As County Social Services eyes expansions on mental health service and infrastructure, the Webster County Supervisors raise questions over a lack of transparency and miscommunications.

Supervisors on Tuesday grilled Bob Lincoln, CEO of CSS, in a discussion of mental health service expansion for the West Quadrant, which includes Webster County.

The county has been requesting specific numbers on the population served and the services requested or provided to gauge demand in the county. Supervisors say that CSS has failed to provide that information after years of requests.

“Saying you want to expand here is insulting because we’ve spent millions (with CSS), and you’re just now wanting to expand here?” Supervisor Mark Campbell said, expressing frustration at the lack of ability supervisors have in being able to detail what exactly the county does to address mental health issues.

“We need things in place. We can’t just say we’re going to do them,” he added.

“How many times do we have to ask for (the numbers)?” asked Supervisor Keith Dencklau, who said he’s asked for county-specific figures from CSS for the last five years. “I’ve gotten an excuse every year, and you’re standing there giving me another excuse. I can’t levy for this stuff if I don’t have any numbers or any facts.”

Other supervisors concurred, saying that grants cannot be applied for without the figures, making mental health services difficult for providers to provide.

“It’s concerning that the only time since we’ve seen you … is if you’re concerned we’re leaving,” Campbell said.

The meeting began with Lincoln’s concerns about Webster County wanting a “divorce” from CSS, something that was quickly debunked by supervisors as an issue cited by another county in the quadrant.

Acknowledging communication issues as perhaps one challenge in the community’s mental health system, Lincoln responded.

“It’s unproductive for us to generate numbers for member counties,” he said.

“We want county specific numbers, and that causes infighting to you in your business,” said County Attorney Darren Driscoll. “If those are numbers we can’t have, I think that’s where we’re hung up.”

Campbell said the numbers were the way the county can measure whether it’s providing the best possible service to its residents.

“We’re trying to figure out the best we could provide,” he said, acknowledging the transitional nature of some of the county’s population.

Nonetheless, Lincoln’s presentation on expansions moved forward.

Tertiary needs were the focus of many expansions, where help for individuals struggling with mental illness issues is crucial and timely.

Primary needs by a patient could be described at “I am struggling but I do not know where to get help.” Secondary needs could be described as “I am struggling but I am unable to get help.” Tertiary needs might say “I am struggling and need help now.”

County Social Services often serves as an access point for secondary needs. Those with primary needs are often referred to outpatient care at UnityPoint Health — Berryhill Center. Those with tertiary needs are sometimes helped by YourLife Iowa.

New expansions for tertiary services include crisis intervention training, mobile response teams, telepsychiatry, increased subacute care and residential support homes for patients with more intense needs.

Tertiary hospital care, he said, will be critical to maintain for a small population experiencing mental health episodes that can’t be treated within three to five days at many private inpatient facilities. The biggest investment need cited was for psych beds in subacute care, where patients could receive medications under monitoring.

“We need inpatient beds, bottom line,” said state Rep. Ann Meyer. R-Fort Dodge.

She said the state Legislature is working on public-private partnership solutions to help with that issue.

“It’s difficult when I go to the supervisor chair and ask for information on how many people are being serviced, because you can only determine what services are needed by what services are being requested,” she added.

Without inpatient bed placements, patients sit in the emergency room or the intensive care unit, where their care is the most costly without effective treatment.

Meyer said the state is working to ensure that telemedicine is reimbursed at the same rate as face-to-face visits as the method expands, and that state legislators are looking into raising Medicaid reimbursement rates, a common complaint among providers.

“In the last several years, we’ve not had appropriate mental health services here. I do think we, in the county, based on what we’re putting in, deserve the beds we need here,” Meyer said. “I hope that’s a big consideration.”

The nearest inpatient psych beds are in Story, Carroll, Clay, Buena Vista and Cerro Gordo counties.

Dr. Megan Srinivas, a local mental health provider, concurred with the need, saying that services need to look beyond the first few days of a crisis, since no medications take effect that quickly.

“This created a band-aid effect,” she said. “We have so many wonderful staff members but don’t empower them with the resources to do what they can.”

“The big picture here is, are we truly providing the services we need?” Campbell asked.