The kind of mental health services provided in Iowa vary from county to county, and funding has not been adjusted for inflation since the present system was set up in 1995, Robyn Wilson of the Iowa Department of Human Services told the Cherokee County Board of Supervisors on August 5th.
Wilson appeared at the meeting with Lisa Langlitz, community services director.
Wilson said there are some legally mandated services for people with disabilities that all counties must provide and there are other services that the county may decide to provide.
"Cherokee County is fairly liberal in determining what people in the county need and trying to provide those services," Wilson said.
A problem arises when a person from one county gets services in another county that may be provided in the home county. In order to avoid expense being lopsided for counties that provide long-term services for the chronically mentally ill, Iowa has what is called "county of legal settlement" that is considered the home county of a person unless a person lives in another county for a year without receiving county services.
As long as a person receives county services, the county of legal settlement is billed for the services provided by the county where the person actually resides. This sometimes results in a county being billed for services the county being billed does not provide for its own residents.
An example cited was Polk County, the county with the highest population in the state, which provides a wide range of services and Polk County bills many other counties for the services provide for people from out of the county.
Wilson noted that since Cherokee County offers a wide range of services itself, it is not often billed for services provided elsewhere that it doesn't normally pay for. However, there are other counties that basically provide only services that are mandated and they protest being billed for other services.
Another problem results from stagnant funding for services that constantly increase in cost. State law restricts the dollar amount counties can allocate for services based on budgets set in the mid '90s. State funding has increased since then, which is good news for local property taxpayers but not good news for recipients of services.
Since the dollar amount is fixed for spending, increased state funding automatically goes toward property tax relief.
Although Polk County provides a wide range of services, inflation has resulted in the services not being provided for everybody who needs it. Wilson noted that there are 350 people on waiting lists in that county. Sometimes this results in a deterioration in a person's condition until the person needs mandated service that might include expensive long-term residential care.
Also, some people needing mental health care end up in jail or prison, according to Wilson.
"There are too many people in the criminal justice system who shouldn't be there," Wilson said.
She noted that providing services in a timely manner often prevents more painful and costly situations later.