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Quad-Cities mental health services have ramped up

Quad City Times - 6/6/2020

Jun. 6--To bolster its case for state approval to build a hospital in Bettendorf, representatives of Tennessee-based Strategic Behavioral Health in 2015 went before the Scott County Board of Supervisors and the city councils of Davenport and Bettendorf, seeking letters of support.

Strategic Health argued why a hospital was needed, while representatives of Genesis Health System, UnityPoint Trinity and others supporting the local hospitals argued why it was not.

The arguments that played out in these public forums brought to light several glaring gaps in the care and treatment of people with mental and behavioral health issues in the Quad-Cities area.

In the five years since then, much has changed for the better, Lori Elam, director of the five-county Eastern Iowa Mental Health Region, said.

Beds for children, beds in general

In 2015, there was literally no place locally to take a child in need of inpatient hospitalization.

Scott County Sheriff Tim Lane well remembers the 7-year-old who was transported to Council Bluffs in the back seat of a marked sheriff's vehicle because that was the closest place for treatment.

Now, there are 14 beds, with flexibility to 22 between the two hospitals, according to hospital representatives.

Genesis operates 28 adult beds and eight beds for ages 17 and under in its behavioral health unit at its West Central Park campus, Davenport.

UnityPoint Health-Robert Young Center operates 31 inpatient psychiatric beds with the ability to flex unit capacity to meet needs. Adult beds can flex from 17-25 and child and adolescent capacity can flex from 6-14.

Total beds overall also have increased.

A coordinated system for dealing with crisis

Another big change has been the establishment in June of 2019 of a crisis service system for the five-county mental health region that involves Genesis East and West, UnityPoint Trinity in Rock Island and Muscatine, Mercy in Clinton, University of Iowa (serving Cedar County) and a hospital in Dubuque.

Robert Young Center for Community Mental Health, Rock Island, helped develop the system and manages it under a contract with the Eastern Iowa Mental Health Region to provide mental health services that had been missing before and does so in a coordinated fashion, Elam said. Although Robert Young is based in Illinois, it has an office in Davenport and serves Iowa patients as well.

The contract is about $4 million per year and out of that, Robert Young pays for some of the services offered through the system, while other services are funded by the state of Iowa, Elam said. The system includes:

--A telephone hotline that is answered 24/7. This is staffed by Foundation 2, a Cedar Rapids-based company that provides hotlines in all 14 mental health regions in the state and is funded by a contract with the state.

--Mobile crisis teams of two that can go out to where a person in crisis is and can talk to that person, or get that person to a hospital. This also is staffed by Foundation 2.

--Tele-health options in the seven hospitals. This assures 24-hour, emergency room access to a psychiatric provider in instances where one is not available on site. Trinity-Bettendorf, for example, does not have a psychiatric unit.

--Peer respite beds in DeWitt, provided under contract with a company called Life Connections. A person who is in recovery and doing well but still in need of help might go to this three-bedroom house for a week or so and receive counseling help from peers (people who also are in recovery) but who have had special training.

Often a person who is recovering can relate better with someone who has "been there," as opposed to a doctor or a therapist, Elam said.

--Crisis beds at Vera French Community Mental Health Center, Davenport.

Vera French operates a five-bed house staffed 24/7 by professionals who can help people who are still in crisis, who have been referred by Vera French or brought by a hospital or law enforcement.

These people stay no more than five days; as soon as they arrive, they and staff begin working on a discharge plan.

This service is provided under contract.

--Care coordinator positions throughout the region who are "real people work(ing) with people who are discharged to help with follow-up," Elam said.

This might include making sure the person takes his or her medications, that they have a safe place to stay and that they have transportation to get where they need to go.

There are three positions in Scott County, two each in Muscatine and Clinton counties and one each in Jackson and Cedar counties.

They, too, work under contract.

--A mental health specialist who can pre-screen court petitions seeking committal of a person. This specialist assesses whether a person really needs to be hospitalized involuntarily or whether there might be other, less drastic options.

The specialists look at every petition unless a family chooses to opt out, Elam said.

"We're seeing more and more families who want to know what is available to help. We're trying to reduce commitments and inflow into hospitals. But some folks really do need to be in a hospital."

One specialist is available in each of Scott, Muscatine and Clinton counties.

Getting creative about psychiatrists

One of the arguments made five years ago was that the area didn't need more beds, it needed more providers, specifically psychiatrists who are medical doctors who can write prescriptions.

That hasn't changed, Elam said, explaining that there is a well-documented shortage of psychiatrists nationwide. And that shortage really hits areas like the Midwest that are perceived to lack advantages found in states with bigger cities or better climates.

As a result, "there was a time when a person had to wait four, five or six months to see a prescriber," she said. "If you need medicine, you need it now."

So, she said, the area got more creative.

Although some psychiatrists have actually moved to the area in the past five years, the mental health system has augmented their presence with other positions that can accomplish the same goal.

A person with advanced registered nurse practitioner credentials, for example, also can write prescriptions, and there is just such a person now employed at Vera French.

In addition, prescriptions are available through the tele-health option in Clinton via a psychiatrist in Arizona.

"People are being creative to get services and medicine," Elam said.

More is needed

Despite all these improvements, though, more is needed, Elam said.

"Both Genesis and Trinity have children's beds, and that helps. But that is not enough. We still have people leave the region for treatment. We continue to monitor that. My hope is that (we come to a time when) a person never has to leave the community for an inpatient bed. That they can always be near family, near support."

That's why she 100% supports the opening of Eagle View in Bettendorf.

"Everybody is going to be so impressed by what they do, with the care and types of services available."

"They do things very differently than other hospitals. They keep people a little longer and then maybe you won't see repeat stays. And they have a lot of treatment modalities. Not everything works for everybody. They're known for their different types of treatment. They work with families as well."

And, yes, there is need.

On any given day, the Scott County Sheriff's Department transports, as one of its duties, people who have been court-ordered at the request of their families to a center for mental health and/or drug and alcohol addiction treatment.

It is not unusual to have "four, five, six every single day who are a threat to themselves or others," Sheriff Tim Lane said.

During the past few years, involuntary committals have hovered around 370-380 people per year, Elam said.

And that is just the people who are involuntarily committed. Others seek treatment on their own, or fall through the cracks, receiving no treatment.

Dennis Duke, president of the Robert Young Center, said in an email that Robert Young "will work collaboratively with SBH (Strategic Behavioral Health) as it does with other community providers and stakeholders to ensure the behavioral health needs of our community are met.

"With SBH committing to serve all payers and patients (Medicaid and commercial insurances), that will be helpful in providing for all individuals that require treatment."

Genesis Health System declined comment.

"There is so much need for mental health services," Elam said. All three will be busy trying to meet those needs," she said, referring to Genesis, Trinity and Eagle View.

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