Friendly Fire in Iowa: The Closing of Mental Health Institutes

We’re digging out in Iowa today. My wife and I just finished–for now. We’ve already been out twice, the second time to respond to Friendly Fire in the form of the city plows, which shoved a thick curl of snow bank into our freshly cleared driveway.

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Speaking of “Friendly Fire,” I’m reminded of the controversy here over Governor Terry Branstad’s plan to close 2 of the 4 state hospitals. They are the Mental Health Institutes (MHIs) at Mt. Pleasant and Clarinda. I’ve mentioned this in a recent post about bringing back the mental health asylum. Some people might disagree with my calling what the governor has proposed Friendly Fire, but I’m just giving him the benefit of a doubt.

shooting yourself in the footOne the other hand, I call it Friendly Fire because it backfires, or more properly, is like shooting yourself in the foot. I don’t think closing mental hospitals will ultimately move us forward in caring for the mentally ill in Iowa.

I sent a message to a few congressmen and one of them enthusiastically endorsed my point of view, which is reproduced below:

“I’m a consulting psychiatrist with the Department of Psychiatry at The University of Iowa Hospitals & Clinics (UIHC) in Iowa City.

I’m not speaking as a representative of my employer. Based on my perspective as a psychiatric hospitalist, I wonder whether it’s possible for Iowa to consider an alternative to Governor Branstad’s plan to close the two MHIs at Mt. Pleasant and Clarinda.

I would be thrilled to know if anyone has a better idea for meeting the needs of Iowans with chronic, severe mental illness than simply closing inpatient units.

The example I’m thinking of is the Worcester Recovery Center and Hospital in Massachusetts, with which I imagine you’re familiar. Below are a few links that tell what the state-funded state mental facility is all about which opened in 2012:

WRCH Fact Sheet

WRCH Brochure

There have been calls for doing something like this by others, including the Des Moines Register editorial board, see link the Des Moines Register’s take  in which it’s stated “The Register’s editorial board has previously suggested closing all of the institutes and opening one centrally located facility to serve the entire state. Staff could be consolidated. Maintenance costs could be reduced. The best workers and practices could be brought together to provide comprehensive mental health services in one location. The state would still have a safety-net facility.”

However, Governor Branstad seems to believe that UIHC can absorb the increase in the need for acute beds. The online Des Moines Register story at link indicates that UIHC can pick up the slack  and actually says that Branstad thinks “…collaboration with the University of Iowa Hospitals and Clinics, will improve the quality of service and outcomes for patients with this admissions realignment…” referring to the closings of Mt. Pleasant and Clarinda.

I think it’s unrealistic to expect UIHC psychiatrists to pick up the slack if the two MHIs are closed and no other options for inpatient resources are explored.

We have 4 adult inpatient units (counting our Medical-Psychiatry Unit) and one child and adolescent unit. Together they add up to 87 beds. They are often full.

There has been an increasing need for more frequent and intensive monitoring of patients boarding in our emergency room as they wait for beds to open in other psychiatric hospitals.

It’s becoming more common for them to spend days languishing in our ER waiting to be transferred out to other hospitals with open psychiatric beds. Sometimes there are no open beds in the state. Violence sometimes erupts when the stress of waiting overwhelms these patients. Closing Clarinda and Mt. Pleasant without a plan for meeting the need for more beds is likely to further strain the ability to maintain a safe environment for both patients and health care workers in our hospital.

It’s superfluous to say Branstad’s plan may push our mental health system to that crisis—because it’s already happening. The violence against workers at the MHI at Independence was clearly detailed in the news.

We don’t just need a better plan; we need a plan because Branstad’s initiative is not a real plan.”

While you’re at it, why not sign the petition?




  1. Jim,

    Your post parallels the Minnesota experience right down to the post that the injury rates in these facilities increases. I have some posts on my blog about that, but the incredible piece is that the APA and District branches are silent on this. It is almost like they think the minute amount of political capital might be endangered if they alienate the state politicians and bureaucrats who are mismanaging the system.

    I guess we forgot that the APA was originally started as an organization of medical directors of asylums.


    Liked by 1 person

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