Iowa lawmakers advanced Governor Kim Reynolds’ legislation to fundamentally restructure the state’s behavioral health system, with initial approval of House Study Bill 653 on a 2-1 subcommittee vote. The bill proposes establishing a Behavioral Health Services System (BHSS) to consolidate mental health and substance abuse services, while relegating the current Mental Health and Disabilities Services (MHDS) system to an advisory role.
System Redesign Details
The restructuring would divide Iowa into seven districts to manage care previously handled by 13 mental health and 19 substance abuse regions. The Iowa Department of Health and Human Services would oversee BHSS and manage contracts with care providers in each district. Disability services currently provided by MHDS would shift to HHS’s division of disability and aging services. According to Iowa HHS Director Kelly Garcia, the proposed changes stemmed from “four years of assessments, agency alignment work and feedback from Iowa communities.” Garcia described the existing system as “fractured” and said the state is taking “a really significant step forward” to address gaps in care.
Critical Gaps in Current System
A January Treatment Advocacy Center report underscored the urgency of reform, ranking Iowa last in the nation for in-patient psychiatric beds available to treat adults managed by the state. Iowa has 64 state hospital beds available for adults with serious mental illnesses—a rate of two beds per 100,000 residents. The advocacy group stated that 50 beds per 100,000 residents is the lower limit required to “provide minimally adequate treatment for individuals with severe mental illness.”
Provider and Advocate Concerns
While mental health providers and advocates largely praised the plan, several raised concerns during the subcommittee meeting. Leslie Carpenter with Iowa Mental Health Advocacy criticized bill language calling for community-based services that “avoid, divert or offset the need for acute in patient services.” Carpenter argued that inpatient care should remain available, stating that acute inpatient services “is a vital life saving piece of the continuum of care and needs to be continue to be available.”
Amy Campbell, representing multiple health care groups, expressed concern that the transition timeline for moving disability services—with BHSS districts fully operational by July 1, 2025—lacks detailed planning. Campbell said questions about funding allocation for disability services moving forward remain unanswered.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://iowacapitaldispatch.com/2024/02/08/governors-bill-to-restructure-mental-health-substance-abuse-care-in-iowa-moves-forward/