Mentally ill wait as hospitals struggle to find available beds

Part 1 in a series on Iowa's mental health treatment issues

DECORAH - Nine hours is too long to wait in the emergency room, Angela Gullickson thought. Particularly with an angry 7-year-old whose mental illness makes him want to harm himself.

But the mother and son waited at the Winneshiek Medical Center in Decorah from 1 p.m. to 10 p.m. last summer while staff called hospitals across the state trying to find inpatient placement for the Noah, who suffers from oppositional defiant disorder and reactive attachment disorder. They found a bed in Council Bluffs - more than five hours away.

Gullickson was planning to hit the road with her son when the Council Bluffs hospital called to say the bed had been taken.

'There was literally no place to go but home,” she said.

For years, Iowa has needed a way for hospital employees to determine where beds are available for mental health patients in crisis. Finding beds nearby could keep patients connected to their families and services, as well as prevent sheriff's deputies from leaving counties with scant law enforcement as they drive patients to beds across the state.

The Iowa Department of Public Health has a bed-tracking system for disasters such as tornadoes, floods or terrorist attacks, but officials say it can't track mental health beds without costly adaptations.

Iowa lawmakers ordered a bed-tracking study in 2013, but it brought no major changes.

But this year is different.

Psych beds scarce

Last month, Iowa Gov. Terry Branstad proposed closing mental health institutes in Mount Pleasant and Clarinda to save $15.5 million next year. Human Services Director Charles Palmer said patients with more severe needs would be moved to facilities in Independence and Cherokee, while others could transfer to less-restrictive community care.

But families, doctors, mental health coordinators and law enforcement officials said it's already hard enough to find inpatient care for Iowans with mental illness.

Mental health institutions 'usually have long wait lists,” said Ryanne Wood, regional mental health chief executive officer for eight southeastern Iowa counties.

If Iowa closes the two facilities, people with mental health crises 'would be more likely to go to hospital-based psych units,” Wood said.

Those beds are scarce - especially in rural areas. Forty-six Iowa counties have no hospitals with psychiatric placements or residential crisis centers, the Department of Human Services reported.

not equipped

When someone having a mental health crisis comes to the hospital emergency room - often brought in by a worried family member or friend, but sometimes by police - a physician must assess whether the patient is a serious danger to himself or herself or to someone else. If the doctor decides the person is seriously mentally impaired, a judge can order the person taken into custody and placed in treatment.

Most rural hospitals don't have a psychiatrist and can't provide inpatient mental health care. Staff are tasked with calling up to 30 hospitals that offer acute care to find one with a bed.

'We've had patients up to three days waiting for a transfer,” said Natalie Shea, ER manager at Central Community Hospital in Elkader.

Shea thinks about what happened Aug. 23 in West Union, when an inmate getting medical care at Palmer Lutheran Hospital grabbed a deputy's gun, shot and injured the deputy and then fatally shot himself.

'That West Union patient that shot himself? He was a psychiatrist patient,” Shea said. 'That could happen in any of these hospitals very quickly.”

counties exposed

Allamakee County sheriff's deputies transport mental health patients up to three times a week to hospitals with available psych beds. On a good day, they wait only a few hours at the hospital until a bed is found and drive four hours round-trip to take the patient to Waterloo.

If a patient is not under court order to get treatment, families may drive their loved ones.

'We've found ourselves going as far as Sioux City, which puts our guys on the road for a long time,” Sheriff Clark Mellick said.

Allamakee County, with only eight deputies, pays off-duty cops to help with transports because Mellick doesn't want to leave the county without law enforcement. But sometimes deputies are the only ones available.

AWAY from families

The haphazard approach to finding psychiatric placement makes it more likely patients will end up getting treatment farther from their families. Establishing community services also is a challenge if they are housed hours away from home.

Tammy Nyden of Grinnell drove her 12-year-old son, Cole, to the University of Iowa Hospitals and Clinics in Iowa City on Oct. 21 because Cole was depressed and suicidal. The Nydens were there 13 hours before hospital staff found a bed for Cole at UnityPoint Health-Iowa Lutheran Hospital in Des Moines.

'I was able to drive four hours round trip to see him for 30 minutes each night, but that's not possible for everyone,” Nyden said. 'It's worse in rural areas, but it's not good anywhere.”

Database LACKING

The Public Health Department got federal Homeland Security money to launch a bed-tracking system in February 2013. If a disaster happens, the agency could look at daily data from all 121 Iowa hospitals to find out where to send victims with specific medical needs.

A 2013 study ordered by the Iowa Legislature showed it would cost $120,000 to adapt the disaster bed-tracking system to also include psychiatric beds. That would pay for software development and at least one part-time employee to make sure the data was up to date.

The DHS report recommended the state launch an electronic bed-tracking system that would allow hospitals to enter specific information about available psychiatric beds, including whether they are in locked wards, open to men, women or children, accept patients with substance abuse issues and accept patients with a history of violence.

DHS Spokeswoman Amy McCoy said the agency will be exploring how this type of system can be developed and used, but had few details.

But Sen. Joe Bolkcom, D-Iowa City, doesn't see what's holding up the program.

'It's long overdue that DHS develop a system that someone dials a phone number to access a database of all available beds,” he said. 'It's time to break through this problem.”

l Comments: (319) 339-3157; erin.jordan@thegazette.com