A recent Des Moines Register article highlighted a handful of cases where hospitals have been cited for their handling of mental health cases over the past few years. The article attempted to insinuate that somehow Iowa hospitals are solely responsible for the problems in the state’s mental health system. Unfortunately readers may have been misled, as hospitals were certainly mischaracterized. As the Register should be aware, in the complex health care environment and even more complicated mental health arena – not everything is as black and white as a newspaper.
The article highlighted five instances between 2005 and 2008 where hospitals were cited for irregularities in mental health care delivery. Putting that into perspective, it is important to note that Iowa hospitals treat approximately 30,000 inpatient mental health cases per year, not to mention tens of thousands of outpatient cases. Clearly the few cases in the article show that there is not an epidemic of hospitals mishandling mentally ill patients.
Iowa’s mental health care system is broken, not providers
What the article failed to point out is that the overall mental health care system in Iowa, not the hospitals or other providers of health care services, is in shambles and has been for years. In fact, hospitals have been outspoken advocates for mental health issues for many years particularly as the supply of mental health professionals has dwindled, payment for mental health services has decreased and legislative inaction has caused the mental health system to near its breaking point.
In particular, hospitals have concerns about two key barriers to mental health care in Iowa. The first is low access to mental health services due to the the lack of behavioral health professionals in the state. The second is coverage as insurance companies do not cover many (non-biologically based) mental illnesses, like substance abuse treatment.
From a health care policy perspective, there have been multiple attempts to re-work the mental health care system, but many have failed. On access, hospitals have supported multiple bills that have sought to increase psychiatric residency slots at the University of Iowa so that more psychiatrists can be trained (see House File 514 from the 2009 Iowa Legislature). This year, the Legislature ultimately passed the language, but did not provide funding for the residency slots, leaving only a handful of new psychiatrists to enter Iowa’s health care workforce each year (though many leave the state due to Iowa’s low Medicare and Medicaid reimbursement rates).
This further compounds the workforce shortage, where in 2006, a report from the University of Iowa showed that 63 full-time and 20 part-time positions were open for psychiatrists in Iowa. In fact, according to the report, the demand for psychiatry ranked higher than OB/GYN, general surgery, internal medicine, general pediatrics and family medicine.
Legislators have had opportunities, but they continue to pass them by
Just this year the Legislature had the opportunity to pass “Mental Health Parity” (House File 234), a bill that would have required insurance companies to provide coverage to individuals with mental illnesses. But after months of partisan wrangling and major opposition from the insurance industry and the business community (hospitals excluded), the bill was not brought up for a vote – and in the end did not pass.
So the problem with mental health care in Iowa is not with the hospitals that are committed to providing some of the highest quality care in the nation, but with an overall poor health care system that has been broken for many years and regulatory inaction that has caused the system to deteriorate even further.
The compound effects are that those who do not have coverage or access to mental health care services are much more likely to delay receiving or even seeking out the care they need. Unfortunately, this can lead to dire consequences as mentally ill citizens often find the care they need only after a behavioral event that puts them in the emergency room.
Once again the Register was on the right track, but the train was going in the wrong direction. Readers would have been much better served had the article analyzed the outdated and failing mental health care system in the state as a whole, and not use a few isolated incidents to, once again, mischaracterize the quality of hospital care in Iowa.
The Iowa Legislature has an obligation to fix the behavioral health system in Iowa, and should not pass up the next opportunity to do so. The next chance will be January 2010, when the Iowa General Assembly convenes. Perhaps then, Iowans with behavioral health disorders will once and for all have access to health care they need and the coverage to pay for it.
IHA supports mental health policy initiatives
Mental health issues have been a formal part of the IHA legislative agenda since 2004 when IHA first identified that declining access points and psychiatrists in Iowa, coupled with an expanding need for services, would make the delivery of behavioral health services the next health care crisis in Iowa.
- Mental Health Parity Including Substance Abuse
- Creation and Funding of Emergency Mental Health Crisis Intervention Teams (previously passed but not funded)
- Coordinated System of County-Provided Mental Health Services
- Expansion of Psychiatric Physician Residency Positions
- Funding of Telemedicine Initiatives for Providing Mental Health Services
- Increased Medicaid Funding for Mental Health Services
- Expanding Mental Health Professional Shortage Area Designations
- Replacing Designation of County of Legal Settlement with County of Residence
- Oppose Further Reductions at State Mental Health Institutes
This post outlines only a few issues compared to the long list of major challenges the mental health system faces.
Feel free to share other issues that may not have been covered in this post. What else is out there? How does your hospital/community handle mental health issues? Has the psychiatric workforce shortage affected you or your family?
Please share your thoughts in the comments below.
You may have heard about Christian James, the slow-pitch softball player from Ankeny who hit 5,000 balls last week at Principal Park in Des Moines to raise awareness about colorectal cancer and raise money to pay for screenings. What you may not know is that Christian is helping sick and injured people every day in the radiology department at Iowa Health-Des Moines.
Swinging for screenings
Christian started swinging at softballs just after the Iowa Cubs finished their game on Father’s Day. He hit for 20 minutes and then took 20 minutes off – something you have to do when the heat index reaches 100 degrees, which it did for much of his effort. In fact, at one point the heat was simply unsafe, and Christian took the advice of medical personnel and made some of his hits in the I-Cubs’ indoor batting facility. Later, his left hand became so fatigued that he could no longer hold the bat, so he taped his hand to the bat.
“I can go through this, cancer patients go through this a lot worse so I can go through a little bit of pain,” Christian told reporters.
At mid-day, while Christian was taking a rest, major league third baseman Ryan Freel, who was on rehab assignment with the I-Cubs, stopped by to talk. Freel was so impressed with Christian’s effort that he wrote him a $1,000 check and donated some autographed items. When he connected with his 5,000th ball 24 hours after he started, Christian had raised $30,000 for the cancer-fighting organization he founded, HelpingHits.org.
PACS provides latest technology to physicians
At Iowa Health-Des Moines, which helped sponsor the event, Christian is the radiology department’s PACS administrator. PACS, which stands for Picture Archiving Communication System, allows for the efficient storage and access of digital medical images, such as x-rays. Compared to old-fashioned film-based images, PACS is highly advanced and efficient. The system allows images to be viewed throughout the hospital and health system and, rather than simply viewing the images with the naked eye, PACS allows physicians and technicians to use the latest computer-based technology to locate, view and analyze images.
Like Christian’s bat and the early screenings it helped encourage and pay for, PACS is a critical tool in the fight against cancer.
The current heat spell underscores the value of hospitals as 24/7 assets to their communities. As temperatures have risen, hospitals all over Iowa have sent forth the message: come here for a cool place to relax and enjoy all the water you need.
There are people in your community who are at the mercy of the weather every day, perhaps because they have no air conditioning – perhaps because they have no home at all. Meanwhile, most of us take our comfort and hydration for granted, both at our workplaces and in our homes. But what if your air conditioning goes out? What if you lose power for an extended period of time, starting at 1 a.m.? What if a water main break leaves you high and dry?
Then your hospital is there for you and your neighbors.
Sure, you might have other options. You can hang out at the library or wander the mall. But eventually the library and the mall are going to close.
Hospitals are always available to their community
Your hospital is always there, come hellish temperatures or – as we found out about this time last year – high water. And what’s more, if the heat has taken an unexpected toll on you and you’re not feeling quite right, your hospital is ready for that, too.
That’s the thing about hospitals: If there is a way to care, a way to do more that makes a community healthier and safer, then your hospital is probably doing it. And they are doing it all day, every day.
For tips on keeping kids safe in the summer heat, see this bulletin from St. Luke’s Hospital in Cedar Rapids.
Clinical laboratory scientists (CLS) play a crucial role in the detection, diagnosis and treatment of disease and pursuing a career as a CLS allows individuals to develop their analytical abilities, perform complex procedures and utilize high-tech computerized equipment. According to an article in Money magazine, Clinical Laboratory Scientists, aka Laboratory Technologists, rank 46th out of the 50 best jobs.
Faster employment growth, excellent opportunities
On a national level, the Bureau of Labor Statistics has predicted faster than average employment growth and excellent job opportunities. The Iowa Hospital Association has consistently ranked the Clinical Laboratory Scientist as one of the greatest hiring needs in Iowa hospitals.
Allen College launching new CLS program
Starting this fall, Allen College will implement a new clinical laboratory science (CLS) program. CLS graduates will receive the Bachelor of Health Sciences degree. Students planning to seek admission to the program must complete all general education requirements at an accredited college or university before enrolling in the health sciences program at Allen College.
Hear from a medical lab technician in Iowa
Take a look to see what it’s like working as a medical lab tech in an Iowa hospital.
Medical costs for employers and their workers are expected to increase 9 percent in 2010, slightly slower than in previous years, according to a report released this week by the PricewaterhouseCoopers Health Research Institute.
The institute’s survey of more than 500 employers and health plans states that the slower rate of growth will be due mostly to the economic recession; ongoing trends that continue to deflate spending growth, including the expansion of wellness and disease management programs and the increased availability of generic drugs; and the prospect of health care reform.
The recession has contributed to increasing costs as well: hospitals have to compensate for significant losses in investment income; cost-shifting to private payers from the uninsured, Medicare and Medicaid has increased; and insured workers who are expecting to be laid off are using more services while they still have health care coverage.