Opinion: In Iowa, attention to children's mental health is tragically lacking
Budgets are moral documents. They demonstrate what is most important to us. They exemplify our values. Further, it is long established that it is to judge a person by what they do, not what they say.
Hence, when Gov. Kim Reynolds states that children, and children’s mental health, are important to her, it is doublespeak. As the legislative session is in full swing, we must hold her and our state leaders accountable to do more for our state’s children.
The state of children’s mental health in Iowa is dire. While the pandemic certainly contributed to children’s mental health concerns, the problems with the system started many years ago. The wait to get into mental health care can be far too long. Finding a therapist with available time can take months. For children who are in residential group care, it is not uncommon to wait five months before starting individual or family therapy in that setting, about when insurance companies are indicating it is time to be discharged.
If there are concerns about potential autism for a young child, many of the experts are booking 18 months out for an evaluation, even though early intervention is critical. Waiting lists for other psychological evaluations in most places in the state are probably a year, if they are even putting people on their lists any longer. Waitlists for psychiatrists can be impossible. If a person in a mental health crisis goes to the ER, they may wait for days for a bed to open somewhere in the state, sometimes being transferred to the nearest open bed hundreds of miles away. In the past year, some children’s residential facilities have permanently closed, unable to continue to make ends meet, hire and retain qualified staff, and manage a milieu damaged by bad executive branch policy decisions, and underfunding, for years.
The situation is even worse if your child is covered by Medicaid, HAWK-I, or the Iowa Wellness Plan. Many mental health providers not affiliated with a hospital or community mental health center do not accept those, as the reimbursement rate is less than half of the rate of some private insurance. Reimbursement for group placement for children remains inadequate to meet the needs of some of the most challenging children in the state, and some of those children are being shipped out of state for treatment at considerable expense, as the system here is inadequate to the need.
The low reimbursement rates are a large part of the insufficient number of providers, the failures of group placements, the insufficient number of mental health beds in the state, and the inability to employ and retain quality staff at mental health facilities. The State Training School at Eldora does not keep children safe from other children. There is not even a comparable service for girls who commit serious crimes. In fact, Disability Rights Iowa recently filed suit against the state of Iowa for its failure to provide medically necessary mental health care for those covered by Medicaid.
The educational system is also on the ropes. While teachers continue to do excellent work, children with serious mental health and behavioral problems disrupt classroom routines and the learning of the remaining students in the classroom. Teachers are leaving the profession, related more to the lack of support in dealing with those children than in the rate of pay per se. Moreover, even though Medicaid will reimburse for many associates to support those children, special education placement and associate support vary considerably across the school districts of the state. The reimbursement is designed in an unfair way that results in some districts providing far fewer services for children with far more extensive problems. Unfortunately, that pattern seems to affect the districts with the most Black and brown students the most.
So, last year, instead of supporting our children, and children’s mental health, the governor proposed, and the Legislature passed, a significant tax cut when mental health services and education have been underfunded for years. This year, she has pushed through a school voucher system that will assuredly shift money to private schools. Public schools will continue to serve those with the highest needs (e.g., those with learning disabilities, autism, intellectual disabilities, behavior problems, English language learning status, and the poverty-stricken with few resources or supports), students private schools may quietly reject.
The ability to serve those greatest-need students is akin to the insurance marketplace — if the pool is not large enough to share the risk, the system collapses. Iowa’s education system, having already fallen from best in the country to mediocre at best, is likely to continue to decline.
Instead of supporting all Iowans, especially the most vulnerable, the governor supports those most likely to vote for her. If we are judging by actions rather than words, and we are using budgets as a reflection of underlying values, it is clear that the leaders of the state of Iowa value neither children nor mental health. We need to insist that Iowa do better. If we are to avert long-term damage to the next generation, it is time we invest in both education and children’s mental health.
David Beeman, Ph.D., has been licensed as a psychologist in Iowa since 1993, specializing in the assessment and treatment of children and adolescents.
This article originally appeared on Des Moines Register: Opinion: Attention to children's mental health is tragically lacking