Of Course It's About Lack of Beds
Week 9 Legislative Updates
This week I was back at the Iowa State Capital to voice support for two bills that moved on to senate sub-committees: a bill for an act relating to testimony at involuntary commitment hearings by physician assistants and advanced registered nurse practitioners, and a bill for an act relating to order for treatment of persons experiencing psychiatric deterioration. Some interesting points to discuss here.
Involuntary Commitment Hearings
HF 313 was new to me but I quickly got up to speed on its origins.
This bill would allow a physician’s assistant (PA) or advanced registered nurse practitioner (ARNP) to be present and testify on behalf of a licensed physician and surgeon, osteopathic physician and surgeon, mental health professional, or certified alcohol and drug counselor who examined a respondent in an involuntary commitment hearing for a substance abuse disorder if the court grants an application that contains certain sworn statement as detailed in the bill.
It’s no secret Iowa has a dearth of psychiatrists. In 2021, the entire state counted 212 licensed psychiatrists practicing that year (down from 236 in 2012) according to Iowa Health Professions Tracking Center at the UI Carver College of Medicine. And of those 212, a staggering 66 percent work in Johnson, Linn, and Polk counties (our most-populated areas), while 73 of Iowa’s 99 counties have not a single psychiatrist within their county lines or neighboring counties. This means many individuals rely on telehealth and virtual meetings or hearings related to mental health matters.
One individual at the sub-committee meeting testified about recent case in northwestern Iowa where a treating psychiatrist failed to appear and testify during a virtual commitment hearing, the respondent subsequently was not committed for treatment, and later died by suicide.
This is a particular problem in our rural counties. While virtual appointments and hearings do increase options for rural residents, scheduling and reimbursements for attending physicians can create a no-show issue. This is a common sense bill that could help address that gap.
Psychiatric Deterioration
Last month I attended the House sub-committee meeting for HF 312, an act relating to order for treatment of person experiencing psychiatric deterioration. This bill goes on to define “psychiatric deterioration” as:
the person is unable to understand the need to treat their mental health condition
based on the person’s history the person is unable to understand the need to treat their mental health condition
within a reasonable degree of medical certainty, unless the person receives treatment, the deterioration is likely to continue until the person has a serious mental impairment.
I again attended the Senate sub-committee meeting to voice my support alongside other advocates, and share personal experiences.
Anyone who has cared for a person living with a serious mental illness learns all too well the symptoms and behaviors of a deteriorating illness. We’re attune to changes in mood, voice, speech patterns, gestures, certain behaviors, and more. It’s like watching a slow motion car wreck, seconds before the collision, and do anything you can to stop it.
Mental health advocates see this bill as a critical preventative measure to avoid serious mental health episodes that can often result in a revolving door of jail, brief hospitalizations, and beyond. Similar laws like this bill have already been enacted in 34 states.
One senate member of the committee asked about statistics in those states, specifically if their law caused a flood of more patients with not enough psychiatric beds to take them.
Which leads to the same point mental health advocates have been arguing for years…
Of Course It’s About Lack of Beds (duh)
When I heard that question I nearly laughed out loud. The critical lack of psychiatric beds, especially in Iowa (dead last in the nation), isn’t a secret. Advocates have screamed about it for years. But no one has stepped up to do anything about it, like pony up funds to create new facilities or units to house these beds.
This conundrum was created as far back as 2015, when then-Gov. Branstad closed two of Iowa’s four state run mental hospitals. Even if we did build new facilities, we don’t yet have enough medical staff to oversee them. According to the Des Moines Register, a “whopping 94% of states reported they were experiencing staffing shortages at state hospitals, resulting in a closure of 15% of beds because of a lack of workers to provide care, according to the report. Researchers found that the issue is largely caused by budget constraints, which don't allow state hospitals to offer the same competitive wages that private facilities provide their staff.”
So yes, there’s always a concern about lack of beds. And while both of these bills relate to the shortage, maybe if we had better early intervention options when a person needs treatment, they won’t become as seriously sick, and the precious few psychiatric beds we do have won’t be occupied as long.
Just a thought.
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