March 28, 2024

Mental health part 2: A proactive approach for patients

The concept of regional mental health services in Iowa has been active about eight months. Union County is part of Southern Hills Regional Mental Health along with Adair, Adams and Taylor counties.

In February, Gov. Terry Branstad proposed to close two of Iowa’s four state mental health institutions. Lori Nosecable, CEO of Southern Hills Regional Mental Health, said no services have been lost and there is not a waiting list for a patient in crisis.

“Things continue much the same,” Nosecable said. “We are trying to expand services, but I don’t think at this point people will find much difference.”

The Clarinda and Mount Pleasant institutes are expected to close July 1, with employee layoffs starting as early as March 30. Branstad’s plan would add 30 beds at the Independence mental institute, however, most other services would be farmed out to private agencies. The other state institute is located in Cherokee.

Iowa Department of Human Services Director Charles Palmer has said the two closures would save the state up to $10 million per year.

In the Creston area, Greater Regional Medical Center is not an inpatient option for psychiatric services. In an emergency situation — under the Emergency Medical Treatment and Labor Act — there is a legal obligation to provide treatment for the patient.

“When we have determined that somebody needs placement ... the bed availability is so limited that we will spend hours on the phone calling all those resources,” said Mary Groves, emergency department director at GRMC.

In response to the Governor’s restructure of mental health, Nosecable said the region is working to be more proactive in providing services to mental health patients.

Medicaid option

For adults and children who are Medicaid eligible, Health Home is an option that provides care coordination services.

Pete Brantner, executive director at Crossroads in Creston, said patients are served by a team made up by a nurse, care coordinator and a peer support person.

“The peer support person is someone who has had a mental health diagnosis, so they know what it is like to be in that position,” Branter said.

The team helps coordinate services for the person’s well being including mental health, other medical aliments and dental.

“The theory is, if you have a team that helps folks get services around them they need, they are less likely to be in crisis, less likely to use the emergency room,” Branter said.

Nosecable said it is important to look at the patient as a whole, not just focus on the mental health issue.

“This is a concept that is changing in health care delivery,” Nosecable said. “We are trying to be more proactive in helping people avoid crisis. The more we do to get services around a person, the more we can make sure they are taking advantage of them.”

Future options

Branter said the region is working on a process to help folks in crisis get a more immediate evaluation and referral for the appropriate level of care.

“We have begun the process to get psychiatric services for screening by telehealth,” said Dr. Matthew Epp, director of emergency medicine at Greater Regional Medical Center. “We will provide a platform to allow a patient to be seen by a psychiatrist.”

While the number of inpatient beds will still be limited, telehealth would allow a psychiatrist to adjust a patient’s medication and schedule appointments sooner. It would cut down the burden of transportation for GRMC and Union County.

“The emphasis is to get more people treated as an outpatient,” Epp said. “True availability of treatment for people who need it is still as much available now as it ever has but, I think it is going to be better allocated in the future.”