Patients in crisis need access to psychiatric care


Imagine this scenario: Your 12-year-old child or grandchild who lives in Iowa needs emergency psychiatric care because of severe, self-injurious behavior. You wind up in the emergency department of your local hospital where you and your distressed child sit for hours waiting for access to psychiatric care. A bed is not available because of a shortage of psychiatrists. In fact, half of the counties in Iowa don’t have a psychiatrist, which means hospitals in those counties can’t accommodate patients suffering a mental health crisis. Your hospital searches for another health care facility with psychiatric staffing and finds one in Sioux City, Iowa, five hours away from home. The child is sent to that hospital for a few days to be treated and stabilized and returns home, in need of continuing care.

Substitute the subject of that scenario with an adult or a geriatric patient. No matter the age, our parents, spouses, siblings, children and ourselves struggle for access to emergency psychiatric staffing in hospitals in Iowa. National statistics indicate that 50 beds are needed for every 100,000 people. In Scott County, which does have psychiatrists, there are 18 beds at Davenport-based Genesis Health System for a population of 170,000, says Lori Elam, Scott County’s director of Community Services. Meanwhile, counties without psychiatrists send their adult patients requiring emergency hospitalization to Scott and other counties that have appropriate personnel. That’s where the bottleneck occurs. We, as people of faith, need to respond with empathy, advocacy and generosity.

Michael Freda, board president of NAMI Greater Mississippi Valley, observes that people don’t care about mental illness until it impacts their lives. At some point, it touches all of our lives. If you know someone dealing with mental illness, offer to do a chore for that person or to go for a walk or to a sporting event, concert or restaurant. Take time to listen; it’s a precious gift.

Explore the reasons why we don’t have enough psychiatrists to treat children and adults in crisis. The majority of the nation’s 28,000 psychiatrists practice in states paying the highest Medicare and Medicaid reimbursement rates. Iowa has the fifth-lowest Medicare reimbursement rate, while Medicaid pays the lowest of all government and private healthcare payers in Iowa, the Iowa Medical Society says.


So what can we do about that? Lobby our state and federal legislators for fair and equitable reimbursement rates to draw more psychiatrists to Iowa. In the long run, that could result in higher taxes, but Christ said those who have been given more must share more. If you enjoy good mental health, you’ve been given more than some.
We can lobby for parity between mental health and physical health care. Mental health care should no longer be viewed as a second-class citizen. Insurers shouldn’t question treatment options at a rate much higher for persons with mental illness than for persons with a physical illness.

We also need to ask: Why aren’t medical students choosing psychiatry as a field? Are the education costs and training demands prohibitive? What can our society due to answer that question without shortchanging the development of skills and knowledge? How can we inspire people to view this field of medicine as a vocation, a calling?
Finally, the Catholic Church has played a vital role throughout history in responding to people’s needs for health care, first by establishing hospitals. As a church, we should explore the issue of mental health care and how to respond to the very real needs in our society. This could be a component of our Holy Father’s Year of Mercy, which begins in December.

Genesis hopes to alleviate the challenge through its partnership with Texas-based Horizon Health in a management agreement that enables future expansion of behavioral services in response to growing community need. That includes geriatric, adult and child and adolescent psychiatric service offerings.

Let’s support efforts like this one and open our hearts in compassion and generosity so that no child, adult or senior citizen suffers in crisis in an emergency department with nowhere to go.

Barb Arland-Fye

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