Spencer, Iowa – The city hospital is a holdout in the name of people who are going through mental health crises. The leaders of the establishment are committed not to close their psychiatric unit for hospitalized patients, as did dozens of other American hospitals.
Holding this promise could soon become more difficult if the congress reduces the funding of Medicaid. The joint health program of the federal state covers an unusually large share of mental health patients, and the hospital leaders’ leaders say that spending reductions could accelerate a wave of closings of psychiatric units for several decades.
At least eight other Iowa hospitals have ceased to offer hospital mental health care since 2007, forcing people in crisis to ask for help in distant establishments. The Spencer Hospital is one of the smallest from Iowa that still offers service.
CEO Brenda Tiefenthaler said that 40% of patients hospitalized in hospital psychiatry are covered by Medicaid, compared to around 12% of all hospitalized patients. 10% additional patients hospital psychiatric patients are not insured. National experts say that such disparities are common.
TIEFENTHALER promises to keep the psychiatric unit of 14 beds from its open -profit non -profit hospital, even if it loses $ 2 million a year. It is a significant loss for an organization with A global annual budget about $ 120 million. But people who use the psychiatric unit need medical care, “just like people with chest pain,” said Tiefenthaler.
Medicaid covers health care for around 72 million Americans with low incomes or disabilities. TIEFENTHALER predicts that if some of them are launched from the program and left without insurance coverage, more people would delay the treatment of mental health problems until their life becomes out of control.
“Then they will enter through emergencies when they are in crisis,” she said. “It is not really a solution to what we have in our country.”
Leaders of the Republican Congress have sworn to protect Medicaid For people who need it, but they have also called up to dollars in reduction in areas of the federal budget that include the program.
The United States is already faced with a deep shortage of mental health health services for hospitalized patients, many of whom have been reduced or eliminated by private hospitals and public institutions, said Jennifer Snow, director of relations and government policies for the National Alliance On Mental Dustal. At the same time, the number of people who suffer from mental problems climbed.
“I don’t even want to think what it could be worse,” she said.
The American Hospital Association estimates that nearly 100 American hospitals have closed their mental health services for patients hospitalized in the last decade.
These closures are often allocated to mental health services being more likely to lose money than many other types of health care. “I don’t blame hospitals,” said Snow. “They must keep their doors open.”
MedicaID generally pays hospitals lower than the rates for services they do not receive private or medical insurance, the federal program which mainly covers people aged 65 or over. And the beneficiaries of Medicaid are particularly likely to need mental health care. More than a third of the unconnected registrants of Medicadaid have a kind of mental illness, According to a KFF report, A non -profit health policy organization that includes Kff Health News. Iowa has the highest rate Mental illness in non -elderly Medicaid beneficiaries, 51%.
In February, only 20 of the 116 community hospitals in Iowa had hospital psychiatric units, according to a state register. Iowa also has four independent psychiatric hospitals, including two managed by the State.
Iowa, with 3.2 million residents, has a total of around 760 mental health beds for hospitalized patients who are personal to take care of patients, reports the state. The Treatment Advocacy Center, a national group in search of improved mental health care, indicates that the “absolute minimum” of these beds would result in around 960 for the population of Iowa, and the optimal number would be around 1,920.
Most of the psychiatric beds of Iowa are in metropolitan areas, and it can take several days for a slit to open. In the meantime, patients are regularly waiting for emergency services.
Sheriff deputies are often assigned to patients transported to the installations available when the treatment is ordered by the court.
“It is not uncommon for us to drive five or six hours,” said County Sheriff Chris Raveling, including the county of North West Iowa includes Spencer, a city of 11,000 inhabitants.
He said that the Spencer hospital mental health unit is often too full to accept new patients and, like many of these facilities, refuses to take violent or crimes.
The result is that people are detained in prison for minor accusations resulting from their mental illnesses or dependencies, said sheriff. “They really shouldn’t be in prison,” he said. “Have they committed a crime?” Yes. But I don’t think they did it on purpose. ”
Raveling said that the authorities decided in many cases to keep people in prison so that they do not injure themselves or do not wait for others while waiting for treatment. He saw the problems worsen during his 25 years in the application of laws.
Most people with mental health problems can be treated as external patients, but many of these services also depend strongly on Medicaid and could be vulnerable to budget cuts.
Jon Ultven, a psychologist who trains in Moorhead, Minnesota, and neighboring Fargo, Dakota from the North, said that he was particularly worried about patients who develop a psychosis, who often starts in adolescence or the beginning of adulthood. If they immediately started on medication and therapy, “we can have a dramatic influence on this person for the rest of their lives,” he said. But if the treatment is delayed, their symptoms often become more difficult to reverse.
Ultven, which helps supervise mental health services in its region for the health system in Sanford with several states, said that it was also concerned about people with other mental health challenges, including depression. He noted a study Published in 2022, which has shown that suicide rates increased more quickly in states that have refused to extend their Medicaid programs than in states that have agreed to extend their programs to cover more low -income adults. If the Medicaid rolls are reduced again, he said, more people would not be insured and that fewer services would be available. This could lead to more suicides.
Nationally, Medicaid covered nearly 41% of patients hospitalized psychiatric hospitalized in 2024 by a sample of 680 hospitals, according to an analysis carried out for Kff Health News by the financial consulting company Strata. On the other hand, only 13% of patients hospitalized in cancer programs in these hospitals and 9% of patients hospitalized in their heart programs were covered by Medicaid.
If Medicaid participants have mental crises after losing their coverage, hospitals or clinics should treat many of them for few or no payment. “They are not rich people. They don’t have much property,” said Steve Wasson, data and strata intelligence responsible. Even if Medicaid pays for relatively low prices, he said: “It’s better than nothing.”
Birth units, which were also Casculated by closures, face similar challenges. In the strata sample, 37% of patients in these units were on Medicaid in 2024.
The Spencer Hospital, which has 63 hospital beds, has maintained both its birth unit and its psychiatric unit, and its leaders plan to keep them open. In the midst of a critical shortage of mental health professionals, he employs two psychiatric practitioners and two psychiatrists, including one offering care via the video of North Carolina.
Local resident David Jacobsen appreciates hospital efforts to preserve services. His son Alex was helped by the mental health professionals of the establishment for years of struggle before his death by suicide in 2020.
David Jacobsen knows how much such services are submitted on Medicaid, and he fears that more hospitals reduce mental health offers if national leaders reduce the program. “They hurt people who need help most,” he said.
The inhabitants of Medicaid are not the only affected when hospitals reduce services or close processing units. Everyone in the community loses access to care.
Alex Jacobsen’s family has seen how common the need is. “If we can learn something about my Alex,” wrote one of his sisters His NECRology“It is that mental illness is real, it does not discriminate, and that makes some of the best people fall into its ugly swirling drain.”