URBANDALE (AP) -- A task force reviewing the operation of Iowa's four state-run mental health institutions recommended Wednesday against closing any of the facilities.
The 12-member task force instead will recommend the state strengthen its community-based mental health system.
"The primary recommendation was we not close any mental health institute until we have a community based mental health system in place to pick up the needs of those people," said former state lawmaker Ro Foege, chairman of the task force. "We are recommending the strengthening of the community based mental health system."
The panel began its work in September and visited each of the state's mental health institutions, in Clarinda, Cherokee, Independence and Mount Pleasant.
The Legislature ordered the review, saying it was needed because of Governor Chet Culver's 10-percent across-the-board State budget cut, continuing declines in population at the institutions, and changing views on how to treat people with mental illness.
The oldest of the facilities -- the Mount Pleasant Mental Health Institute -- was built in 1861. The newest is the institute in Cherokee, built in 1902.
Populations at the facilities peaked during the 1940s, when they were home to about 6,000 people. By 2009, the numbers dropped to a daily average of about 231.
The steady population decline came as new medications were developed, a growing social aversion to the accepted process of "warehousing" the mentally ill materialized, and experts concluded that treatment in smaller centers closer to home was more effective.
Foege said the panel will present its recommendation to the director of the Iowa Department of Human Services by Dec. 15.
He said the group determined it could not look at the four institutions without considering other factors, including other providers that work with the facilities.
"They don't operate in a vacuum," Foege said. "They operate with private hospital beds, psychiatric beds and other services.
"You can't separate that out without looking at the whole system," he said.
Foege said the state will save money if the recommendations to expand and improve community based services are followed. However, he could not provide a dollar amount for the savings.
Ultimately, it would take an act of the Iowa Legislature to close one of the four Iowa MHI facilities.
The task force held meetings and hosted public hearings in the four communities involved, with more than 1,700 people attending those hearings and speaking for their own MHI.
The task force broadened its review to include more than a study of the four MHIs, finding that many entities play a role. Task force members found that policies by judicial ancd corrections officials, private sector providers, and other mental health services directly impact the admissions, length of stay, and discharge of those in the public mental health system.
According to Cherokee MHI Superintendent Dr. Daniel Gillette, closing one MHI would obviously strengthen the remaining three institutes in Iowa by consolidating goods and services; however, the economic impact on the affected community would be devastating.
Gillette, a child and adolescent psychiatrist, said the Cherokee facility has the lowest per-diem costs of the four State institutes, and provides much-needed services to nearly half of Iowa's 99 counties. Gillette has figures, charts, and graphs comparing the four state institutes to verify the meaningful statistics that reveal the Cherokee institute's efficiency, clinical services strengths and expertise.
"It is nice to know the task force recognized the good work the four Iowa MHIs do, and the importance of that work." said Gillette Thursday. "It's very true the (MHIs) system of care is not very organized. They (Legislature) should look at that before closing anything.
"But, in all actuality, the task force is just kicking the can down the road. The DHS has been ordered to give a recommendation to close one of the MHIs. Basically, it's a three-round fight and the task force has called the first round a draw. The second round is the DHS recommendation, and the third round the final Legislative action, whatever that might be."
All four Iowa MHIs were built between 1861 and 1902, with Cherokee opening in 1902 and admitting 1,022 patients the first year. The four institutes are operated by the DHS under the directorship of Charles J. Krogmeier and under the leadership of Sally Titus, deputy director for field operations.
The Cherokee facility - Iowa's largest with 637,038 square footage of buildings and structures - provides inpatient and outpatient psychiatric services for adults, children, and adolescents. Outpatient services include psychiatric diagnosis, medication management, individual therapy, and family therapy.
The Cherokee MHI serves adults for 41 counties in Northwest Iowa, and children and adolescents from 55 counties. Clinical staff assistance is available around the clock seven days a week.
According to Gillette, about 90-percent of the Cherokee patients are sent to the MHI by a court order.
The Cherokee MHI also leases space for a variety of clinical and family services, among them Iowa Vocational Rehabilitation Services Office, the Pride Group, Jackson Recovery Center, Juvenile Court Services, DHS Targeted Case Management Offices, Youth Emergency Services, Northwest Community Empowerment, and Cherokee County Board of Supervisors.
The Cherokee MHI Campus also houses Iowa's Civil Commitment Unit for Sex Offenders (CCUSO).