Is This the Worst State for the Mentally Ill?

Is This the Worst State for the Mentally Ill?

Why you should care

There are just 64 public psychiatric beds in Iowa.

Join OZY as we travel through all 50 states to uncover the challenges and meet the innovators reshaping a country that's more divided than ever.
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Kali VanBaale, who lives in a suburb near Des Moines, Iowa, had never given serious thought to mental health care until this spring, when a horrific tragedy struck her neighbors: 20-year-old Chase Nicholson murdered his parents and older sister on April 6. “We had lived next to them for 15 years, and Tawni, the daughter, had babysat our children,” says VanBaale. Nicholson had been suffering from severe depression for many years and had multiple suicide attempts, VanBaale recalls. But all efforts by his parents to find him a place at a mental health facility had been unsuccessful.

In Iowa, that’s very common. According to a 2016 report by the Treatment Advocacy Center, a national nonprofit organization that works to remove barriers to treatment for severe mental illness:

Iowa has 4 percent of the psychiatric beds it needs and has the lowest number of state psychiatric beds per capita.

The study also found that Iowa has only two public psychiatric beds per 100,000 persons. The national average is 11.7, while the recommended number is 50 beds.

Between 2010 and 2016, Iowa lost more than half of its public psychiatric beds, bringing the total down to 64, in part because of the closure of two main state psychiatric facilities — which sparked a heated debate in the state and drew harsh criticism for the then governor, Terry Branstad, who had lobbied for the closures. Iowa also puts more mentally ill individuals in prison than it admits to its hospitals, according to a 2010 report by the Treatment Advocacy Center — a ratio of 2.6 to 1.

Iowa also ranks in the bottom five when it comes to the number of psychiatrists per capita.

The bed shortage is a problem shared by many states, but what makes Iowa’s situation even more challenging is that it’s mostly rural, says Dr. James Potash, former chair of psychiatry at the University of Iowa. And “psychiatrists don’t want to live in the rural areas since it’s hard to practice,” he says, adding that Iowa also ranks in the bottom five when it comes to the number of psychiatrists per capita.

So what can be done to improve mental health care in the state? Amy McCoy, public information officer at the Iowa Department of Human Services, points to the recent approval of a private, for-profit, 72-bed psychiatric hospital in the Quad Cities region. But Potash is skeptical: “[For-profit hospitals] tend to admit patients and discharge them very quickly.” Patients with severe mental health conditions need long-term care, he adds.

After witnessing the tragedy that struck her neighbors, VanBaale wrote an opinion piece in The Des Moines Register. In response, she was flooded with messages from Iowans sharing similar personal stories. She’s since written about several other families torn apart by lack of mental health care. “When we don’t take care of our most vulnerable in our own society, we’re failing as humans,” she says. Her advice: Write to your representatives. “They’re not going to do anything unless people are bombarding them,” she says. After all, she adds, only the squeaky wheel gets the grease.

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