-Alison Hauser

One year after a key piece of mental health legislation was signed, big changes are rolling through the system, including the creation of new access centers to see that people get help more quickly.

The law was signed in March 2018, and most of the provisions go into effect by July 1, 2021, giving limited time to put major systems in place.

Fortunately, Webster County’s region has been working ahead, according to Alison Hauser, western quadrant supervisor for County Social Services.

“We are trying to do it sooner,” Hauser said.

And the access center for this half of the region may end up being in Fort Dodge.

Hauser spoke after a meeting of the CSS western quadrant’s stakeholders Wednesday in Fort Dodge, presented by Regional Coordinator Todd Rickert.

CSS is the 22-county mental health services region, formed in 2012 when management of mental health went from counties to regions. The west quadrant includes Webster, Humboldt, Emmet, Kossuth, Pocahontas, and Wright counties.

Speaking to an audience of mental health care providers, Rickert went through 20 items which will need to be provided in the future.

These range from complex, like the Assertive Community Treatment only needed by a small percentage of the population, to things like Mental Health First Aid, which is already being taught to anyone at all in the region, from first responders to church groups.

“Basically what we’re calling this is the 2456 plan. Just to address those needs that legislation has placed on us,” said Rickert, referring to Iowa House File 2456.

Organizations including Lifeworks, Community & Family Resources, the UnityPoint Health–Berryhill Center, and the peer support group Freedom Pointe joined for the stakeholders meeting to learn about the changes–and to meet with each other.

Providers said one of their concerns is, how does a person with mental health needs transition from one service to another, without falling through the cracks?

“Rural hospitals have been dealing with this more and more. We reach out to different entities, and it’s so complex,” said Susan Aden, director of inpatient and ER at Pocahontas Community Hospital.

“Here are all your different programs and things going on, and here’s what you have to do to be eligible for these different programs — if that was all on a roadmap for us, it would be much more seamless for us,” she said.

Berryhill Director Aaron McHone said that’s one thing that could improve how services are provided.

“(Suppose) a gentleman is sitting on Main Street talking to himself, maybe makes some threats, maybe breaks a window, I don’t know,” McHone said. “Who gets him, how do they get to the access center? What happens for the access center if they end up needing sub-acute, if they end up needing to transition from sub-acute to ACT, or the other services they need?

“I like that we have all these pieces, but I think the magic is how all these pieces will work together to seamlessly transfer.”

Maybe it would help to map this all out, using an invented patient — a John Doe or Jane Smith, said Lifeworks Director Teresa Naughton.

“Call it a tabletop exercise,” Naughton said. “If someone presented in the community in this way, how would the system handle them? And where are the pain points? How do we address the pain points?”

That’s one thing the new advisory committee can work on, said McHone. This group is made up of a few people out of the larger group of stakeholders, and will meet to present ideas to the full governing board which meets every month.

Randy Hoover, head of the Freedom Pointe peer support program, hopes this is an area his group can really aid.

“If you look around this room, at Aaron and Community Health and all that, we have a tremendous service pie here. But too often, people only get one piece of that pie,” Hoover said. “They don’t get the whole thing.

“We want to be the ones to do that. We want to be that conduit to everyone else, because we can be there for them and talk to them, but we’re not going to fix them. These places can.”

Hoover isn’t certified to treat mental health, but he and the other peer support workers have seen the other side of the process.

Creating good peer support is one of the 20 items on Rickert’s list from the state — an area he said Webster County excels at thanks to Freedom Pointe.

“We appreciate the development of these programs, and the support the quadrant has shown to them,” Rickert said. “As you said, what better way of assisting someone than with somebody who has this lived experience?

“We don’t have that everywhere.”

Hoover spoke out on the importance of having people who know this side of mental illness involved with the discussions.

“You have a lot of providers on that committee, but you need a consumer,” Hoover said. “If you want to help people, you need to talk to the people you want to help and see how you can help.”

The purpose of the access center is to give patients a place to go right away when they’re in crisis, so that they aren’t stuck in a hospital, or taking up the time of county sheriffs.

“We are looking at 15 minute turnaround for law enforcement,” Rickert said. “We don’t want people sitting in ERs if we can help it. We want people to be able to be seen as quickly as possible, and get to where they are going for the short term.”

From the access center, staff can figure out what kind of care the person needs, and where the best place to go is.

Rickert and Hauser said the hope is that the new CFR building in Fort Dodge can be this half of the region’s access center, and be available by July 2020.

However, it depends on the legislature. Many of the rules governing access centers haven’t been written yet, Hauser said.

For people with great need, there’s a lot of trouble now finding a place for them, McHone said.

“The state tracks open beds. In doing open beds, they note we don’t have every inpatient bed filled,” he said. “Therefore you have some who argue we don’t need any more beds. The truth is the beds we do have don’t match the level of acuity the patients in the ER have.

“So there’s an open bed, but the problem is the receiving hospital won’t accept the patient,” McHone said. “It’s not just how many are there, it’s are they the type for the patients that are out there.”

“It used to be they would wait a few hours in our emergency room,” Aden said. “Now they wait days, and sometimes we never do find a bed.”

“I’ve been in the Humboldt ER quite a bit lately, and have been making calls trying to find beds,” Hauser said. “They say we’re too busy right now, and hang up on you. You don’t even always get a live person to deal with.”

Another item on the list is 24-hour crisis response. CSS has providers who do that in nearly every western county — either UnityPoint or Integrated Telehealth Partners — and there’s also a statewide crisis phone line now, run by the state.

That number is 855-581-8111.

For residential crisis stabilization, the goal is to have a place within 120 miles; CFR currently serves this role in the western half with seven beds.

The region has 20 beds in total.

For community-based crisis stabilization, the region hopes to have teams in place to offer face-to-face contact within 120 minutes of referral, and plan to start on Jan. 1.

Mobile response is also in the plan to start Jan. 1, so that a person could be face-to-face with mobile crisis staff within 60 minutes of dispatch.

“That is a huge challenge in a rural area,” Rickert said.

Not everything that the state mandates comes with funding.

“They don’t actually give additional money, no. It’s up to us to fund what is being done,” Hauser said. “And we’re already doing the majority of it. We are ahead.”