With few Iowa treatment options, parents of children in crisis look elsewhere for help
Sharing another critical article on the youth mental health crisis by journalist Lee Rood for her Reader’s Watchdog column from August 15, 2024.
With few Iowa treatment options, parents of children in crisis look elsewhere for help
With no options for mental health treatment for violent kids, parents leave children at hospitals, send youth out of state.
Numerous public and private residential facilities for foster and delinquent youth shut down over the last decade.
Last October, Iowa Department of Health and Human Services announced it had agreed to take steps to address "decades-long issues" in mental health and behavioral health access for Medicaid-eligible children.
The move was part of a lawsuit settlement agreement reached with Disability Rights Iowa and national health and law advocacy organizations, including Children's Rights, the National Health Law Program and a Boston law firm. The suit accused Iowa of a "longstanding failure" to provide Medicaid-eligible children with legally required and medically necessary mental health and behavioral health services.
Despite receiving federal funding for children's mental health, the state administered "an inadequate, inaccessible and dysfunctional mental health system," the suit said.
The much-publicized agreement came a month after Watchdog reported that wait lists for psychiatric medical institutions for children, called PMICs, had reached new highs. Providers reported widespread worker shortages, and programs shuttered or scaled back for lack of financial support.
But close to a year later, parents who rely on the federal insurance program for low-income families say they still struggle mightily to get children the mental health care they need.
Madalin Akers, a single mother from West Des Moines, said she was forced to bring her 13-year-old daughter frequently to Iowa Lutheran Hospital in Des Moines for lack of anywhere else to go.
“With her aggression toward me, things weren’t safe,” Akers said.
She said she didn't blame her daughter for the violence or aggression: The girl suffered abuse when young at the hands of someone who is no longer in the picture. But that abuse triggered PTSD, anxiety and behavior problems that started when her daughter was 7.
Now, she’s bigger than Akers — and capable at times of hurting her and her 9-year-old son.
Last fall, she said, she refused for a time to take her daughter home when care providers thought she should. But instead of getting any kind of additional help to deal with the girl’s behavior, Akers said, she was accused of neglect.
She said state child-protective workers threatened to remove her son from her home if she didn’t take her daughter home.
“Truthfully, it’s been hell,” Akers said. “It’s been incredibly hard to find help."
Amid youth mental health crisis, Iowa's group home and shelter beds tumble
More:US Surgeon General: It's crucial we do more to protect our kids from social media
Earlier this year, U.S. Surgeon General Vivek Murthy made headlines when he called the increase in youth mental health needs nationally “the defining public health crisis of our time.” Murthy said increased use of social media has helped lead to more feelings of isolation, stress and inadequacy among kids as they compare themselves to others.
At the same time, however, Iowa and other states have failed to restore treatment and services for families that have been stripped away over the years. The number of minors admitted to drug treatment programs in the state plummeted in the years leading up to the COVID-19 pandemic, while overdoses exploded, state figures show.
Numerous public and private residential facilities for foster and delinquent youth shut down over the last decade.
From Iowa's 2019 through 2023 fiscal years, the number of group home beds for youth in the child welfare system tumbled by nearly half, to 357 from over 660. Shelter beds dropped by 55% to just 107 statewide last year, according to data obtained from Iowa's DHHS.
According to the latest numbers on DHHS’ website, those numbers dropped even more in 2024, leaving fewer than 330 group homes and 100 shelter beds.
DHHS officials repeatedly declined requests for an interview related to those cuts and what specifically the agency is doing to improve access for low-income families.
Iowa care providers say children with the most extreme behavior tend to get what beds are available. Those whose families can’t afford to pay private providers through their own insurance or savings often go without. If a crisis reaches a tipping point, shelters and hospitals become the options of last resort.
Acute psychiatric hospital setting often isn't the best option for kids, official says
Megan Simpson, UnityPoint's director of behavioral health, said Lutheran has 14 beds in its inpatient unit for kids having mental health crises. But the hospital sometimes cannot use all of those beds because conditions in the unit would not be safe.
Many of the children using the acute psychiatric beds have suffered significant trauma or abandonment or have substance abuse issues and are harmful to themselves and others, Simpson said.
“I do believe community providers are doing everything they can to help,” she said. “But caregivers are also feeling like the hospital is the only option because the right level of care doesn’t exist in Iowa.”
Simpson said kids with intellectual disabilities and chronic behavior problems aren't best served in an acute psychiatric hospital setting, where long-term care and therapy aren’t available.
“There’s a real complication between hospital level of care versus a residential level of care,” she said. "True trauma-focused therapy is long term and takes a lot of time.”
Iowa Lutheran does offer a partial hospitalization program for children and adolescents, offering around 20 hours of therapy before they can go home. The goal, Simpson said, is to try to help them avoid hospitalization.
Iowa parents feel forced to send children away: 'There was no other choice'
Simpson said it’s becoming more common for caregivers to resist taking children home from the hospital — and more common for children to be released to programs in other states.
Akers said she had no alternative: Some Iowa agencies wouldn’t accept her daughter because of safety concerns. Others denied her because she’d already been through the program before. Some denied her with no explanation, she said.
"I finally had to send her to a program in Florida," she said. "There was no other choice.”
Akers said she wasn’t able to get any long-term help until Molina, one of the state’s Medicaid managed care providers, finally agreed to pay for therapy in Florida in March. That decision came after her daughter had been hospitalized repeatedly.
The goal now is to get her daughter back home in six to 12 months, she said.
“She’s not a bad kid; she just has bad struggles with anger and aggression,” Akers said. “I just feel like where she’s at now they truly want to see kids get better. It’s a therapeutic environment but also provides some normalcy to life.”
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