On Oct. 27, Governor Kim Reynolds was present in Corydon to visit with Community Health Centers of Southern Iowa. Among the hot topics were the status of mental healthcare in the state, the opioid addiction crisis in America, and Iowa’s transition to privatized Medicaid.
Across the United States, especially in rural areas, there is a shortage of general practice physicians. The need is even greater for mental healthcare providers. A big question is how to address this vacuum.
Matt Dzak is a Licensed Clinical Psychiatrist for CHCSI. He touched upon this need for mental health providers and Iowa’s last-in-the-nation standing in terms of number of psychiatric beds available:
“To the best of my knowledge, CHCSI has the only successful psychology program in Iowa. Our demand has overwhelmed the supply.
“In the most recent data, Iowa ranks 46th per capita in terms of psychologists, so we’re really underserved from a national perspective. And then our area is one of the most underserved in Iowa. There’s a huge need for people who [once] had to drive to Des Moines or Iowa City for these services. In terms of psychiatric beds, were at the bottom in the country.”
Part of the problem involves recruiting young physicians and mental healthcare professionals to a rural setting.
“I joined Community Health Centers in 2009,” said Danielle O’Brien-Day, LMHC, Behavioral Health Director of CHCSI. “I knew going into this field even out of high school that I’d be eligible for loan repayment programs, and that was a big factor. Yes, I want to go into healthy professions, but what do I want to do? For myself personally, I chose my profession knowing there were a lot of resources available.
“Part of my job is the improvement in hiring behavioral health staff. Since 2010, five of the staff I’ve recruited have shown significant interest in choosing work here at Community Health Centers because of our loan repayment factor.
“In 2009, we had across all of our counties we serve, one substance abuse counselor, two psychiatric providers and only eight therapists served in that whole area.
“Now in 2017, we’ve seen a significant increase to three substance abuse counselors, seven different psychiatric providers, 14 masters level therapists, two psychologists, as well as our fully integrated health department of at least seven fulltime staff. We’ve had really tremendous growth. We’ve felt it at times.
“That’s not over either. We continue to have big eyes about what the opportunities are.”
One of the areas of focus has been patients with both serious mental health disorders and issues with substance abuse.
“They see people in jail, on the street, they see the homeless population, which not everyone sees in smalltown rural Iowa, but it’s there,” O’Brien-Day said. “These are people using a lot of dollars in our system, too, so the more effective treatment we can get to them, the better outcomes will be.
“Sometimes referrals are coming from law enforcement, sometimes from primary care providers, sometimes from their established mental health provider, sometimes from psychiatrists, and unfortunately sometimes from our schools. Most of the referrals come from the guidance counselor and the school liaison. They are key factors in identifying kids that are at risk. The teachers we work with are grateful for the help.”
Service has gone from three school districts to six school districts in the region, and five in Missouri awaiting accreditation. Preferably, sessions can be held within the school to avoid parents missing work and students missing class. Poor mental health is strongly correlated to poor academic performance, and subsequently poor income levels later in life.
“That’s good to know,” Reynolds said of the spread of mental health services to adolescents. “Because there’s a struggle and tremendous need for that kind of service also.”
Jeanne Winslow has provided therapy in Wayne, Appanoose and Lucas County for the last 15 years.
“We live in an area in the State that is a very long distance between towns,” Winslow said. “We also have a geriatric population that is large.
“The upper end of that population, they were born and lived in a time when they didn’t seek help for mental health issues. I’m getting more and more seniors, and it’s a wonderful thing when you can have a breakthrough.
“There are two things relatively new. The first thing is the cell phone. That’s evolved into the smart phone, where children as young as five have access to the Internet at their fingertips. Parents get phones, and it’s a great idea for safety, but it’s also being used as an abuse tool.
“Teenagers and young people have a difficult time controlling and regulating their phone usage. So we have the issues of sexting. We have people using their phones who don’t understand the concept of future, like this is going to matter.”
Winslow just returned from a conference about a similar issue, video gaming. Children born into this age are referred to as digital natives, while Winslow would be considered a digital immigrant.
“In families, many hours a day are spent onscreen,” Winslow said. “Communication, family interaction, friendships occur with a joystick and whatever game they’re going to pop in—it happens. One of my challenges as a therapist is how do I communicate in that language if I don’t know it?
“So, I am going to be focusing on that. I really think the future of our counseling lies with the ability to speak the language spoken by our target. That’s where I’m at—I’m excited about it. And people say, ‘Wow. You get excited about weird things.’
“But it’s great for mental health and for this organization that we’re in a time and a place that we can offer help for things, a year before, didn’t have a name for it.”
Reynolds finished the afternoon by alluding to O’Brien-Day’s point about poor mental healthcare being connected to underemployment.
“I think you’ve received a grant and some recognition for the great work you’ve done,” Reynolds said of CHCSI. “Especially in rural Iowa, I think it’s so necessary to approach it from this perspective. We’re trying to learn more, trying to understand it better. I think I’ve done a fairly good job at trying to capture your concerns that we can follow up with and just make sure we’re asking the right questions when we’re taking a look at how we move forward.
“We talk about the whole patient and generational mental health and how that impacts educational and job attainment. This is a big piece of what we’re doing, too.
“But also, we’re going to be launching an initiative called Future Ready Iowa. It’s really designed to work with underrepresented, underserved, underemployed and unemployed and help provide them with the support system they need to get the skills that should help match them up with an employer.
“I’m asking you to be a facilitator for us. As we work on this piece, and we’re getting people healthy and stabilized, getting a good job is a good piece of that, too—to maintain that stabilization.”