New statewide behavioral health model reshapes care

MT. PLEASANT — As of July 1, Henry County and the rest of Iowa began phasing out the regional mental health structure and shifting behavioral health oversight to Iowa Primary Care Association, a transition that officials say promises more streamlined service but raises questions about continuity, funding and local voice.

  Buy Photo

Under House File 2673, Iowa merged its 32 regional mental health and substance use programs into seven larger behavioral health districts. The Iowa Primary Care Association now oversees the system as the state’s Behavioral Health Administrative Services Organization. For Henry County, that shift ends Henry County’s participation in Southeast Iowa Link — meaning residents will now turn to a new statewide structure for crisis response, addiction treatment and other behavioral health care.

To give more insight on this shift, former Henry County Disability Services Director of 24 years, Sarah Berndt, returned to the Henry County Board of Supervisors. In her new role as the district leader for District 6, Berndt laid out how the new system will function, introducing key staff and explaining how “system navigation” will become the front door for many Iowans needing help.

In District 6, she said, system navigators answer or triage calls from people in distress, walk individuals through Medicaid forms, schedule referrals, and follow up to close the loop on services.

To date, from July through September, the system in District 6 handled about 1,300 navigation contacts, including nearly 2000 outbound service referrals. About 930 of those contacts came from clients themselves; the remainder came via providers, law enforcement or third-party callers. Berndt suggested those numbers reflect early demand and evolving infrastructure. This new shift redraws the relationship between county government and behavioral health.

  Buy Photo

Within District 6, Iowa PCA has established a District Advisory Council made up of law enforcement, provider representatives, people with lived experience, and elected officials. Berndt named 10 members. These members include elected officials Washington County Supervisor Jack Seward Jr. and Appanoose County Sheriff Gary Anderson; a law enforcement representatives, Washington County Sheriff Jared Schneider and Henry County Sheriff Rich McNamee; provider representatives Christina Schark, Jacquiline Smith Duggan, and John Levy; and individuals with lived behavioral health experience, Denise Skippel, Brianna Kramer, and Jennifer Olson.

The council meets in person and via Zoom, and offers 15 minutes for public comment.

One new feature the system promises is integration: mental health and substance use disorder services will no longer operate in silos.

“On July 1 of this year, Iowa launched the new unified behavioral health system, and this unification combines behavioral health and substance use disorder services, so it’s all under one umbrella now,” Berndt said. “There’s no more siloing with that, because, you know, one comes with the other — the other comes with one. So it makes perfect sense that we’re focusing on that.”

According to Berndt, staff also plan to fund services in jails (such as medications and prescribers), school-based mental health programs, peer services, the co-responder crisis model (pairing law enforcement with mental health professionals on calls), and connect to federal grants like PATH (for housing transitions) and SAMHSA prevention funding.

Still, challenges loom. In her presentation, Berndt acknowledged that 60% of people who need help never made contact with the prior system, citing barriers of complexity and frustration. She said the new system must “calm them, stabilize them, ensure they’ve got access, follow up.”

Some callers prefer just phone numbers; others want someone to dial with them and walk the path.

That follow-through happens through system navigation, a service led by Iowa Primary Care staff such as Unity Stevens, senior lead system navigator for District 6. System navigators act as guides for Iowans who find the behavioral-health system confusing or overwhelming, helping them locate providers, complete applications and connect to services.

“System navigation was born out of this reality that a lot of people — individuals, families — face what feels like a very complex system,” Stevens told supervisors. “Whether it’s the papers you’re filling out or knowing who to call, especially when you’re in a state of distress, that’s sort of where we come in and help them along the way.”

Navigators also assist with Medicaid paperwork, make referrals and even stay on the phone while clients call a provider, if they would like.

“Some people just want you to call and talk to somebody, get that information, give them a tentative idea of who’s going to be calling them,” Stevens said. “Others ask staff to dial that phone number with them while we’re on the phone together.”

Stevens said the service logged about 1,300 navigation contacts statewide from July through September, generating nearly 2,000 outgoing referrals. Most calls involved mental-health or housing needs, with substance use following close behind.

“We’re building the system while we’re doing it,” she said, “so we have numbers — I just want to make sure our process is accurate.”

Counties also worry about non-Medicaid services, safety net programs, and continuity of contracts. Some local drop-in centers, crisis stabilization units or recovery programs may have depended on regional funding streams that may not map cleanly into the new statewide architecture. Berndt said Iowa PCA replicated existing regional contracts initially to maintain stability, then will monitor spending under district oversight.

After a thorough presentation from Berndt, Supervisor Chair Marc Lindeen expressed his respect for Berndt’s opinion and honesty throughout many years working together in Henry County. With such a high regard for her, he asked her opinion on how the transition is now going.

“We are in a good spot,” Berndt confidently told him. “Iowa Primary Care is designed to do this work. And Iowa Primary Care, I don’t know how they do it, they hie phenomenal people. They really do. I have mad respect for everybody that we work with. And they are dedicated, they are passionate, they are wanting to do the right thing, to improve access for our citizens.”

Comments: AnnaMarie.Kruse@southeastiowaunion.com