Letter to the Editor

Lack of access to mental health care in rural Iowa

Thursday, March 30, 2017

As the nation debates the pros and cons of both the Affordable Care Act and the American Health Care Act, I think it’s important for us to discuss what the tangible issues are within our currently healthcare system that need to be addressed. For rural Iowans, one of the most pressing issues is the lack of access to mental healthcare treatment for those who need it. This is an incredibly important issue because while the physical effects of mental health disorders may not always be visible, living in communities with inadequate mental healthcare has been associated with an increase in rates of suicide, domestic violence, drug abuse, and behavioral health problems.

The magnitude of this problem in rural Iowa is somewhat startling. The U.S. Department of Health and Human Services now estimates that approximately 60% or rural Americans live in areas with mental health professional shortages. This issue in Iowa can also be demonstrated by the state’s low number of mental health professionals. Of the 99 counties within the state, 68 of them have no practicing psychiatrists. Additionally, Iowa ranks 49th nationally in the number of practicing psychiatrists per capita. These low numbers of psychiatrists have led to a situation where there are ~120,000 Iowans living with serious mental illness, but with only 300 psychiatrists, nurse practitioners, and physician assistants trained to treat these patients. This means that many patients throughout the state are being forced to see primary-care physicians for their mental health treatment.

There are several reasons why rural Iowa faces this shortage. For starters, many rural regions throughout the country suffer from shortages of mental health professionals, including psychiatrist, psychologists, and mental health counselors. The lack of providers in the rural areas is not due to lack of opportunity, but because of lack of incentive to live in these areas. It has been shown that while 70% of psychiatric residents graduating from the University of Iowa work within the state after graduation, only 40% remain in Iowa after working for 10 years as a provider. The state of Iowa has attempted to recruit these types of physicians to rural areas through debt forgiveness programs, like, the Primary Care Recruitment and Retention Endeavor, but Iowa still faces significant difficulties in recruiting these types of mental health professionals towards practicing in rural areas where their services are needed the most.

Additionally, individuals in Iowa often also lack access to telemedicine, medical treatment over the internet, which is becoming one of the key methods in treating and diagnosing mental health disorders. Iowa is one of the few remaining states that does not guarantee that these types of treatment are covered through either private or public insurance. Access to these types of treatments could be guaranteed to all Iowans through a parity law, which would require all insurance providers to cover telemedicine treatment. A parity law bill was proposed in the Iowa state legislature in 2015, but it did not pass.

The Iowa state legislature should revisit the issue of passing such a parity law in the near future because telemedicine can be a way to reduce the negative impacts caused by Iowa’s shortage of mental health professionals. As the federal healthcare debate continues in the months to come, we also need to recognize the importance of state health care laws that can significantly change the lives of Iowans, including those who suffer from mental health issues and those who are the most vulnerable in our community. We need to collectively call upon our state legislators to enact policies that benefit these Iowans.