The Des Moines Register held a mental healthcare forum this week, where 12 gubernatorial candidates discussed their ideas on the critical matter. All seven Democratic candidates were there, as well as two Republican challengers, two Libertarian contenders and a left-leaning independent. Governor Kim Reynolds was on vacation that week, but she recorded a video address that was played at the beginning of the event.
Starting Line asked National Alliance for Mental Health Iowa’s executive director, Peggy Huppert, to weigh in on her thoughts from the event. You can watch the entire event from this Register live stream.
— The most remarkable thing about the event was the fact that we had 12 candidates for governor who all committed the time to prepare and attend. You wouldn’t find that for many issues, and certainly not this early in the cycle when it wasn’t televised. That shows the weight and momentum behind it.
–There were platitudes, sure, but there were also sharp observations and specific suggestions. It was NOT all political talking points. That was also quite remarkable.
— I was pleased that most of the candidates favor lifting the dollar cap on the mental health property tax levy, but none of them addressed the elephant in the room on that – the Farm Bureau. They stopped that cold in the last session. Until someone is willing to take them on the cap will stay in place.
— Taking that point further, some of them addressed how adult mental health should be funded, saying it should not be property taxes. Others did not. Should the state take it over and fund it, like most other states? There are pros and cons to both approaches, but the current Regional system has serious flaws, chief among them being governed solely by county supervisors. Stakeholders should be part of the mix.
— They all criticized Medicaid managed care, but none of them addressed the big question on that – how would they contain costs if it went back to the state? (That begs the question of whether we actually WILL save money on this system, which at this point is hard to tell and debatable.) Governor Reynolds (and Branstad before her) maintains the former system was unsustainable, with average annual increases of about 10 percent. That alone could be a whole separate forum. We don’t necessarily disagree with the concept of managed care. When done right it improves care and health for patients. But how it’s been carried out here in Iowa is a disaster.
— Some were better on details than others, but I forgive them for that because mental health is a complex and nuanced issue. Honestly, when I compare their performance at the forum to what they had to say to me in July and August, the progress is remarkable.
— The bottom line is it is NOT all about beds. Simply opening more inpatient beds, especially at Clarinda or Mt. Pleasant, is not the answer, although many families think it is. As several candidates said, we need a robust continuum of care, starting with early childhood interventions.
— I appreciated what Ross Wilburn said about mental health being “the flavor of the month”. I worry about that. We need to keep the drumbeat going until we achieve change. I think what would be really interesting going forward is to have small groups of the candidates meet with peers (people living with serious mental illness), family members and providers to learn more about their concerns and the issues they face every day. We organized that for Chuck Palmer last January and February and it was eye opening to him. It’s what led to the Complex Needs Workgroup, which by the way is another thing the media should be paying attention to and reporting about. We have our last meeting next Tuesday (12th) and will be making some specific recommendations.
by Peggy Huppert