiatric hospitals, including the mental health institutes and other hospitals.
To do this, the work group is asking that the Governor and Legislature make the following changes:
  • Require mental health and disability services (MHDS) regions to establish, implement, and maintain the following services as required core services: 
    • Access centers
    • Assertive Community Treatment.
    • Comprehensive crisis and subacute services.
    • Intensive residential service homes (IRiSH)
       
  • Direct DHS to establish a single set of provider qualifications and access standards that are used for mental health services provider accreditation (chapter 24), Medicaid enrollment (DHS), MH/DS region standards, and MCO utilization review standards.
  • Direct DHS to establish access standards that allow and encourage multiple MH/DS regions to strategically locate and share intensive, specialized services among and between MH/DS regions to best serve Iowans in the most efficient manner possible.
  • Eliminate the cap on subacute care facility beds.

  • Encourage the 2018 Legislative Interim Committee on MH/DS funding to consider these recommendations.

  • Request that DHS work with the courts to discuss how Iowa's commitment laws (Chapters 125 and 229) could be amended to make the best use of these changes and include precommitment screening.

The Governor highlighted one of these recommendations (access centers) in her Condition of the State speech, saying "In many cases, Iowans suffering from mental illness don’t need hospitalization. But they also can’t get the care they need at home. They need a safe place to stay that offers professional services and a watchful eye.  We need to establish residential access centers that will provide short-term care for those in crisis. A place with the resources necessary to get these Iowans stabilized and back home to their families."    

While she called out the Access Centers specifically, she was clear that more must be done. "To improve our mental health system, we can’t just focus on the sheer number of beds; we must identify the gaps in our system." Governor Reynolds went on to say, "I am asking the mental health regions and our stakeholders to work with me to create a long-term and sustainable funding structure to establish these much-needed crisis access centers. Creating a mental health system is complex and it won’t be solved overnight. But no parent, child, friend or neighbor should suffer in silence when it comes to mental health."

The full report is available at www.legis.iowa.gov/docs/publications/DF/865801.pdf.