Iowa governor candidates lay out plans for mental health

A dozen candidates for governor gathered Tuesday night to lay out their plans for improved access, funding and treatment for mental health services across the state. 

At a public panel organized by The Des Moines Register, the candidates voiced near-universal criticism of Iowa's privatized Medicaid system, which has faced a tumultuous couple of months following the departure of one of the private companies hired to manage services. 

The Register staged the panel, hosted by Des Moines University, following an outpouring of support and concern after Mary Neubauer penned an emotional obituary for her son, Sergei, who committed suicide. She and her husband, Larry Loss, called on policymakers to better address the "crisis" of declining access to mental health treatment.

"(We) believe it is a crisis facing America, one that must be acknowledged, better understood and ultimately addressed for people to have the tools to heal," they wrote. "Iowa did not have adequate mental-health resources during Sergei's times of crisis and he spent several months out of state this year in residential treatment."

Every candidate for governor was in attendance with the exception of current Gov. Kim Reynolds, a Republican, who is traveling this week. In her absence, the other candidates — Democrats, Republicans, Libertarians and independents — took turns leveling their criticism of her leadership. 

They were also nearly united in their frustration over the closing of two state mental health institutes under former Gov. Terry Branstad, which dramatically reduced the availability of mental hospital beds in the state. Iowa currently ranks 49th out of 50 states for its number of state mental hospital beds.

Many candidates also expressed hope that Iowa could move away from a system they say criminalizes mental health and unnecessarily jails and imprisons those with mental health or substance abuse issues. The focus needs to be on reducing the stigma associated with mental health, they said, and ensuring access to treatment. 

Here's a look at some of the key points raised by each candidate.

Republicans

Ron Corbett, outgoing mayor of Cedar Rapids: Corbett said the closure of two mental health institutes in Clarinda and Mount Pleasant has resulted in compression of the system.

"The state may have saved some money on their line item, but the people didn’t evaporate," he said. Instead, the results are being manifested as homelessness, higher rates of incarceration and overcrowded hospitals.

He said it may not make sense to reopen the two facilities now, but it would make sense to increase the number of available beds. 

Steven Ray, Boone city councilman: "I started seeing this 30 years ago," said Ray, who previously worked in law enforcement. "We would have requests for committals through the sheriffs’ office where I started out at. And we were often finding, even back then, that it was difficult to find a bed in this state. Sometimes deputies would have to drive 150 miles to find a bed, and that’s inexcusable." 

He said that although closing two state mental institutions may have saved the state money, local taxpayers are still bearing the costs in other ways, including through the criminal justice system. 

"That is not where this should be dealt with, and our law enforcement people are not mental health specialists," he said. 

Kim Reynolds, Iowa governor: In a video statement, Reynolds highlighted the state’s efforts to expand access to jail diversion programs as well as its efforts to provide a regional approach to mental health services.

“My administration has taken a number of steps to address the critical mental health needs in our state,” she said. “Today, Iowa’s mental health system is serving more Iowans in more modern ways with better services and more local home and community settings than ever before.”

Democrats

Nate Boulton, state senator and attorney: Boulton levied criticism of Reynolds and the Republican-controlled Legislature for presiding over a "manufactured budget crisis" that favors special interest "tax giveaways" over mental health funding.

"One of the critical problems that I can see right now is the fact that we just had an address of a video from our governor who doesn’t seem to acknowledge that there’s much of a problem here," he said. 

Cathy Glasson, nurse and president of SEIU Local 199: Glasson, who has positioned herself as the most progressive candidate, said the state should immediately move to reverse the privatization of Medicaid, which “has been devastating to so many families and providers in the state." In the longer term, she said Iowa should move toward a Medicare-for-all system.

“If we can’t count on the politicians in Washington, D.C., to do the right thing, I believe we need to fight and work to pass a universal single-payer health care plan right here in Iowa," she said. "Everybody covered. Nobody left behind."

Fred Hubbell, retired insurance executive and philanthropist: Hubbell said the state needs about 50 to 75 more acute, long-term care beds as a result of the closure of state institutions, but he also said he favors generally a community-based approach. 

"At the same time, we don’t have enough psychologists, we don’t have enough psychiatrists, we don’t have enough trained clinicians to help in these issues," he said. "We’re going to need to incentivize more of them to get the training and we’re going to need to incentivize more of them to stay in Iowa once they get trained."

Andy McGuire, health care executive and past chairwoman of the Iowa Democratic Party: McGuire said one of the biggest problems Iowa needs to confront is the stigma of substance abuse and mental health issues. 

“As a doctor, this is a disease," she said. "It’s not a character flaw. It’s not a problem with a person. It’s a disease, and we need to treat it as such."

She said the state needs all kinds of additional beds, not just those for acute mental health issues. She said that includes transitional beds, long-term beds and community-based options.

Jon Neiderbach, former president of the Des Moines School Board: Neiderbach said he does not believe mental health programs should be funded with local property taxes, as the system is currently set up. 

“We need to make this a statewide funded program, just like all other kinds of health," he said. "I have proposed legalizing cannabis to raise $200 million. That would be a big shot of improvement and new money into the mental health and substance abuse system."

John Norris, chief of staff under Tom Vilsack and official with the USDA’s Foreign Agriculture Service: Norris said the state should end its privatization of Medicaid.

“Commercial MCOs will never be motivated for health care first,” he said. “… The governor needs to admit failure. That’s part of being a leader.”

He said the state should convene experts to develop a strategic plan that includes oversight and a budget to match. 

Ross Wilburn, former Iowa City mayor and city councilman: Wilburn said he would invest in increasing the number of mental health beds in the state as well as work to provide incentives or loan forgiveness programs for students who commit to working in mental health here. In addition, he said privatized Medicaid should be reversed.

“Iowans are not being served … providers are being put in a position where they have to think about getting a loan to cover their payroll because they’re not being reimbursed at a level that’s going to support the level of care they’re providing.”

Libertarians

Marco Battaglia, musician: Battaglia said he's opposed to tying mental health funding to local property taxes, as the system currently is designed. He said mental health should be funded in a more transparent way through the overall budget.

"We treat so many people suffering from mental illness as criminals," Battaglia said. "And I think that is where we have to start."

Jake Porter, business consultant and co-founder of a web design company: Porter said the biggest hurdle to addressing mental health issues is overcoming the stigma. He said he’s faced struggles in his own life and understands how difficult it can be to talk about.

“There’s all kinds of things we can do within the legislative process as well, whether it be making sure that budget cuts are not impacting mental health…” he said. “Also looking at the policies we’ve got for our drug policies.”

Independent

Brent Roske, filmmaker: Roske said it's important not only to attract new medical professionals to Iowa, but to retain graduates who often don't stick around. 

"We need more culture. We need more funding for culture," he said. 

Roske called the move to managed care under privatized Medcaid "managed chaos," and said the system is not serving Iowans. He also advocated for single-payer health care.