Iowa's Most Shameful Ranking Yet...
In late January, the Treatment and Advocacy Center (TAC) released an annual report, “Prevention Over Punishment: Finding the Right Balance of Civil and Forensic State Psychiatric Hospital Beds.” It says in part:
The number of state psychiatric hospital beds for adults with severe mental illness has continued to decline to a historic low of 36,150, or 10.8 per 100,000 population in 2023, with a majority of state hospital beds occupied by people who have been committed to the hospital through the criminal legal system. This strategy of prioritizing admission of forensic patients effectively creates a system where someone must be arrested to access a state hospital bed in many states.
Other Key Findings:
· An increasing number of the remaining beds are being utilized for forensic patients, leaving fewer and fewer beds for civil patients.
· Forensic bed waits remain an issue, with significant and sometimes tragic consequences.
· Staffing shortages, lack of appropriate discharge facilities and the COVID-19 pandemic have all contributed to the loss of psychiatric beds in the more recent years.
Furthermore, according to TAC research, Iowa’s Rank among the states:
#51 in beds per 100,000 population in U.S. and the District of Columbia.
Read that again.
We still, since 2016, rank DEAD LAST, even behind the District of Columbia, for number of acute psychiatric beds per resident.
There are also no state hospitals specifically designed for forensic patients in Iowa. State officials told TAC researchers that hospitals do have forensic patients, but those numbers in state hospitals aren’t tracked. When most or all of a state’s beds are used for patients who are involved the criminal legal system, it leaves people with severe mental illness who have no criminal behavior with fewer options for treatment (and logically then increases their chances of criminal behavior as their illness progresses). The shortage of civil beds in particular means civil patients who rely on state hospital for care—those with SMIs, complex needs, and co-occurring issues like SMI and addiction—may have few options for treatment.
Out the remaining state hospitals left after former Gov. Branstad closed two of the four, the Independence Mental Health Institution has 40 beds for adults and 16 for children, with a reported 91% occupancy rates in 2022 and average length stay of 6.6 months/157 days.
The Cherokee Mental Health Hospital has 24 beds for adults, and 12 for children with a reported 97% occupancy rate in 2022, and average length stay of 1.9 months/56 days.
Hospital occupancy rates greater than 85% are indicative of bed shortages. Iowa state hospitals have occupancy rates of 91% and 97%, suggesting the current number of state hospital beds in Iowa is insufficient for addressing community needs.
Which feels like an understatement.
A state psychiatric bed (or any psychiatric bed) in 2017 might have saved the lives of Mark, Charla, and Tawni Nicholson, my neighbors murdered by their son/brother in the grips of an SMI and acute psychotic episode, but there wasn’t one available across the entire state when he needed it. And here we are in 2024, and the family would’ve faced the exact same dire situation if it were to happen today.
Besides my relationship with Chase Nicholson, I also have an extended family member suffering from a complex and co-occurring mental illness. He’s homeless in downtown Des Moines as I type this. As an adult in his early 20s, he’s completely responsible for navigating the tangled and intricate mental healthcare system, treatment options, and basic living needs like holding down a job, securing safe and affordable housing, and transportation. He’s sought treatment and medical care many times, getting admitted to various hospitals around the metro only to be discharged a week or even hours later. He’s tried checking himself into rehab clinics only to be turned away because he “didn’t meet their criteria” for admission, likely due to his co-occurring mental illness. Which means he continues to flounder on his own, oftentimes too ill or suffering psychosis to even recognize how sick he really is. Because of his complex illness, co-occurring issues, and chronic homelessness, he’s also been in and out of the criminal legal system, which only compounds the problem.
It’s impossible to ignore that with admission to a long-term state facility, he could receive acute care, treatment, life building and coping skills, and ultimately stability, and then transition into therapeutic housing as he reintegrates into society. But here in Iowa, he’s “not sick enough” and even if he were, like I saw firsthand with Chase, it probably wouldn’t matter because there’s likely not a bed available.
In the eight years since Iowa earned that shameful ranking, the names of the people from high profile cases who’ve died because of it are engraved on my heart:
Jackie Dieckmann and Illa Pfeiffer, Council Bluffs, March 2016
Mark, Charla, and Tawni Nicholson, Bondurant, April 2017
Brian and Michelle Glasz, DeWitt, June 2017
Linda Selters, Burlington, October 2017
Diana Lensgraf, Muscatine, December 2018
Celia Barquín Arozamena, Ames, Sept 2019
Rev. Allen Henderson, Fort Dodge, October 2019
All cases committed by an individual with an identified mental illness or SMI, and with family members who reported struggling to get even adequate mental health care for their loved one. Several individuals on that list died at the hands of their seriously ill and grossly undertreated loved one while still fighting to get them help.
Not to mention the thousands of other suffering families whose nonviolent mentally ill loved one struggles without adequate treatment.
Iowa, when are we going to collectively decide this is unacceptable and do something about it? ~
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The decision for me to go public with my chronic and severe mental health on Facebook and Substack is precisely for reasons such as this. I refuse to hide, even though going public has come with consequences.
I’ve lost friends, and my family has disavowed me, Because of my illnesses. they’ve chosen anger, embarrassment, and an unwillingness to acknowledge and educate themselves about mental illness, and understanding and acceptance of me. I’ve published numerous articles, but received little attention from my peers.
I experienced the public mental health system at its best, when I was at County Road Home, in Linn County, for 18 months. I credit the programming and leadership there for saving my life. Without that intervention I cannot bear to think about how my life would have changed with my severe psychosis, and other severe potential symptoms. Police had come to my home to remove me from my home after weeks of my inability to go outside to see family, or run errands. I was terrorized by things I was experiencing.
The solid coursework at County Home Road helped me find answers to some of the trauma I experienced in recent years. I had no idea that there were parts of my personality that reacted from earlier life hood trauma. I left with solid coursework to constantly revisit and I discharged to a ABBE Center Transitional Living Program for the next 18 months, which still exists.
Right now I’m bouncing between assisted living and back to independent living in an apartment. My biggest fear is being alone with the return of psychosis and not knowing where I can go. Can I go to the hospital? Or will I be able to get an emergency bed? Or will I remain fearful in my apartment, hiding in a closet?
So many people I’ve known over the years with mental health problems died early. Way too early. I wonder about my future.
Watching the dismemberment of the State Mental Health System is a personal pain for me. It hurts me as if someone stabbed me. It’s the State of Iowa aborting me from existence, without any care, thought, responsibility for me as an ill person.