Create a single mental health institute
11:00 PM, Jan. 18, 2011
- Filed Under
- Opinion
- Register Editorials
Last year, Iowa lawmakers planned for the worst in regard to the state budget, requiring an $84 million budget cut from operations across state agencies. The Iowa Department of Human Services planned for its share of the reduction, but needs to cut more. It could mean a sudden and drastic reduction of staff and services at state mental health institutes.
Charlie Krogmeier, the former director of DHS, laid out options in an e-mail to staff last week. He acknowledged the devastation of the proposals, but he had no choice. The department must follow the law, which requires cuts be made.
On Friday, the new DHS director, Chuck Palmer, walked into the job of dealing with the mess of this budget reality. He should encourage lawmakers to backfill money to avoid these cuts during the current budget year. Longer term, lawmakers must address the reality that Iowa doesn't need four mental health institutes anymore.
In the short term, there is a projected $331 million surplus in the current budget year. Lawmakers can tap into that money to avoid immediately displacing psychiatric patients, shutting down substance-abuse programs and laying off scores of mental health workers in rural Iowa.
Sen. Jack Hatch (D-Des Moines) says he will work to do just that. "You don't have to cut services this year," he said.
He's right. But making major changes at the mental health institutes, though painful, is the right move for the state going forward. In the past, lawmakers have failed to consolidate them. They must plan to do this during this legislative session - and Palmer should lead the charge.
Many years ago, 6,000 people lived in Iowa's mental health institutes. The four facilities were built in the late 1800s and early 1900s, in keeping with a national movement to institutionalize the mentally ill.
But today looks nothing like then. Over time, the focus has shifted to providing community-based mental-health services. Iowa now has about 230 people residing in those four sprawling state campuses around the state.
It doesn't make any sense to continue to maintain them.
Danny Homan, president of the union that represents public employees, says the cuts being proposed now would "decimate our rural communities" by cutting jobs in towns where the facilities are located.
But government shouldn't maintain the status quo to keep people employed. Government is obligated to make the best use of dollars to serve vulnerable people. Even when doing so is difficult.
Lawmakers should craft a transition plan to consolidate institutes without acting hastily and abandoning the mentally ill - including children and elderly - in the process. Eventually all patients should be served at a single facility. That would no doubt be more cost effective than the four different locations employing 700 people and costing more than 27 million public dollars each year.
Iowans already drive long distances to receive care at existing facilities. Older Iowans with long-term mental and physical health needs live at Clarinda. Children and adolescents are served at Cherokee and Independence. Mount Pleasant specializes in substance abuse treatment for those with mental illness. Consolidation, ideally at a central location, makes sense.
Iowa doesn't need four mental health institutes, but a sudden closing that could displace many vulnerable and ill Iowans and leave more than 100 mental health workers unemployed is unnecessary.
- - -
As any of my regular blog readers know, this was not an editorial that I could let pass unremarked. These are my comments:
MarkRG
This article is distressing. First, because it assumes that the words "mental illness" define some sort of reality. NOTHING could be further from the truth. The concept of "mental illness" permits the Pharmacuedical Industry and the Psychiatric Guild to flourish and prosper at the expense of a duped public. Literally, we are being sold snake oil by these fly-by-night hucksters who have settled down to positions of prominence and power within our community.
Some history: At various of it incarnations, the Diagnostic and Statitistical Manual(s) of Psychiatric and Personality Disorders have included AS MENTAL ILLNESS all of the following:
(a) homosexuality
(b) chain smoking
(c) excessive masturbation
For NONE of the illnesses listed is there ever given an etiology, a scientifically observed, predictable course of events which the "illness" will follow under various programs of treatment.
But the characteristics used to define ALL mental illness are BEHAVIORAL. That is, a list of "mentally ill" behaviors is given, typically around 9, and a human being exhibiting 3 or more of such behaviors is put into that particular "mentally ill box" to be treated (medicated) accordingly.
In what other illness is the patient's decision to quit taking medication (because the patient feels cured, well) greeted with such alarm, and so many protests: "No. You CAN'T go off your medication. You might get depressed again, or worse!"
In other words, one MUST take medication (which only mask the symptoms of the illness) for the rest of one's life, otherwise one will (almost) surely become mentally ill again.
In other words, once you get mentally ill, you never get over it.
NOW .. in no way do I mean to disparage the concept of mental health. It is vital to our functioning as human beings. It's simply that, on my experience, the psychologists who characterized certain depressive episodes as "existential crises" are surely far closer to accurately describing the situation of depression.
- Filed Under
- Opinion
- Register Editorials
Last year, Iowa lawmakers planned for the worst in regard to the state budget, requiring an $84 million budget cut from operations across state agencies. The Iowa Department of Human Services planned for its share of the reduction, but needs to cut more. It could mean a sudden and drastic reduction of staff and services at state mental health institutes.
Charlie Krogmeier, the former director of DHS, laid out options in an e-mail to staff last week. He acknowledged the devastation of the proposals, but he had no choice. The department must follow the law, which requires cuts be made.
On Friday, the new DHS director, Chuck Palmer, walked into the job of dealing with the mess of this budget reality. He should encourage lawmakers to backfill money to avoid these cuts during the current budget year. Longer term, lawmakers must address the reality that Iowa doesn't need four mental health institutes anymore.
In the short term, there is a projected $331 million surplus in the current budget year. Lawmakers can tap into that money to avoid immediately displacing psychiatric patients, shutting down substance-abuse programs and laying off scores of mental health workers in rural Iowa.
Sen. Jack Hatch (D-Des Moines) says he will work to do just that. "You don't have to cut services this year," he said.
He's right. But making major changes at the mental health institutes, though painful, is the right move for the state going forward. In the past, lawmakers have failed to consolidate them. They must plan to do this during this legislative session - and Palmer should lead the charge.
Many years ago, 6,000 people lived in Iowa's mental health institutes. The four facilities were built in the late 1800s and early 1900s, in keeping with a national movement to institutionalize the mentally ill.
But today looks nothing like then. Over time, the focus has shifted to providing community-based mental-health services. Iowa now has about 230 people residing in those four sprawling state campuses around the state.
It doesn't make any sense to continue to maintain them.
Danny Homan, president of the union that represents public employees, says the cuts being proposed now would "decimate our rural communities" by cutting jobs in towns where the facilities are located.
But government shouldn't maintain the status quo to keep people employed. Government is obligated to make the best use of dollars to serve vulnerable people. Even when doing so is difficult.
Lawmakers should craft a transition plan to consolidate institutes without acting hastily and abandoning the mentally ill - including children and elderly - in the process. Eventually all patients should be served at a single facility. That would no doubt be more cost effective than the four different locations employing 700 people and costing more than 27 million public dollars each year.
Iowans already drive long distances to receive care at existing facilities. Older Iowans with long-term mental and physical health needs live at Clarinda. Children and adolescents are served at Cherokee and Independence. Mount Pleasant specializes in substance abuse treatment for those with mental illness. Consolidation, ideally at a central location, makes sense.- - -
Iowa doesn't need four mental health institutes, but a sudden closing that could displace many vulnerable and ill Iowans and leave more than 100 mental health workers unemployed is unnecessary.
As any of my regular blog readers know, this was not an editorial that I could let pass unremarked. These are my comments:
MarkRG
This article is distressing. First, because it assumes that the words "mental illness" define some sort of reality. NOTHING could be further from the truth. The concept of "mental illness" permits the Pharmacuedical Industry and the Psychiatric Guild to flourish and prosper at the expense of a duped public. Literally, we are being sold snake oil by these fly-by-night hucksters who have settled down to positions of prominence and power within our community.
Some history: At various of it incarnations, the Diagnostic and Statitistical Manual(s) of Psychiatric and Personality Disorders have included AS MENTAL ILLNESS all of the following:
(a) homosexuality
(b) chain smoking
(c) excessive masturbation
For NONE of the illnesses listed is there ever given an etiology, a scientifically observed, predictable course of events which the "illness" will follow under various programs of treatment.
But the characteristics used to define ALL mental illness are BEHAVIORAL. That is, a list of "mentally ill" behaviors is given, typically around 9, and a human being exhibiting 3 or more of such behaviors is put into that particular "mentally ill box" to be treated (medicated) accordingly.
In what other illness is the patient's decision to quit taking medication (because the patient feels cured, well) greeted with such alarm, and so many protests: "No. You CAN'T go off your medication. You might get depressed again, or worse!"
In other words, one MUST take medication (which only mask the symptoms of the illness) for the rest of one's life, otherwise one will (almost) surely become mentally ill again.
In other words, once you get mentally ill, you never get over it.
NOW .. in no way do I mean to disparage the concept of mental health. It is vital to our functioning as human beings. It's simply that, on my experience, the psychologists who characterized certain depressive episodes as "existential crises" are surely far closer to accurately describing the situation of depression.
Some history: At various of it incarnations, the Diagnostic and Statitistical Manual(s) of Psychiatric and Personality Disorders have included AS MENTAL ILLNESS all of the following:
(a) homosexuality
(b) chain smoking
(c) excessive masturbation
For NONE of the illnesses listed is there ever given an etiology, a scientifically observed, predictable course of events which the "illness" will follow under various programs of treatment.
But the characteristics used to define ALL mental illness are BEHAVIORAL. That is, a list of "mentally ill" behaviors is given, typically around 9, and a human being exhibiting 3 or more of such behaviors is put into that particular "mentally ill box" to be treated (medicated) accordingly.
In what other illness is the patient's decision to quit taking medication (because the patient feels cured, well) greeted with such alarm, and so many protests: "No. You CAN'T go off your medication. You might get depressed again, or worse!"
In other words, one MUST take medication (which only mask the symptoms of the illness) for the rest of one's life, otherwise one will (almost) surely become mentally ill again.
In other words, once you get mentally ill, you never get over it.
NOW .. in no way do I mean to disparage the concept of mental health. It is vital to our functioning as human beings. It's simply that, on my experience, the psychologists who characterized certain depressive episodes as "existential crises" are surely far closer to accurately describing the situation of depression.
