Mental Health System Redesign in Iowa
Legislation passed in 2011 directed the Iowa Department of Human Services (DHS) to recommend a complete redesign of Iowa’s current system of delivering mental health care to those eligible for services. Iowa DHS Director, Chuck Palmer appointed workgroups to address core services and delivery systems with recommendations due to a Legislative Interim Committee in October 2011. The workgroups included adult mental health, brain injury, children’s disability, intellectual disability services and regional services. Chatham Oaks staff attended the adult mental health workgroup meetings and the Legislative Interim Committee meetings. DHS Director Chuck Palmer has presented a final report and recommendations to the full legislature. It is anticipated that bills addressing the redesign will be introduced late January or early February.
Minutes of all meetings and reports are posted on the DHS System Redesign website:
http://www.dhs.state.ia.us/Partners/MHDSRedesign.html
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We strongly recommend everyone stay informed regarding this important process!
Contact your legislators to voice your opinion!
Residential Care Facility (RCF) services were not included in the core services recommended by the adult mental health workgroup. Individuals with mental illness who need this level of care could be at risk.
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Another resource to stay informed on legislation affecting mental health issues is:
www.infonetiowa.com/
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The following Guest Opinion Column was written by the Chatham Oaks Board of Directors and published in the Iowa City Press Citizen and Gazette on January 5, 2012
The Iowa Mental Health and Disability Services System Redesign Committee issued its report on December 9, 2011 outlining its 5 –year plan to redesign Iowa’s funding and service delivery to persons with disabilities. Preliminary discussion has centered on reducing or eliminating funding for residential care facilitates (RCF) as well as other providers of mental health care. Chatham Oaks Inc., a RCF, is a private non-profit corporation formed by Johnson County in 1988 to provide services to people with mental illness. As the Board of Directors we wish to share how Chatham Oaks fits into the “continuum” of mental health care. Chatham Oaks, located on several acres of county land along Melrose Avenue, provides services and living arrangements for approximately 75 individuals in the RCF plus 18 separate apartment units next door. Chatham Oaks provides Supported Community Living Services (SCL) in Iowa City and Coralville.
Chatham Oaks is one step on the mental health care service delivery ladder leading to a better and improved quality of life. Often, the first step is psychiatric hospitalization where evaluation is completed and treatment plan determined. Step two is often a period of time at Chatham Oaks, or a similar setting, to give the person time to stabilize on the treatment plan and make modifications. Along with mental illness, a person may also need treatment for multiple physical health issues and/or substance abuse. Key to a successful outcome is Chatham Oak’s professional full time nursing staff making sure the individual is doing well on their medications. While at Chatham Oaks the person is encouraged to gain skills that will lead to independent living, as well to take part in staffed recreation activities, exercise and participate in community activities. Transportation is provided for doctor appointments and some activities. An Iowa City bus also stops at the front door. The third step is for most individuals to move into their own home, with the option of receiving SCL services.
During 2011, there were 171 referrals to Chatham Oaks Inc.. Seventy people were admitted and 62 were discharged. The average length of stay for individuals who were both admitted and discharged in 2010 was 71 days. While there are people who have lived at Chatham Oaks for a longer period of time, the primary goal is for the individual to return to independent living as quickly as possible. One hundred and one people were not admitted because they were considered too ill or too dangerous to themselves and others to be admitted. Where do people too sick for this level of care go? to prison? to a homeless shelter? Or, do they die somewhere in a dirty apartment, alley or under a bridge? No detailed research has provided the answer.
Some people, because of the severity of their illness, by their choice may reside at a RCF like Chatham Oaks where they know that their medications will be monitored and their social and physical needs will be met. Any proposal for a mental health care plan should include allowing persons with a mental illness a “choice” in where and in what manner they would like to live.
As hospitals may recommend a patient with a broken hip or back surgery stay for a period of time following release in an assisted living facility or home with 24 hour nursing coverage - we believe it also critical the response to treatment by many individuals with mental illness be closely observed for a time following release from the hospital. There is empirical evidence that going from the hospital directly to a home environment without a period of medical oversight frequently leads to relapse. We urge the Iowa Mental Health and Disability Services System Redesign Committee and Legislators to further consider the necessity for maintaining the present continuum of care which include RCFs.