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New Solution Emerging to Ease Mental Health Treatment Problems in Iowa

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DES MOINES, Iowa -- It's one of the biggest challenges for police: officers forced to take on the role of a mental health professional. It's happening more and more often in Iowa with prisons serving as mental health facilities, and that might be the easiest place to get treatment.

The Iowa Department of Human Services says there are 740 public and private inpatient beds across Iowa. They also say on average, 60 beds are open and ready for patients on any given day.

However, metro hospitals have a different opinion.

Jail is where convicted criminals end up. Their crimes vary but the majority all have one thing in common.

"57 percent of our prison population has at least one chronic mental health diagnosis," said Research Director Lettie Prell, Iowa Department of Corrections. "It`s been increasing for the past eight years."

Of the 4,700 inmates suffering from a mental illness, more than 2,700 are considered seriously mentally ill. That includes those suffering from schizophrenia, major depression, bipolar disorder, and dementia.

"We don`t control who is sentenced to prison, so what we do with people while we have them is we diagnose and treat all the conditions that they have, whether it`s mental illness, substance abuse," said Prell.

The prison system has been forced into becoming mental health facilities because in many cases, mental health services are lacking on the outside. Doctors at Broadlawns Medical Center deal with the crisis daily. No one is turned away but often patients must wait for a bed to open up.

"We have patients in the emergency department for up to 120 hours," said Jeff Jarding, Nursing Director, Emergency Department & Crisis at Broadlawns Medical Center.

The waits of up to five days or more only make the problem worse for the patient.

"Being in an overstimulating emergency department when you`re having an acute mental crisis, is not the best environment for you," said Jarding. "It`s not a nurturing environment because you`re dealing with the continual chaos of an emergency department."

When the backlog of mental health patients waiting in the emergency department stacks up, Broadlawns turns to other medical facilities for help.

"It is continually calling every psych facility in the state until someone says 'we have a bed open' or until a bed opens up here. So, it`s non-stop," said Jarding.

Even when Broadlawns does locate a facility willing to accept the patient, the wait isn`t over.

“The frustration that I hear from our staff, our social workers for example, will get the information that a certain patient on our Sands unit needs to be placed, meaning they’re beyond their acute phase, they’re into now what we would call the chronic phase, and so they need to be placed and literally without any exaggeration, our social workers are on the phone, all day long for multiple days, trying to find a place to place these patients," said Dr. Vincent Mandracchia, Executive Vice President and Chief Medical Officer for Broadlawns Medical Center. "If you’re fortunate, a place will say sure, you know that patient’s appropriate, we’ll take them, but we don’t have an opening for a month or six weeks, so we hold those patients. That’s a fortunate situation. The unfortunate situation is we have no availability for a long term bed anywhere. We have tried to go out of state, in certain cases, to find placement for these patients. (It's) very, very difficult, so the lack of beds for long term care has become an issue," said Mandracchia.

"The biggest reason why we got into this business is because we`ve got people that are sitting in emergency rooms for days, as well as we`ve got patients that are waiting weeks to get seen by a psychiatric provider," said Doug Wilson, President, Integrated Telehealth Partners.

Integrated Telehealth Partners is trying to eliminate that wait by connecting patients with psychiatrists from around the country.

"When a patient presents an emergency room with a mental health need, they contact our company. We then have a psychiatrist connect in through video conferencing and then they`ll conduct a full assessment and then in collaboration with the emergency room physician determine the appropriate level of care for patients," said Wilson.

Following the video conference evaluation, the psychiatrist can write a prescription, order additional care, or divert patients from the hospital to outpatient services.

"If we can get them an appointment within five days and they can a psychiatrist on an outpatient basis, that then prevents them from having to go to the hospital, which is a huge cost savings to the healthcare system, as well as lessens the burden on the inpatient beds," said Wilson.

ITP currently works with 22 health facilities around the state. The Boone County Hospital started using it over a year ago.

"They`re able to speak with a mental health provider, a psychiatrist right there and they may not have to be there for days if the psychiatrist feels they could do outpatient treatment as opposed to inpatient treatment.," said Mindy Royster, Nurse Practitioner, Boone County Hospital.

The ability to have a psychiatrist on standby also allows ER staff to focus on patients, rather than working the phones.

"With the addition of ITP, that`s eliminated the process of our emergency room having to do the calling around. So it`s freed our nurses up to do more patient care, direct patient care as opposed to on the phone, trying to find a bed," said Royster.

Telehealth psychiatrists like doctor Sunil Parashar say telehealth is the way of the future.

"My own feeling is that we will actually have even more specialties of medicine that will move this way," said Parashar. "You know as how moving cars are driving without drivers and technology keep going I think medicine is going to be that way. Especially for psychiatry and mental health. I think it is a big move and a big step, for example, if I'm here at a conference I would have never been able to see a patient from Austin but today I can thanks to ITP.

Channel 13 reached out to the Iowa Department of Human Services for comment and in response it says it has plans to convene a workgroup to identify effective services for individuals with severe multiple complex needs and report recommendations for the provision of the identified services. You can find more about those plans by clicking here.

It also says the conversation needs to be expanded beyond just the availability of beds.

And here is a news release from the governor's office on grants for training more psychiatrists. https://governor.iowa.gov/2016/03/branstad-reynolds-announce-creation-of-mental-health-residency-programs