Closing Iowa mental health institute wouldn't help budget woes, some say

From the Des Moines Register:

Closing the Clarinda Mental Health Institute wouldn't improve patient care or save money, several state officials and mental health experts say.

One of state lawmakers' latest plans would shift the 35 beds for elderly patients at the psychiatric hospital into smaller units around the state. That would require expensive and time-consuming renovations, officials said.

"There's some problems that are not insurmountable with enough time and with enough money," said Charlie Krogmeier, director of the Iowa Department of Human Services, which oversees Iowa's four mental health institutes. "There would be considerable expenses involved."

The Clarinda Mental Health Institute is a hospital and nursing home for elderly people with especially challenging behavioral and mental issues. It's the only state-run psychiatric unit for geriatric patients.

The Iowa Legislature is considering closing one of the mental health institutes both as a cost-cutting measure and to better focus on local mental health care closer to Iowans' homes.

A plan approved by the Iowa Senate last week calls for shifting patients at Clarinda to other places — possibly the state-run facility for people with mental disabilities at Glenwood, 60 miles away; or the state-run Iowa Veterans Home in Marshalltown, 180 miles away.

Neither place is equipped to handle geriatric psychiatric patients, officials at the two facilities said.

Glenwood has empty cottages, but they would need renovations to become licensed hospital beds, Krogmeier said. The beds would have to meet newer license standards, and officials would have to sort through issues with housing people with mental retardation and psychiatric problems on the same campus, he said.

"I'm not saying it's not doable," Krogmeier said.

Lisa Purvis, lobbyist for the Iowa Veterans Home, said the plan presents "significant hurdles." The home is not a licensed hospital, she said. The home has transferred patients to Clarinda because staff couldn't manage their acute mental health problems or aggressive behaviors.

It wouldn't save the state money to convert space into a locked unit, hire workers to deal with special patients and meet stringent licensing requirements, Purvis said. Also, residents or their spouse must be a veteran.

The latest analysis by the nonpartisan Legislative Services Agency doesn't estimate any specific savings from the Senate's plan. It says the plan would cost the state money next budget year because of relocation and renovation expenses. For the following budget year, fiscal year 2012, any savings "would be offset by any ongoing costs still at the Clarinda campus," the report says. In years deeper into the future, if the state could draw more federal matching Medicaid money, "it is possible there would be savings."

The Senate plan to close Clarinda runs counter to recommendations from the Department of Human Services. DHS said closing the Mount Pleasant Mental Health Institute would be easiest, quickest and cheapest of the four.

Sen. Jack Hatch, D-Des Moines, defended the plan to close Clarinda in an e-mail to The Des Moines Register.

Hatch said a private consultant hired by Gov. Chet Culver recommended closing the mental health institutes at Mount Pleasant and Clarinda. The other two mental health institutes are in Cherokee and Independence.

"By closing Clarinda, we are able to consolidate the population of adult psychiatric patients in Cherokee, minimizing administrative redundancy," Hatch said. "We are also able to provide more efficient services by consolidating juvenile psychiatric services in Independence."

The plan would let the state serve "more geropsychiatric patients, for whom nursing homes can no longer provide services because of advanced dementia or violent behavior," Hatch said.

It's a good idea to create smaller independent inpatient units as other states have done, including Minnesota, said Dr. Michael Flaum, director of the Iowa Consortium for Mental Health, a group of University of Iowa psychiatrists who advise the state on the public mental health system.

Yet, Flaum said, "this would probably take more money, however, than would be saved by closing" a mental health institute.

Flaum said the state should delay any changes in the mental health institutes until there is a clear plan for better community services.

Not unexpectedly, the plan is unpopular with officials in Clarinda.

Clarinda Mental Health Institute Superintendent Mark Lund said the elderly patients there were rejected from at least 10 other treatment settings before they came to Clarinda. "These are the nowhere-to-go patients," he said.

Doctors see the patients every day, Lund said. "That wouldn't occur in most nursing homes," he said.

Licensed social worker Mike McFarland, who is director of a juvenile home on the same campus as the Clarinda Mental Health Institute, said: "Ethically, as a mental health professional, I worry if it's in the best interest of the patients."

Closing the Clarinda Mental Health Institute would drive up costs for the juvenile home, which shares its maintenance, laundry and food services. Costs would also go up for the state-run prison on campus, which shares those same services plus administration, a pharmacy and housekeeping, Lund said.

"For us to pick that facility doesn't make a lot of sense," said House Minority Leader Kraig Paulsen of Hiawatha. "Every time I've been through the numbers, it appears to me to cost the state more money."

Sen. Gene Fraise, D-Fort Madison, said senators rejected closing the mental health institute at Mount Pleasant "because the savings wasn't there."

"The whole purpose of the thing is to save some money," he said.