Iowa's Failure To Address Mental Health | Jeff Bullock

Iowa’s Failure To Address Mental Health

This post, titled; “Iowa’s failure to address mental health affects more than jails“, was published on September 19th in the Cedar Rapids Gazette.


Erin Murphy’s recent story (“Iowa sheriffs at the front lines of mental health crisis”) does an excellent job of defining part of the tragic shortcomings of Iowa’s mental health care system.

Noting Gov. Terry Branstad effectively ordered the closing of two state mental health institutions last year, Murphy reported that Branstad and numerous advocates believe many mental health patients are better-served by community-based care, but the closures did not shift vital resources to the local level. Instead, an estimated one in three people being housed in Iowa jails actually need mental health care.

Murphy’s story made it clear that the issue is hardly a partisan one.

John Miller, a Black Hawk County supervisor and Democrat, said county jails “have become the mental health institutions for the state.” Scott County Sheriff Dennis Conard, a Republican, observed that “the entire system seems to be broken.”

As a state and a people, we are better than that.

In fact, the problem is hardly a new one; it began in the 1980s with a national push for “deinstitutionalization.”

I’ve been asked what stake a university president has in mental health care and discussions to improve it. Just like our jail system, colleges and universities are beset by challenges created by a mental health system that does not work.

By many estimates, more than 25 percent of our population struggle with brain health challenges ranging from anxiety and depression, dyslexia or dyscalculia to schizophrenia. According to ACT, the Iowa City-based college entrance testing firm, 70 percent of entering freshmen are not prepared to do C-level college work. A significant contributor is attributable to the 33-to-50 percent of college-age students who require medication for various disorders — anxiety and depression being king and queen, respectively. Early intervention would diagnose the problem and provide treatment long before these conditions metastasize into more aggressive brain-health/mental-health issues.

Yet, that is not happening. For a variety of reasons — fear of rejection, ridicule or stigma being at or near the top of the list — discussions about mental health stay in the proverbial closet. It is also for those reasons and others that brain health issues often go undiagnosed and worsen.

One reason they should not go untreated, however, is because of a lack of dedicated resources or an unwillingness by state officials to fix the problem.

Patrick Kennedy, son of the late Sen. Edward Kennedy, was in Dubuque recently to headline a mental health awareness fundraiser. Kennedy shared his history of mental illness, which was undiagnosed for years, and how it had been the source of much pain, disappointment, and embarrassment to him and his family.

His telling of his life story and coming to grips with his disease was one of the most courageous acts of public disclosure that I’ve ever witnessed. Kennedy’s book, A Common Struggle: a Personal Journey Through the Past and Future of Mental Illness and Addiction, will be a comfort and inspiration for many people who either cope with or try to provide support for those who live with diseases of the brain.

Interestingly, my upbringing, world view and politics could not be more different from Kennedy’s. Yet, what we do share is a commitment to making better the lives of those who endure this common struggle. In response to the question — “Why are you so interested in this subject?” — I’m interested because more than one-third of the students I see daily on my campus face significant challenges created by anxiety, depression or other mental health issues. I care because members of my family are challenged by this illness. And, finally, I care because Jesus took the time to care about it.

As Murphy reported, Iowa has the fewest state psychiatric hospital beds per capita in the nation — two beds for every 100,000 residents. When it comes to the number of mental health professionals, the statistics aren’t any better.

It is incomprehensible that residents in almost two-thirds of Iowa’s 99 counties do not have access to a local psychiatrist. It is incomprehensible that two-thirds of Iowa’s 99 counties do not have access to a local psychiatrist. Click To Tweet

In this state, we invest in centers that specialize in the treatment of cancer, heart disease, diabetes, eye disease and more. Yet, somehow, treatment centers for diseases of the brain — the one organ of our body required to facilitate the function of all other organs — are woefully lacking.

It is time to recognize the scope of challenges created by mental health issues in Iowa — and finally get serious about creating solutions. It is time to recognize the scope of challenges created by mental health issues in Iowa. Click To Tweet


  1. Sir, thank you for writing so boldly and sincerely about the Sahara atmosphere of mental health care in Iowa. All those grand ideas about releasing patients to local care was self-defeating with the lack of making sure local care would be there. Incarceration is no substitute for proper and adequate care. Thank you, Dr. Bullock

    • Robert,
      Thank you so much for your words of affirmation. There is a lot that can be done and needs to be done. Keep the faith.

  2. Jeff – Thank you for your article. As the legal guardian of my adult cousin with mental health issue, I have experienced first hand the struggle of obtaining, and then maintaining, health care for him —both before I became his guardian, and since. While our story resides in Illinois, it’s a story that’s no different than the one in Iowa. Cut backs, closings, lack of care and lack of social understanding have all contributed to an uphill battle for him and for us.

    My cousin and I were born on the same day, same year and in the same hospital. My journey with him has covered our entire lives. We’re now 46. Derick is in a longterm health care facility diagnosed with severe bi-polar and Schizo-effective disorders. He’s brilliant and witty, and deserved a life much better than the one handed to him.

    Through the grace of God, I wasn’t born with mental health issues, but I have watched not only my cousin, but my family and friends struggle under the weight of it. My mother is bi-polar, my uncle suffered from debilitating depression and eventually committed suicide, others have experienced depression and anxiety. The lack of understanding and available resources exacerbates an already difficult situation to one that can be unmanagable. For everyone involved.

    This is a subject that touches all of us. It’s also a subject that needs more discussion and more resources. If I can contribute to further discussion or action, both on and off campus, please let me know.


    • Angie,
      For one of the few times in my life, I’m speechless. I so appreciate your candor, transparency and compassion. It’s really hard to describe, Angie, but I feel very grateful to have somebody like you as a colleague. Thank you!

  3. Dr. Bullock – Thank you for bringing this topic to light. Many persons in my family – including myself – are suffers of anxiety and/or depression. I only recently became someone to know that I had anxiety. Thankfully, my family and I are able to afford the healthcare and resources needed to combat this disease. Our faith also gets us through the tough times that we have experienced in our lives. We only pray that there be a way that others would be able to experience the blessings that we have been able to have when overcoming our mental illnesses.

    • Shauna
      Thank you for sharing–and for reading the blog! Brain health is like any other health issue, the only difference being that, as a society, we don’t talk about it. Keep the faith. I’m proud of you.

  4. Dr Bullock-Thank you for bringing this very real problem to the forefront. My twenty year old daughter has dealt with depression and anxiety from a very young age. This summer she experienced the most debilitating depressive episode to date resulting in four hospitalizations in one month from overdoses in suicide attempts. Our family requested she receive the intensive inpatient treatment she needed but each time when she appeared stable and no longer a threat to herself she was released from the hospital where she received no therapy. Within a week she was back in the hospital only to be released three days later. Finally I resorted to having the court system order her to remain in the hospital until a court hearing. Even with a court hearing and after the third suicide attempt, she was still not given inpatient treatment because as the judge and doctor both said, “there are not enough beds in Iowa since the governor closed mental health facilities and unless my daughter was incapacitated she would not get inpatient hospital treatment.” A week later she ended up back in the hospital for suicidal tendencies. This time the court system and doctors agreed to inpatient care but it could take up to 8 weeks for an available bed in Iowa. Fortunately, I had the financial means to arrange for private treatment out of state and she was able to enter treatment within three days. She returned home two weeks ago having received 30 days of intensive therapy for bipolar disorder. My daughter now understands her illness, the limitations she must live within, and has the tools to help her continue to deal with her illness. She is happy and hopeful, looking forward to returning to college at U of D. She is one of your students you spoke of seeing on campus in your article. Thank you for noticing her. Thank you for caring, and thank you for being those students’ voice. Why are young people leaving Iowa? Adequate funding for healthcare and education might just be part of the solution.

    • Sandra,
      We are all moved and humbled by your very courageous comments. Thank you for being such a wonderful and supportive parent, and for entrusting your daughter to UD. We look forward to her return and to her continued improving health. That she is was able to receive the care she needed and acquire the tools required to help her learn to cope with her brain health issues is very encouraging. Like many health-related issues, brain health issues are very often manageable but, as you know, we can’t learn to manage by denying that the challenge exists in the first place. The more people like you and your daughter share your story, the more brain health issues become demystified and far less of a stigma. Families and individuals are hurting, and often don’t know where to turn for help. Your comments will help show others the way forward. Thank you.

  5. I too read mr. Kennedy’s book and heard him speak about the challenges of mental health problems in his life. I am so happy that he has made it is goal to advocate for mental health treatment. I so agree that medical insurance companies tend to neglect the treatment of brain disorders in their coverage of medical ailments. As a mental health clinician, I can say that all our lives will be touched by mental health issues whether it is a chronic issue or a situational depression. Local and state resources are woefully inadequate. There still seems to be a stigma associated with a diagnosis of a mental problem. However, there but for the grace of God go we all. I so agree with Dr. Bullock that resources. Are inadequate. When will insurance companies and medical resources treat the brain like any other organ in the body?

    • Linda,
      Thank you for your response…and for reading the blog in the first place! As a mental health clinician, your insights far surpass mine. Thank you for your good work, and for contributing to this on-going conversation.

  6. President Bullock, Thank you for caring and writing about this topic. I’ve witnessed your remarkable leadership at UD for years, and you have the potential of your voice being heard concerning our sad state of affairs regarding mental health resources. Mental health, substance abuse and suicide are three of many topics I am passionate about. Like Mr. Kennedy, I too could write a book about my life experiences starting with my father’s diagnosis of schizophrenia in my parents’ early marriage. Unfortunately, he struggled throughout his life and died to cancer at the young age of 51. I married in my early 20’s and my husband battled with addiction and mental health issues and committed suicide at the age of 40 leaving behind two young daughters. I remember the last time I committed him, he was admitted, stabilized, discharged (no inpatient treatment beds available), and three days later killed himself. Two more family members died related deaths and I could share of more family and friends and their experiences, but I won’t in this comment. Lots of our scarce household income went to pay for insurance and limited coverage for mental health and substance abuse treatment. My daughter is a physician’s assistant in a rural Iowa community, and she has shared her immense frustration in getting help for patients with mental illness and substance use disorders. As previously mentioned, local and state resources continue to be sadly insufficient, and these diseases are marginalized in so many ways. As Christians we are called to love and help all of God’s people. We are called to believe that no one is ever beyond hope and that every life matters. Every disease, whether mind or body, deserves the same respect and adequate resources. Thank you for anything you can do in this regard.

    • Carla,
      You story is inspiring and your message will be helpful and hopeful to all of those who suffer in silence. Thank you for the courage of sharing your story, and for your work of compassion and advocacy for those who cannot care for themselves. The last part of your reply is truly moving. Keep the faith. As the New Testament, we look forward to that day where there shall be no more pain or suffering or tears… .

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