Law enforcement challenged with limited resources
This 10-part series, a collaborative effort of the newspapers of Rust Publishing, NWIA, examines the myriad issues surrounding the mental health care crisis in Iowa. Reporters and editors from the Spencer Daily Reporter, Storm Lake Pilot-Tribune and Dickinson County News have contributed to the report.
Regional law enforcement administrators agree, a lack of area mental health care services is taxing on staff and budgets – and there doesn't seem to be any relief in the immediate future as agencies continue to close and services disappear.
"You're not going to find a sheriff who will tell you it’s not a crisis," said Buena Vista County Sheriff Kory Elston.
Mark Prosser, Storm Lake Police Chief and Public Safety Director, took it a step further.
"You have an absolutely broken system. Crisis is an understatement."
Elston added, "You're not going to find anybody in my field who thinks what we're doing now works because it doesn't."
Dickinson County Sheriff Greg Baloun concurred. "It's a nationwide problem and it's not getting any better."
Including Spencer Police Chief Mark Warburton, the regional veteran law enforcement officials have a combined 125 years of experience, and like many in their industry, they are doing all they can to serve those dealing with mental health challenges with the training and tools they are given. Unfortunately those tools are extremely limited and it's putting a financial and time drain on those charged with public safety as well of the individuals in desperate need of care for behaviors which, on occasion, border on criminal.
"Everyone knows there's a lack of funding and a lack of beds," Elston said. "If there is one area in my career where we are lacking as a society, or a state, or blame who you will, it's the mental health area and there isn't a close second."
When law enforcement officers encounter a person who may be acting out, the responding officers are challenged to make the determination if the act is criminal and if the individual in question is a threat to themselves or others. If the officer believes the person is in need of an emergency mental health evaluation, they must transport them to the hospital.
"Challenges of mental health on law enforcement we see conservatively every week, sometimes every day, often every shift," Prosser said.
Warburton, who has been in law enforcement for 25 years, said the responsibility falls on police and sheriff's staff to take care of the individual through the evaluation process.
"The time delay it takes to get them processed and get them someplace can sometimes take hours and hours," Warburton said. "It's not unusual for an officer from our department to be sitting, four, six hours at the emergency room. Those are valuable services being tied up with an officer there when he could be doing other things. It compounds other problems as far as being able to manage calls for service."
"The person has committed no crime," Prosser said. "They're not criminals, they're sick. We're watching them on behalf of the safety of the emergency room staff while the folks in the ER are trying to find a bed or a facility."
Elston said the need for a law enforcement official to be involved while the individual is being evaluated can span shifts and sometimes days. Once a bed is located, it falls on the county sheriff's office to provide transport to the available site. With limited space available, the trip isn't always a short one.
"HR social workers in the hospital start calling hospitals in the area – Cherokee, Spencer, Carroll, Sioux City – looking for a bed," Elston, whose office performed 65 transports last year alone, said. "If they can’t get an answer or they get a 'no,' they keep expanding. It's not unlike us to take that person to Iowa City, Council Bluffs, Davenport or Mason City."
"We're always joking, but it's not really a joke," he added, "we will meet somebody from Johnson (county) taking a person to Cherokee. It's absolutely troubling."
Baloun, said he's had staff transporting persons needing mental health services to Mount Pleasant. "That’s as far away in Iowa as you can get. The transportation end of it is just phenomenal."
As a result of the time dedicated to emergency room evaluations, the care facility bed location process and need for transportation, from a financial standpoint, area law enforcement leaders agreed it's almost impossible to budget for the man hours necessary annually when handling individuals in the midst of a mental health crisis. The regional administrators agreed approximately 50 percent of their responses involve people dealing with some form of mental illness or substance abuse.
In Spencer, Warburton said his department has embraced the state's 2017 Mental Health Stepping Up Initiative.
"We are trying to keep people in a mental health crisis out of incarceration and instead place them in some type of facility to get them to a counselor, getting them the help they need rather than putting them in jail."
The problem is the process for matching the person in need with available resources.
Warburton, his officers and the Clay County Sheriff are seeing benefits from the development of an experimental Mobile Crisis Unit operated through Seasons Center Behavior Care based in Spencer. It incorporates local mental health professionals and law enforcement who can be called to a scene when officers are confronted with a situation involving a person who could be in need of an emergency medical evaluation. The state is encouraging other areas to adopt the program as well.
Elston said he has been attending regional mental health meetings over the past couple of months where the idea of crisis intervention teams is being stressed, something he said sounds great in theory.
The other idea being proposed by the state is the development of mental health access centers.
"Essentially they are telling each region to develop a plan within two years to develop guidelines and how you want to proceed with an access center," Elston said. "Rather than taking them to BVRMC (Buena Vista Regional Medical Center), we would take them to the access center. There would be one, perhaps two, in the whole mental health region, which would be staffed by medical professionals to make a care diagnosis."
Unfortunately, there is a caveat to both the state proposed concepts.
"They sound great and I support both of those programs, but they're unfunded," the BV sheriff explained. "They're telling you, 'If you want a brick and mortar structure, that's fine. If you want 16 beds in it, that's great. You staff it, you pay for it, you fund it.' That sounds great but you know how much it's going to cost. It's going to be an absurd amount of money the region is going to have to pay."
Elston noted even those suggestions aren't "the easy answer." Calling it a "temporary stop," he pointed out it's not creating more beds to address the long-term care needs.
Prosser said by the very nature of the system, it's broken because of the limited resources and a "gross shortage" of beds to care for those needing services. He said there are people on the streets and even in homes who are in need of much greater care. He said sometimes the people they're dealing with are violent or paranoid, creating scenarios which are dangerous for both the individual and the officers responding.
The Storm Lake police chief was blunt when assessing the root of the problem.
"In my tenure here we have seen the state of Iowa cut budgets and reduce budgets in many different areas but certainly one of those areas was on the back of good mental health treatment," Prosser said. "… The bottom line of the mental health issue is money. It's funding, it's budget. At some point we have to say, 'Where are we spending money, and where are we not?'"
Elston said, "Look at a place like Cherokee MHI. There is room for hundreds of beds over there. I'm not sure of the exact number of beds they have now. I believe it's around 12 or 13. Last I heard, half of those were full with full-time commitments. That leaves about six that everybody in the state is calling for on a daily basis. … The facilities are there, it's lack of funding. It's mind boggling we're still even considering closing more facilities down."
Prosser said mental health funding for counties was hurt by the tax rollbacks the state enacted as a means to enhance economic development in the state. Calling it a "sham," the Storm Lake police chief said all the rollbacks did was crush services at the city, county and state level.
"One of the hits that was taken were the county level mental health providers," he said. "So do we elevate taxes or return them to where they were to provide good services? Within those good services is the entire topic of mental health."
- Responding to the mental health crisis in NW Iowa: Beating the stigma (05/29/19)
- At the forefront of mental health (06/04/19)
- New programs, static funding strain Iowa's mental health system (06/04/19)
- The people who care (06/04/19)
- Mental health caseload takes a toll on hospital ERs (06/11/19)
- MHI Cherokee: a portal between the past and future of mental health care (06/11/19)
- 'The biggest mental health facility in the state is the county jail' (06/18/19)
- The two Jeffs -- Part I: Criminal cases reveal hidden hurt (06/25/19)
- The two Jeffs -- Part II: Guilty plea leads to tragic end (06/25/19)