An Open Letter to Governor Terry Branstad on Planned MHI Closures

Regarding the planned closure of the Mt. Pleasant and Clarinda MHIs, I sent the letter below to Iowa Governor Terry Branstad at weblink

The letter includes a comment on my sense of personal connection to this issue as well as my sense of responsibility as a medical professional and teacher to medical students and residents.

I’m not surprised that I had to choose “other” for a message subject because there is no selection for “mental health.” My message is about your plan to close the Mental Health Institutes at Mt. Pleasant and Clarinda, a plan to which I propose you consider an alternative.

I’m a staff psychiatrist at the University of Iowa Hospitals & Clinics (UIHC). News sources indicate you’ve told them that you’re collaborating with UIHC Psychiatry to somehow pick up the slack after the MHIs are closed. That comes as a surprise to me and the rest of my colleagues. We’re not aware of any formal conversation you’ve had with us about it. And many are entering their signatures on a petition I’ve started to register their disappointment in your plan and their hope that you’ll consider an alternative.

Regarding that petition, I was reminded by one of our administrators that I should not have sent a message to my colleagues about it on my University of Iowa Outlook email account because employees are not to use it for “personal or political purposes.” The rationale was the delicate relationship between you, the State Board of Regents, and The University of Iowa. I wondered about the fear which drives this rule and I’m not really sorry I bent that rule.

Many of us believe that it’s wrong to send a false message to the public that UIHC can somehow make up the difference for the inpatient beds which will be lost by the closure of the MHIs at Clarinda and Mt. Pleasant. This is a puzzling way to reach out to the public for support of a plan to reduce access to inpatient psychiatric care at a time when we need the opposite.

Our inpatient units are often full and patients sit in our  Emergency Department waiting, sometimes for days, to transfer out to other hospitals in the state—which are also often full. This sometimes leads to violent confrontations with patients burdened with persistent, severe mental illness, raising the risk for injury to themselves and to hospital workers.

What I hope for is a genuine vision for improving access to inpatient mental health care in Iowa, not just shutting down beds. This is about a lot more than cutting budget costs. It’s about human lives. Just yesterday, I returned a call from a patient’s legal guardian who was looking for my help with his granddaughter who has severe, persistent mental illness and who was psychiatrically hospitalized at UIHC in the past. He’s frustrated because the patient is not able to move forward in the outpatient community mental health setting and has failed many placements. He spontaneously deplored your plan to close the MHIs and is thinking of contacting his state legislators, a move which I encouraged.

The kind of vision I hope you would embrace would be similar to what Massachusetts did by building the Worcester Recovery Center and Hospital, which opened in 2012. It was built partly with the bricks and mortar of the former state mental asylum it replaced and appears to hold promise for treatment of the population of patients who have not been well served by the deinstitutionalization of the state mental hospitals in the 1960s.

The MHIs are old, even “ancient” as I believe you have called them and I have no argument with that view. What I contest is the short-sighted move to cut access to sorely needed mental health care when there might be an avenue to improvement.

I also have my own story about the MHIs in Iowa which serves to partly explain why I’m so passionate about it. My brother was a patient at the MHI at Cherokee in the distant past. He needed it at the time and I was glad it was there for him. He’s been dead many years. Part of my memory of him will always be connected to the state hospital which helped him. At a deeply personal level, I know a great deal about the travail of families who struggle to care for loved ones who can’t fend for themselves because of mental illness.

As a faculty member at UIHC, I see myself as a teacher of the next generation of doctors. I know that one of the most talented and dedicated trainees in our psychiatry residency program wrote a letter to you conveying her concern about the closure of the MHIs. You replied with an impersonal form letter which did not respect her as a professional and indicated that you had not read her letter nor did you make an effort to understand the point we are all making—we must all work together to build a mental health care system which truly cares about Iowans.

You needn’t bother replying if that is what you would send to me. Instead, as one of my colleagues has suggested, it might be more helpful for you to meet with a group of Iowa psychiatrists to discuss how we might address the crisis of mental health care in our state.