Iowa worst in the nation for state psychiatric beds, report says. How a new plan may help

As state officials and legislators begin the arduous effort to consolidate Iowa's mental health and substance use care system, new research released this week highlights how dire the situation is for many Iowans.

Iowa ranks last in the U.S. for the number of state psychiatric beds per 100,000 residents, according to a new Treatment Advocacy Center report published Wednesday.

The state had 64 state-managed in-patient beds to treat adults in 2023 — just two beds per 100,000 residents — ranking Iowa 51st on the list of 50 states and the District of Columbia, the report states.

According to the Treatment Advocacy Center, 50 beds per 100,000 people is required to provide "minimally adequate treatment" for individuals with severe mental illness.

"Iowa fails to meet this minimum standard," the center states.

It's estimated that more than 84,000 Iowans are living with severe mental illness, including schizophrenia, severe bipolar disorder and major depression. About 35,000 receive treatment in a given year, according to the Treatment Advocacy Center.

There's been no change in Iowa's state-run bed count since 2016, when the center last published a report on state psychiatric bed totals nationwide.

However, the total number of state psychiatric beds in Iowa dropped nearly 80% between 2010 and 2016, when totals fell from 149 to 64, according to the Treatment Advocacy Center. In 2007, Iowa had 223 psychiatric beds.

The new report comes as Gov. Kim Reynolds has made improving access to mental health care one of her top priorities for the current legislative session.

"Improving access to mental health care has been one of my highest priorities since taking office," Reynolds said in a statement to the Register. "While we have made mental health a priority, there is still more work to be done."

Reynolds continued, "That’s why we are focused on building a full continuum of psychiatric care that focuses not only on high quality state psychiatric hospitals for the most complex needs, but also private psychiatric hospitals, crisis services, and outpatient care. We must also emphasize early interventions and ongoing behavioral health needs to align the entire continuum and ensure Iowans receive the right care, in the right place, at the right time.”

Report: Health care workforce shortages play large role in in-patient availability

The new report from the Treatment Advocacy Center tallies only state-managed psychiatric beds, but advocates have said there aren't enough beds at private facilities either.

Iowa has a total of 905 licensed psychiatric beds across the state, including 813 beds at community hospitals and 92 for adults and youth at one of the state's two mental health institutions, according to data from the Iowa Department of Health and Human Services.

State data shows only about two-thirds of those beds, or 676, are actually staffed, further limiting access to that in-patient care.

Though a lack of access to inpatient mental and behavioral health care had plagued the country long before COVID-19, the Treatment Advocacy Center says the pandemic's effect on the health care workforce nationwide has exacerbated this issue.

"The mental health care system is not spared from the significant health care workforce shortage in the U.S., and many states currently have a number of beds that cannot be used for patients because there are not enough professionals to staff them," the report states.

A whopping 94% of states reported they were experiencing staffing shortages at state hospitals, resulting in a closure of 15% of beds because of a lack of workers to provide care, according to the report.

Researchers found that the issue is largely caused by budget constraints, which don't allow state hospitals to offer the same competitive wages that private facilities provide their staff.

The Treatment Advocacy Center report states the total number of state hospital beds nationwide reached "a historic low" in 2023, with an average of 10.8 beds per 100,000 people.

Some advocates say Kim Reynolds' proposed consolidation would be 'a game-changer' for access

Advocates say the proposal from Reynolds and the state's health and human services agency to integrate Iowa's behavioral health and substance use regions could be a solution to the shortfall of services for Iowans with the highest mental health needs.

More: Kim Reynolds proposes in annual speech to boost Iowa teacher pay, overhaul AEAs, cut taxes

"The connection and integration of mental health and substance use disorder systems will be a game-changer for Iowa," said Ryan Cane, executive director of NAMI Iowa.

Iowa currently has 13 mental health regions and 19 substance use regions statewide, which were created to provide care to Iowans within that area. The regions are governed by local boards.

Reynolds has proposed consolidating these 32 regions into seven unified districts that manage both behavioral health and substance use services. Iowa Department of Health and Human Services would oversee that effort and establish contracts with local administrative service organizations to manage each of the seven districts.

During her 2024 Condition of the State address earlier this month, Reynolds noted that more than 25% of adults with serious mental health conditions also grapple with substance use disorders, yet "there's little to no coordination" between the mental health regions and the substance use regions.

"Through Behavioral Health System Alignment, we will align Iowa’s fractured local delivery models for substance use and mental health care into a simplified structure supporting improved statewide access to care for all Iowans," Reynolds said in a statement.

Reynolds and state officials have proposed an increase in Medicaid payments for behavioral health care, including inpatient psychiatric care.

That alignment will also entail refocusing care within the state’s mental health institutions on care for behaviorally complex youth and those who have committed crimes, as well as increasing access to behavioral health outpatient services through Certified Community Behavioral Health Clinics, Reynolds said.

Services for children with mental health conditions were a central focus in Reynolds' Condition of the State address and subsequent statements on the issue.

She has highlighted projects such as Ember Recovery Campus, a new YSS residential treatment program for youth ages 12-18 in Story County. Once open later this year, the facility will have 70 beds for crisis stabilization, emergency shelter and substance use disorder treatment.

"We've made schools a site of service," Reynolds said on Iowa Press last week. "We've increased funding for behavioral health providers. We're taking a look at the mental health regions to make sure that we're really being efficient and effective. And again, we're getting that money on the ground and to the people that need it and can access it. I was proud to highlight the Ember Recovery campus."

More: Iowa settling lawsuit alleging state hasn't provided adequate mental health care for kids

Mental health advocates seem to agree that this move could fix Iowa's current siloing of behavioral health and substance use treatment. Cane with NAMI Iowa, the state chapter of the the National Alliance on Mental Illness, said one of the group's advocacy priorities is to increase resources for those with co-occurring substance use disorders and mental health conditions. That includes residential treatment options and acute crisis stabilization.

"We believe the proposal has the potential to address areas of need across the continuum of care — from prevention, to intensive treatment, to recovery," Cane said.

"While the proposal is still new, we are supportive of the goals DHHS has laid out: to make sure Iowans have access to the same set of behavioral health services no matter where in the state they live, and to eliminate administrative red tape and duplication of services," Cane said.

Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com, at (319) 339-7354 or on Twitter at @Michaela_Ramm

This article originally appeared on Des Moines Register: Iowa worst in US for psych beds. Can Reynolds' plan fix the problem?