Evolving role of the Mental Health Institute at Independence - KWWL - Eastern Iowa Breaking News, Weather, Closings

Evolving role of the Mental Health Institute at Independence

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Dr. Bhasker Dave, MHI Superintendent, says how best to provide better treatment & better access to mental health treatment in Iowa is a difficult question to answer. His facility is one of just two state hospitals in Iowa still open to treat Iowa's most seriously ill mental health patients.

Dr. Dave believes  the answers might be found in what he calls the evolution of care for the mentally ill over several decades.

The main building at the Mental Health Institute in Independence was built in 1873. At one time, there were multiple buildings on the MHI campus which housed seriously ill patients.

In the second half of the 19th Century, like every other state, the State of Iowa built State hospitals, where the mentally ill would be cared for as in-patients. Iowa built four of these hospitals.

The first was built in Mt. Pleasant and opened in 1861. It was originally known as the Iowa Lunatic Asylum.

To relieve overcrowding, the State of Iowa built a second mental hospital in Independence in 1873.

The Clarinda State Mental Hospital opened in 1884. The fourth opened in Cherokee in 1902.

Iowa closed both the Mt. Pleasant and Clarinda state hospitals in 2015, leaving Independence and Cherokee to handle Iowa's most serious in-patient mentally ill.

Dr. Dave says well into the first half of the 20th century, there really wasn't any treatment designed specifically for the seriously mentally ill. While patients received care inside the hospital, there was no real treatment available which could manage or control their psychiatric symptoms.

Dr. Dave says patients would be manic, terribly depressed, delusional and often hallucinating But, there was no specific treatment available at that time to truly help the patients. As a result, early MHI patients stayed for long periods of time, and very few ever got out to return home.

Back then,, tools of the trade all across America were straitjackets, metal cages, lobotomies, insulin shock electroshock therapy and a wide variety of less than ideal methods. There was nothing to actually help the patient.

At the four mental hospitals in Iowa, and all across the country, tens of thousands of mentally ill patients lived in huge buildings on huge campuses, but never received the help they truly needed.

By 1955, Dr. Dave says there were 560,000 state hospital beds across the United States. Today, there are around 40,000 public sector beds. In addition, there are about 56,000 beds in private psychiatric hospitals.

A mental hospital in Milledgeville, Georgia, was once the largest mental health institution in the world.

The Central State Hospital opened in 1842 and was called the Georgia Lunatic Asylum. It was built five years after Georgia lawmakers authorized creation of a “Lunatic, Idiot, and Epileptic Asylum. It once housed 13,000 mentally ill patients. Today, Milledgeville serves less than 200 patients.

Mental health treatments began to change in 1955, with the advent of the first generation of anti-psychotic medications used to treat the mentally ill.

Between 1955 and 1965, 15 to 20 news kinds of medications were discovered. New medicines for depression, anxiety, manic behavior.

Dr. Dave says those new medicines began to control, and in some cases, completely stop, the symptoms of mental illness in serious ill patients.

Thus, a reduction in the overall number of in-patient state hospital beds began in the 1960's, because the new mental illness, anti-psychotic, drugs were working for so many patients.

People began thinking that those patients were again like any other normal person in the community, so why should they remain in a hospital?

Dr. Dave says there were 3 of 4 other influences in the 1960's which have played a role in treatment.

President John F. Kennedy signed the National Mental Health Center Act in 1963.

That led to the creation of local mental health centers across the country to provide treatment within local communities, away from the larger state mental hospitals.

In addition, a considerable amount of legal reform was taking place in the late 1960's to ensure due-process rights of mentally ill Americans. This reform produced major changes in commitment laws in Iowa and around the country. These new laws were designed to make sure that patients whom were committed without their personal consent, and against their desire, actually needed to be hospitalized in a state institution.

In Iowa today, that means you must have a diagnosis of mental illness and/or be a danger to yourself or others before commitment to a mental health hospital.

The legal reform also brought with it an evolution of public insurance programs around 1965 with medicare and medicaid. These new insurance programs began providing funding for the treatment of mentally ill patients in special psychiatric units created inside local hospitals.

Dr. Dave adds that a U.S. Supreme Court ruling has also played a role in mental health treatment.

The landmark 1999 Olmstead decision ruled that people with disabilities should be treated in the most integrated and least restrictive setting.

Today, most people with mental illness receive treatment within the local community. The first line of treatment is through the family doctor, the local pediatrician, local psychiatrist and the community-based local health centers.

They are first treated at the out patient level, but, if they need in-patient care, local hospitals usually have psychiatric units.

In Waterloo, for example, both Covenant Medical Center and Unity Point-Allen Hospital have in-patient psychiatric units with the general hospital.

In Iowa, The Mental Health Institute at Independence today has 55 beds for inpatient treatment. It is always at capacity, and, there is a waiting list to be admitted to MHI in Independence. That waiting list usually comes mental health patients being treated at local community hospitals, like Covenant Medical Center and Unity Point-Allen Hospital.

Between Black Hawk, Linn and Johnson counties, there are approximately 233 total beds available for psychiatric patients within the general hospital. Again, these units are usually at capacity.

Across Iowa, between the Independence and Cherokee state mental hospitals, there are just 96 total beds today. There are approximately 639 beds in the general hospital psychiatric units in Iowa.

At M-H-I, there are three patient wards at MHI. A male ward; a female ward and a child's ward. All are separate.

The male ward has 25 beds. The female ward has 15 beds. The child ward also has 15 beds for children as young as 8 and as old as 18.When a child reaches 18, they are either discharged back into the community for outpatient treatment, if needed.

If they still need inpatient treatment, they are transferred to an adult ward at MHI. Dr. Dave says the median stay for an adult patient at MHI is about 3 months.

For a child, the median stay is 50-days. Dr. Dave says, “The focus for hospitalization currently is to manage the acute symptoms. as rapidly as one can, and then, get them back out the community, for outpatient care, for other type of care and long term, ongoing care, which is needed for the seriously mentally ill.”

Patients whom end being sent to the MHI are the most difficult to manage and have not responded to treatments given them at the local hospital. He says they are the patients whom are difficult to manage in a community more complex and more difficult to treat. As well as more expensive to treat.

“The patient whom ultimately ends up with us is one of the more difficult to treat, and whom has not responded to care in that very short period of time.”

“The community has developed resources, where the based psychiatric service providers can manage some of the patients that, 30-years ago, would have come to a state hospital. Now, they are treated in the local community.”

“The patients that we get, are all patients that have had multiple failures in their history. They have been to numerous hospitals without being completely controlled of their symptoms. And they exhibit severe symptoms. Aggression, self abusive behaviors. There are patients who swallow foreign objects, and patients that exhibit problematic behaviors. Inappropriate sexual acting out, and fire setting. These are the types of patients that are difficult to manage in a community-based hospital setting.”

He says, “It's a skewed population. And, since the numbers are fewer, the patients that we do have are more complex and more difficult to treat. As well as more expensive to treat. Our patients, at times, require one to one staffing. We've had patients who needed two to one staffing. Meaning there are two staff watching that one patient around the clock.”

Iowa began reducing the number of mental health beds long ago, starting in the Governor Tom Vilsack administration.

“We had 170 beds at one time. Then, the recession of 2000-2001 led to a 44-per cent reduction in the beds at Independence. 40-per cent reduction statewide in the state hospitals at that time. So, we have had a waiting list for 15 years now. It's a short waiting list, but, that waiting list is always there.”

The waiting list, Dr. Dave says, is always at least 5 patients, saying MHI's services are needed. “We really are the provider of last resort, and we are a safety net for some very difficult to treat patients who are difficult to handle in the community settings.”

Today, Iowa has 14 regions, instead of the previous 99 county service system. The system is still developing, says Dr. Dave.

88 'crisis' beds have been created to help treat mental health patients. These 88 news beds are in addition to the 731 acute care beds available in Iowa.

In the last year, Senate file 504 mandated the Iowa Department of Human Services to create a work group of stakeholders to find out what can be done to service the needs of individuals with complex needs; individuals whom are seriously mentally ill. Especially those who may have intellectual disability or a substance abuse disorder. and are prone to assault or are self-abusive.

The work group consists of stakeholders like the DHS Division of Mental Health, The Iowa Department of Public Health, the Iowa Hospital Association and the Mental Health Center Association. 

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