Snafu with mental health funds in Iowa causes people to wait even longer for help

From the Des Moines Register:

Confusion over whether Iowa can distribute millions in federal money earmarked for mental health services is causing hundreds of people in Polk County who are waiting for help to wait even longer.

Polk County recently learned it was approved to receive about $7.3 million in federal stimulus money to buoy mental health programs and chip away at a waiting list that has swelled beyond 500 people, a Polk County record and the largest in Iowa.

But uncertainty over whether the state government, which administers the money, can disburse the dollars abruptly halted plans this week to begin providing people on a waiting list with much-needed services.


"At the eleventh hour like this, it's really almost cruel," said Robert Brownell, a Polk County supervisor. "I hope we can find a solution to it."

County officials, who in March raised concerns about the burgeoning waiting list, expected the money to help reduce the number of people waiting for assistance. Officials are now uncertain whether matters will improve.

"It's not even as good as a 'wait and see,' " Brownell said. "It's more of a question mark as to whether that money is coming or not. This was a great opportunity to take a lot of very vulnerable people off of the waiting list and start providing services. The fact that we're not going to be able to move off of square one is frustrating."

The waiting list could grow to 700 by December, county officials estimate.

Individuals on the waiting list, many of whom are low-income, uninsured, or under-insured, face higher rates of homelessness, incarceration and hospitalization without proper care, county officials said.

Lack of access to care also can elevate suicide risks, a factor that concerns county officials and mental health advocates.

"It's a crisis, and I think it will continue to grow," said Margaret Stout, executive director of the Iowa chapter of the National Alliance on Mental Illness.

Iowa lawmakers during the last legislative session put about $10 million secured from the federal economic stimulus in a mental health "risk pool," a program created about a decade ago to keep counties with financial shortfalls from denying care.

Historically, mental health advocates argue that the risk pool has been under-funded. The conditions of mentally ill people forced into prolonged waits for intensive care often worsen substantially, experts said.

By Iowa statute, money from the risk pool should be released in mid-September. But strings tied to how the federal stimulus money can be used have state officials questioning whether additional action from the Legislature is needed. Polk County officials are now uncertain that their mental health programs will get any of the $7.3 million.

The demand for services has increased during the economic recession, according to the National Alliance on Mental Illness.

"With the economy, and the concerns of citizens about foreclosures and job loss, people have more distress than ever before, and they're going to need these types of services," said Angela Connolly, chairwoman of the Polk County Board of Supervisors.

The situation in Polk County follows trends elsewhere in Iowa and the nation where demand has outpaced the manpower and money needed to deliver intensive care for people with mental illnesses and disabilities.

For instance, mental health officials in El Paso, Texas, are holding a series of forums to discuss how to overcome budget shortfalls that have rendered about 1,500 people ineligible to receive outpatient services for mental health and mental retardation.

Not all counties in Iowa have waiting lists. However, waiting lists were activated during the 2010 budget year in Clinton, Harrison, Howard, O'Brien, Polk and Scott counties, according to an Iowa Department of Human Services report.

People on Polk County's waiting list can still receive such urgent treatment services as hospitalization, medication or visits to psychiatrists and therapists. Budget constraints, however, could cause others to wait years for more intensive support, such as group home placement, in-home care and job assistance.

If the state disburses the money in January or at some other point, there are no guarantees that legislators will preserve comparable funding for the risk pool in the next budget.

That means people could be taken off the list only to go back on if funding dries up.

"Is it really fair, humane or even moral to bring people off of a waiting list into services and then to cut those services, let's say six months later?" Brownell asked. "Nobody wants to be in that position. Frankly, I think that's kind of cruel."

County leaders will continue to meet with legislators and the Iowa Department of Human Services to see whether a solution can be reached.

About 7,500 people receive mental health services from Polk County each year. Most receive outpatient services, and about 2,900 get the more intensive care sought by people on the waiting list.

Only one-third of Americans with mental health problems get proper care, according to Mental Health America, a national nonprofit group.

Polk County residents whose income is at 150 percent of the federal poverty guideline - $16,245 a year for an individual - can receive free mental health services. People whose income is at 300 percent of the poverty guideline pay full cost, and there is a sliding fee scale for others.

The need for a mental health waiting list has been rare in Polk County. The county had one about six years ago, but everyone was removed from the list within about a year.

The current backlog began in June 2006 and surpassed 500 by the end of February. The figure has basically doubled since it stood at 263 in December 2007.

Polk County's health services budget was about $50.5 million for the fiscal year ending June 30. About $29 million of the budget came from state and federal sources, about $14.5 million came from Polk County taxpayers, and about $7 million came from Medicaid reimbursements.