Some News About Mental Health In The Nation And In Iowa You Could Take With A Grain Of Salt

I ran across an article on the Forbes site, “Trump’s Stealth Health Plan Could Be ‘Medicare For All'” by John Wasik, posted Jan. 20, 2017. It had 43,537 views when I read it this morning. I’m pretty skeptical of just about everything I read in the news these days. I’m sure you want to know what makes Wasik believe that President Trump’s health care plan is Medicare For All (MFA).

Because Trump said so.

Boy, am I glad we finally got the health care financing issue whipped. Now let’s tackle holiday garbage collection times. But hang on, Wasik’s link to MFA doesn’t take you to Bernie Sander’s campaign site. This is the other MFA website and it’s low budget, run by a guy named Bob in Michigan. Bob says MFA is also known as single-payer health care. He’ll be glad to take your donations. And remember, Trump has also said that his plan is not single-payer. For a single-payer proposal, you can take a look at H.R. 676 at the Physicians for a National Health Program (PHNP).

Wasik’s article is not fake news. But you should take it with a grain of salt.

There’s another piece of news on the legal front and it’s SF 26 in the Iowa Legislature. If signed into law, it would allow women who’ve had an elective abortion to sue their doctors if they suffer mental or emotional distress at any time after the procedure. I learned about this from my trainees on rounds last week. One news item from the Globe Gazette carried the main idea, published in the Globe Gazette online Jan 17, 2017, “Abortion change would allow claim for mental damage,” by Rod Boshart. SF 26 is a bill introduced by Mark Chelgren, R-Ottumwa on 1/10/2017.

My sentiments on the bill are similar to those expressed by Sen. Nate Boulton, D-Des Moines in the news story.

Further, if this were signed into law, it would also have a chilling effect on consulting psychiatrists who might also be named as defendants at some later date at any time with no statute of limitations after an elective abortion if they provided decisional capacity assessment consultations in this setting. Psychiatric consultants are frequently asked to assist in this regard.

Defensive medicine can lead to defensive psychiatry and, in my opinion, it’s easy to see why. This would not serve our patients well. It looks like SF 26 is a Republican maneuver to interfere with the practice of providing abortions.

There is obviously no way to predict emotional reactions after abortions. An open-ended path to lawsuits based on the possibility someone will have a mental problem of any kind following abortion could be a disaster for both doctors and patients. It will drive doctors, including psychiatrists, out of Iowa, a place that is already dead last in the nation in terms of access to mental health care.

That is probably one of the reasons why the Iowa Medical Society is also opposed to SF 26. But more than that, it interferes with access to medical care for women.

Senator Chelgren’s rationale for introducing the bill should be taken with a grain of salt. The challenges with access to mental health care are a major problem for this bill. And Lt. Governor Kim Reynolds is adopting a “wait-and-see” approach for now, but expressed reservations about bills that, if enacted into law, could head for “legal entanglements.” If Governor Terry Branstad is confirmed as Ambassador to China, Reynolds would be in a position to decide on whether or not to sign off on it. I have already written my congressman and both the Governor and the Lt. Governor.

The Iowa Hospital Association (IHA) has recently had a lot to say on line about access to mental health treatment in Iowa. It’s too bad that the Webroot Filtering Extension has identified its web site as “Moderate Risk: When visiting this website, there is some probability that you will be exposed to malicious links or payloads.”

You should take that with a grain of salt. But you can believe the IHA message, which has been provided to newspapers across the state as a guest column:

Mental Health in Iowa is Fragmented and Costly

When mental health issues become visible, it often happens explosively and tragically. The shootings at Newtown and Virginia Tech, along with countless other deadly crimes, were carried out by mentally unstable individuals. About a year ago, an Iowa veteran dealing with post-traumatic stress disorder was angered by two teens who were horsing around at an Ankeny McDonald’s. He shot and paralyzed one of them.

This is when, like a volcano erupting, mental health explodes across the headlines, only to eventually be replaced by some other disaster or scandal. But, as health care providers well know, the problem not only doesn’t go away, it’s getting worse.

Unlike volcanoes, poor mental health and the dangers that can accompany it can be controlled. Where we are failing as both a nation and a state is in providing the right care in the right place at the right time.

Health care providers know this means many of the mentally ill end up in emergency rooms, but perhaps the most tragic evidence of failure are the number of mentally ill inmates in American jails. The National Alliance on Mental Illness estimates that nearly 15 percent of men and 30 percent of women booked into jails have a serious mental health condition. That’s about two million Americans each year.

Here in Iowa, more than 120,000 people live with serious mental health issues and 80,000 Iowa youths cope with severe emotional disorders. Yet Iowa has fewer psychiatric beds and mental health professionals than nearly every state in the nation.

The idea behind the “deinstitutionalization” of the 1950s and ’60s, and more recently the closing of two Iowa mental health institutes, is that the mentally ill could be helped more humanely while living and being treated in community settings. But the community-based infrastructure was never really put in place or properly supported, so a huge number of those released never got the local help they needed.

Now the price is literally being paid, as Iowans in need of mental health services are churning through emergency rooms and sometimes in jails, places that are costly not only terms of real dollars, but in their inability to properly address an individual’s long-term mental health. Good intentions in the form of deinstitutionalization are not enough, but there are solutions.

This is why during the upcoming legislative session, Iowa hospitals will be advocating for increased behavioral health care access across the continuum to help relieve the systemic bottleneck that has patients languishing in hospital beds or in jails.

Iowa needs a full care continuum in behavioral health that includes sub-acute services, crisis intervention, crisis homes, nursing facility care and community-based services. With that infrastructure in place, more hospital inpatient psychiatric beds will become available for patients who truly need them, while patients needing less intensive care will receive it close to home.

Properly investing in these more efficient and effective resources now will put our state on a path to reduce behavioral health care costs in the long run. Otherwise, reliance on stop-gap measures will continue to extract a high price from both Iowans and Iowa communities.

Kirk Norris, President and CEO

Iowa Hospital Association

norrisk@ihaonline.org

The IHA has also bought TV airtime in markets across the state for short videos focusing on mental health, one of which is below:

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