"We've taken 100 steps back as far as I'm concerned in providing services to those that need them. And we don't have a choice."
Eastern Iowa Mental Health and Disabilities region board chair Jack Willey said that at the end of an emergency meeting in September, when the board cut over $1 million.
When the Eastern Iowa Mental Health and Disabilities Region made those cuts, it was to ensure the region would have enough fund balance to make it through the first few months of Fiscal Year 2020.
And now, some are left wondering what happens next. That includes Rhonda's House, which offers a peer respite house for those going through a mental health crisis.
"It's the idea of bringing a peer-run respite house to the state. Thirteen states have it, and it's been a way to divert people from having to get a higher level of care when they really don't need a higher level of care," Life Connections executive director Todd Noack says of the house.
Region looks for more flexibility from legislature
"I think the most important thing we can do is educate them, and Lori's done a great job putting facts and figures [together] not just for our region but for the state," Board chair Jack Willey said in an interview Friday.
Eastern Iowa's cap for tax levy is $30.78, one of the lowest in the state. Out of the 14 mental health regions, Eastern Iowa's is the 11th lowest. That levy is based on the Fiscal Year 2015 expenditures divided by the region's population.
"We were only a region for one year," Mental Health region CEO Lori Elam points out. "So we didn't have a lot of crisis services up and running at the time, so that's why our cap is low."
Willey says the real per capita cost for the services is around $42.77 rather than the $30.78.
Another issue for the region is the increased amount of services that are mandated by the legislature. Among these are the Complex Services Needs Act passed in 2018 that mandated new services by July 2021 and also moved services from "Core Plus" to "Core."
"They're adding, too, and there's no adjustment in the amount of revenue that we can generate," Willey said.
That also includes implementing children's services. "We're already cutting with the programs that we have, let alone adding services for children," Willey said. "Even hiring a director is going to be a costly move."
Board secretary Dawn Smith says there is a sense that legislators feel they need to do something this session.
While the cost per capita is around $42.77, Elam says there's also the possibility of needing wiggle room. "We always seem to have unexpected expenses, whether it's people going to the Mental Health Institute. We have no control over the number of commitments," she said. "We hope that that will decrease with some of our crisis services, but we just don't know."
Elam says they've done everything they possibly can to comply with the state's directives-including spending down the fund balance and cutting services-and now they're up against a wall.
Willey says they're not expecting the state to pay for all the services, but providing seed money to help out. . "If they're expecting us to look at providing those services under this fee structure that we already have, it's literally impossible for us to do it without them being part of the program."
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Genesis, other health systems may provide support
At the meeting where the Mental Health board cut services, Genesis Health System Government and Community Relations Officer Henry Marquard told the board that Genesis would help lobby the legislature, and that they would rally other health systems to help.
Marquard noted that last year, Scott County had worked on legislation to provide relief and more flexibility for the region. "Last year, Genesis weighed in in support of their efforts to get that language passed," he said. If there's a similar bill this year, Genesis will again support it.
In addition to Genesis, Marquard says they work with UnityPoint Health and MercyOne on advocating governments to take down barriers to providing healthcare. "So I'll certainly take this to our two partners there and probably to the Iowa hospital system as well and explain the situation, ask them to support it."
Working with the Eastern Iowa Mental Health region helps accomplish the Genesis mission of providing compassionate care to Iowans, Marquard said. "This is absolutely something you'd support."
"MercyOne Clinton Medical Center supports the efforts of the Eastern Iowa Region to increase funds for mental health services," Director of Behavioral Health Care Jacie Wherry said in an email Tuesday.
Legislature must play its part
Rep. Cindy Winckler, who also spoke at the region's emergency meeting, says she's committed to helping them. "We can't expect them to increase the services they provide while limiting their resources," she said in an interview Tuesday.
Rhonda's House left in limbo
Rhonda's House, located in DeWitt, provides a safe place for people to go and rest while also having access to mental health resources.
The house was provided by Genesis Health in DeWitt, and the project has received seed money from a variety of sources, including $88,000 from the Eastern Iowa Mental Health region.
While the house has received some sustainable funding, Noack says this one is the only peer respite house out of the ones in 13 states that is not fully funded by the state. "Because they know and see what it's worth. It costs $1,800 to be in a Robert Young inpatient unit with no insurance. It costs two grand to be in Genesis inpatient unit. It costs about $243 a day here."
At the house, residents get support, people who will listen to them 24/7 and the knowledge and resources that they need. "They get the possibility of hope," Noack says. "Hope is the thing that they come here and they don't have. But when they leave, they have hope."
The residents at the house were appreciative of the opportunity they had.
"When you get to that certain point, it's hard to know what to do," Eli Erickson of Geneseo said. "I'm really thankful for a place to go instead of on the street."
Dawn Shafer says Rhonda's House is the one place in her time of struggling with mental health where she feels there's hope for her. "The staff here are amazing. They've been through it, they listen, they don't judge you," she said.