Mental health care providers express concern to Sen. Hart at Hillcrest

By Grace King, Mt. Pleasant News

State Sen. Rita Hart (D-Weatland) sat down with mental health professionals at Hillcrest Family Services in Mt. Pleasant on Wednesday to dialogue with them about the roadblocks facing mental health providers and people seeking their services.

Henry County was just one stop Hart made during her statewide mental health tour as she campaigns for the position of Lieutenant Governor alongside gubernatorial Democratic nominee Fred Hubbell.

The mental health providers discussed challenges they face when Managed Care Organizations (MCOs) refuse to pay for services, the need for 24-hour supervision for patients and law enforcement and the necessity to treat patients for both mental health and substance abuse.

?For me, the biggest disconnect is that these MCOs want to apply a medical model to an environment that does not fit into a medical model,? said Sarah Berndt, Henry County coordinator of disability services.

Chris Betsworth, therapist at Hillcrest, explained that the privatization of Medicaid requires mental health providers to justify the services they provide each patient. The amount of time and attention it takes to devote to get services authorized is prohibitive to those very services.

Berndt, who sits on the Alcohol and Drug Dependency Services board (ADDS), said they had to write off $250,000 to $300,000 worth of denied payments from Medicaid recently. ?We?re talking a very small organization that serves four counties and has a 20 to 25 bed residential unit,? Berndt said. ?That?s catastrophic to our organization and they?re trying very hard to stay alive and viable.?

Mary Lane, lead therapist at Hillcrest, sees the same problems facing integrating substance abuse and mental health treatment. People who used to be eligible for 21- to 28-day treatment are now only getting treated for seven to 14-days.

Lane called it despicable that they have to deny services because MCOs refuse to pay, saying that 95 percent of people she sees for substance abuse problems also struggle with mental health.

?We?re having to send those individuals out or take that loss as an agency,? Lane said. ?That?s been very difficult because substance use is everywhere. Once we send them back on the street, they?re likely to relapse.?

That?s the story Hart said she is hearing across the state and for the last couple years in the Senate. ?We?re hearing across the state from providers, patients, family members who are struggling to figure out the system and figuring out how to get better care. It truly is a crisis,? she said.

The deinstitutionalized model of services is another hard-hit for mental health care. Berndt said the Sheriff?s Office expresses frustration when it comes to where to take people in crisis in the middle of the night, adding that she sees no point in arresting someone because they are so symptomatic that they have to go to jail or risk being dangerous toward others or themselves.

?We need to have at least one mental health institute back in the system or beds back in the system that can be that drop off center,? Berndt said. The Mt. Pleasant Mental Health Institute closed in 2015.

Hart said that when the MHIs closed down, they needed to have proper community supports in place. ?By shutting down those institutes, it caused this disconnect,? she said, sympathizing with Berndt.

Berndt explained that it continues to be a problem for mental health patients who end up in the jail and prison systems. Even now, she is working to get someone out of the prison but can?t get them funded, she said.

That being said, Betsworth is proud of the services they provide. Hillcrest provides services by going directly into emergency rooms and assessing mental health patients. People can get in immediately without sitting on a waitlist for six months to see a provider, he said.

It?s lead to a reduction in unnecessary hospitalizations and reduced the need for transport. Patients don?t have to go across the state to be hospitalized but can be served right here in the community.

The regionalization of mental health services when the institutes closed down was the right direction. They just need the appropriate funding to make it more effective.

At the close of the discussion, Hart said she and Hubbell are committed to turning the Medicaid privatization back under state control. ?We?re going to have to do that in a thoughtful, careful manner,? she said. ?We want to make sure we?re not making that same mistake, that we?re sitting down with providers, patients and people on the ground dealing with these things.?

Hart said mental health care is important to not only the well-being of Iowans but to the economy of Iowa, adding that money spent in the correctional facilities might not have to be spent if there was more time, energy and resources in the prevention aspect of mental health care.

Finally, Hart praised mental health care providers for not being in it to make money. ?People who run this business really care about people. To say we just want to recoup our cost is reflective of the kind of people in this business,? she said.