DES MOINES — Iowa’s mental health care delivery system received a massive overhaul in 2018 that was well-received by mental health care advocates.
The reforms created critical access centers for people experiencing an immediate mental health crisis and a statewide crisis hotline, removed a cap on the number of beds a health care facility can house, expanded the use of teams of community-based professionals who collectively can offer comprehensive treatment for people with serious and persistent mental illness, and established services for those types of patients.
But more significant work remains ahead for state lawmakers. The system needs a reliable and steady funding stream, and the state still lacks a mental health care system for children.
Gov. Kim Reynolds appointed a task force to research the children’s mental health care issue and develop recommendations. The group delivered its plan late last year, and Reynolds said she and state lawmakers will consider it.
Reynolds will highlight the need to create a state children’s mental health care system during her condition of the state address Tuesday.
“We don’t have one. They’ve been talking about it for years, and now it’s time that we do something,” she said.
It will take time, she said, noting recent reforms to the adult system were spread out over several years, with a redesign to regions in 2014 and the latest reforms passed in 2018.
“You can’t do it all at once,” Reynolds said.
House Speaker Linda Upmeyer, a Republican from Clear Lake, said state representatives Joel Fry and Shannon Lundgren are working on the issue and reviewing the task force’s recommendations.
“It’s a very ambitious list, obviously. But where do we start? How do we get moving down this path? What are the things that are possible? And what do we need to do first to sort of set up the infrastructure base for accomplishing some of these things,” Upmeyer said. “I think that will be something we’ll want to work on, and I’m hoping that that’s something we can do in a very bipartisan way. We worked together to do that last year. I think that’s important to do. We are here to govern, and we want everyone involved in that.”
House Minority Leader Todd Prichard, a Democratic from Charles City, expressed similar hope.
“There’s definitely room with mental health to find bipartisan support to solve Iowa’s mental health crisis,” Prichard said.
In addition, state legislators will be faced with how to fund the adult system.
For all the praise the 2018 reforms received, many also noted it lacked a funding plan. The current system is funded largely by local property taxes, which are capped by state law. Some counties have asked for the cap to be raised or eliminated, so property taxes can be increased to create more funding for local mental health care services.
Legislators may debate whether the state should pick up the entire tab.
The ongoing push from water quality advocates to pass a three-eighths of 1 cent sales tax for natural resources funding has spurred a new debate: legislators could pass a full 1 cent sales tax increase, use three-eighths for water quality funding and hold a debate over how to spend the remaining five-eighths.
Such a debate could include mental health care funding.
Legislative leaders’ opinions on such a proposal were mixed.
“One thing our caucus is interested in is lowering taxes, especially property taxes,” said Senate Majority Leader Jack Whitver, a Republican from Ankeny. “If there are ideas or options to remove (mental health care funding) from the property tax rolls, we’re willing to look at it. ... That’s part of a larger discussion.”
Reynolds and Upmeyer said mental health care funding should be generated at the local level because that keeps funding in the hands of the government closest to the citizens.
Upmeyer said it used to be funded at the state level, and she finds the current funding system better.
“It was a state program, and it really didn’t work that well because it wasn’t in touch with people,” Upmeyer said. “Especially when you’re dealing with mental health issues, I think we are absolutely committed that the best way to do this is in a much more local way.”
Another potential state versus local tradeoff could involve the funding, called backfill, the state sends local governments to compensate for lost revenue as a result of property tax cuts passed in 2013. Republican statehouse leaders are considering eliminating it.
Such a tradeoff was not palatable to Senate Minority Leader Janet Petersen, a Democratic from Des Moines.
“I would hope they would fix our mental health funding structure without some type of hostage-type of package deal that puts local leaders in a bad position,” Petersen said. “If they get rid of the backfill, it will come down on local property owners, and I don’t think people around the state want to see property taxes go up. ...
“I think Iowans are looking for stable, ongoing funding for our mental health system.”