This is the second of a three-part series running each Saturday in the Clinton Herald looking at mental health issues in the state of Iowa and Clinton County.

The staff at Bridgeview Community Mental Health Center try to take a “glass half-full” approach to their work.

Rather than thinking of themselves as treating mental illnesses, they prefer to be thought of as promoters of mental health. The stigma surrounding mental illness and the need for psychiatric care, while weakened considerably through the sweeping public awareness campaigns of the last few decades, lingers.

But mental health issues are present all over, not just in the chronically mentally ill or intellectually disabled.

“Everyone has days when they’re not feeling 100 percent emotionally well,” said Pat Everly, a Bridgeview therapist. County woes

Clinton County is far from immune from mental health issues. In fact, Everly thinks that the county’s proximity to Chicago may contribute to a higher number of mentally ill persons per capita.

Bridgeview currently has more than 2,200 open clients, both children and adults, taking advantage of outpatient care programs. Services like therapy, psychiatry, evaluation and medication and the treatment of serious or persistant mental illnesses are all offered.

Finding money and psychiatrists willing to stay in Iowa is where things get tricky.

Clinton County ranks near the top of Iowa counties in terms of spending on mental health per capita.  In FY2010, an average of $152.35 was spent on mental health services for the county’s 50,149 residents.  However, Becky Eskildsen, County Central Point of Coordination administrator said this level of service is a drain on funding. Clinton County consistently spends its allotted budget for mental health services, constantly flirting with going into negative numbers. Many other counties are in the same boat, but some still maintain more than 80 percent of their budgets at the end of the year.

“What the heck is that about?” Eskildsen said.

Clinton County spent $7.6 million on mental health services in FY2010. Only about $2.7 million came from property taxes, which are levied at the maximum 100 percent. The rest comes from state and federal programs.

However, the county is one of only four across the state that have to wait-list patients for non-mandated services. Sometimes these waits can last up to two years.

Eskildsen said the county is even considering trying to snag some risk pool money to keep things solvent through 2012.

But that would only be a temporary fix.

“It doesn’t address what we’re going to do next year,” Eskildsen said.

The disparity in county spending is one of the irksome issues legislators hope to address. However, it is possible that a more uniform system could create a whole new set of problems.

“It swings back and forth on a political level, said Larry Flesburg, a Bridgeview therapist.

While establishing a more uniform system will certainly benefit some counties, counties like Clinton that spend more on mental health care, could lose funding or access to services.

And putting more control in the hands of counties instead of state bureaucracies, the argument that led to a county based system, still holds water.

“There are good arguments on both sides,” Flesburg said.

Bridgeview has not been immune to budgetary ills. A program, designed to be a step between in and outpatient care became a funding casualty. This “partial-hospitalization” was a compromise of full and part time care, but was still too expensive.

The situation may be convoluted and difficult, but that doesn’t mean we should stop trying, according to Eskildsen.

“We need to talk,” Eskildsen. “Not just county versus another county or a county versus the state.”

The doctors is out

All the funding in the world won’t cure what ails Iowa if there are no doctors, however. Clinton County, while better off than many rural areas, is not immune to the statewide shortage of mental health care professionals.

One of the primary reasons psychiatric beds are disappearing across the state is because it is nearly impossible to keep a psychiatrist working in inpatient care.

This kind of care is especially tricky to staff as it often requires psychiatrists to be on call at all hours. Eskildsen said the state is leaning more and more on alternative diagnostic methods, like tele-psych care, but those aren’t ideal.

Trained mental health care professionals are flocking to more urban environments.

“That’s for two reasons,” Everly said. “They can make more money there and there’s more to do.”

“It’s tough,” Eskildsen said. “You may have to go to Sioux City to get hospitalized even on a volunteer basis.

“If you’re a psychiatrist, you can write your own ticket anywhere,” she added. “Iowa’s probably not as lucrative as San Diego.”

Everly said that incentives are in place for psychiatrists to practice in Iowa, but they’re not effective at keep professionals here long term. Considered to be an understaffed area, student loan forgiveness programs are in place for psychiatrists who work in the area.

However, these programs only last for about three years which usually isn’t enough time to pay for up to $100,000 in debt.

Eskildsen said the county is constantly seeking new ways to improve its presence. In addition to methods like tele-psych care, registered psychiatric nurse practitioners are being utilized more and more. Though not doctors of psychiatry, psychiatric nurse practitioners can prescribe medication.

Help is out there

Seeing the full half of the glass can be difficult at times for the mentally ill in Iowa, but that does not mean there are no options.

Bridgeview still offers a wide variety of services, and other providers in the county offer support for those in need.

Obtaining money and the proper personnel may be a constant struggle, but advocates are always working on behalf of Clinton County.

“We’re doing everything we can,” Eskildsen said.

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