For violent, mentally ill youth, Iowa has few options

Debra Briggs couldn’t help but think of her 17-year-old son when news broke of the mass shooting at Umpqua Community College in Oregon.

Zachery Briggs is autistic, has a low IQ and a long history of violence. He’s smashed windows, attacked neighbors, injured caregivers and fought with police.

In theory, he should be the kind of youth who should be a priority for stable long-term, residential mental health treatment in Iowa.

But since 2010, when Zachary was made a ward of the state, he’s been bounced around the region — from Coralville, to La Crosse, Wis., Salt Lake City to Kansas City — when he was too much to handle or facilities could no longer meet his needs.

Debra Briggs learned at the end of September her son was being discharged yet again from an acute care facility in Kansas City. A worker at Iowa’s Department of Human Services checked dozens of places, but said she could not find a facility willing to take him.

“You can’t just put these kids on the street. People are going to get hurt,” the Davenport mother said, airing a heap of frustration. “We have to have more facilities to fit these types of kids. But they’re all full. They don’t have any room.”

Of course, the vast majority of youth with mental illness or developmental disabilities are not violent, but they still require treatment and services to prevent a litany of problems down the road.

Iowa has 80,000 youth who have been identified as having “severe emotional disruption,” or mental illness so severe they can’t fully function.

But the state has very few options for those with chronic mental health issues who are violent, several services providers say.

Settling for less-than-needed services

Andrew Allen, chief executive officer of Youth & Shelter Services in Ames, says he’s facing growing pressure to place high-needs kids with violent backgrounds in shelters, even though they really need higher level care.

“When the problems are chronic, it’s scary,” he said. “There’s nowhere to put them.”

Allen said his staff recently failed to find an appropriate place for an Iowa girl who needed more care than he could provide at the unlocked shelter.

“She went to another shelter and then to a hospital,” he said.

That, he says, is no way to treat with mentally ill youth in need of more stability and treatment.

“In so many of the tragic situations that have played out over the course of the last 10 years, we’ve found not only was there a mental health issue, but there was a mental health issue that wasn’t being addressed.”

Systems overhauled in neighboring states 

Facing similarly chronic shortages in appropriate mental health care for youth, some states, like Wisconsin and Minnesota, have pumped millions into overhauling their systems.

But no state leaders have initiated any widespread changes that would lead to a better system of care in Iowa.

“We’re in pretty bad shape,” said Tammy Nyden, a mother and volunteer on children’s mental health issues serving on the Children’s Mental Health and Wellness Workgroup created this year by the Legislature.

“We don’t really have a children’s mental health system right now," she said. "We have a bunch of silos of service.”

The waiting lists for the mental health waiver helping families pay for services not covered by private insurance or Medicaid is three years long. That's an all-time high.

And after a long period of deinstitutionalization, Iowa has few facilities of its own where mentally ill youth can be placed when private facilities won’t take them.

Allen and others believe options for Iowa youth will only shrink in January, when four private managed care companies take over running Iowa’s $4 billion Medicaid program.

Many hope the work group on children’s mental health will lead lawmakers to craft a better system to treat those with severe mental health needs.

But change requires funding for services, said Amber Rand, vice president for Orchard Place, which provides mental health services for children in Des Moines.

“We need to have more intensive community-based services that are funded through private insurance or Medicaid.” she said.

Watchdog query prompts action

KVC Prairie Ridge Psychiatric Hospital in Kansas City is an acute care facility, where children typically only spend a few days. Zachery Briggs was there for almost three months.

With Briggs set to be discharged Tuesday, his mother’s lawyer in his child-in-need-of assistance case contacted the Reader’s Watchdog.

Attorney Rachel Antonuccio said she and her client were at a loss over what to do.

His only option at the moment appeared to be an emergency shelter.

Most facilities DHS contacted were full. Others couldn’t or wouldn’t provide the high level of services the teenager needed for residential placement, Antonuccio said.

Debra Briggs lost the ability to take care of her son five years ago — after he had gotten in trouble several times with the police.

She says he’s about 5-foot-6 and 180 pounds, and quick to anger.

“If someone makes him mad, he becomes like the Incredible Hulk and everything gets destroyed,” she said. “You have to talk to him so as to not set him off.”

When Antonuccio and Debra Briggs inquired about placing Zachery in one of the state’s two resource centers for people with disabilities and mental illness, they said they were told they were already about 30 people over capacity.

The state has been decreasing the population of each facility by 12 residents a year.

“When I asked if the ultimate goal was for the facilities to decrease in population until they’re closed altogether, I did not receive a clear response,” Antonuccio said.

After I contacted DHS about the failure to find placement options, however, Antonuccio said she received a phone message that Zachery would be placed immediately at Glenwood Resource Center.

Amy Lorentzen McCoy, a spokeswoman for DHS, said circumstances with placements can change quickly, and staff members try to make them as soon as possible so that families may have stability.

“Every situation is unique and there are individuals who are more difficult to place — so, it can take longer for us to secure the right placement,” she said.

She also said DHS is working to develop the capacity of community-based programs to serve individuals with more difficult, complex needs.

Lawmaker says legislative action is needed

But Liz Mathis, a Democratic state senator from Cedar Rapids, says there are hundreds more families who have the same trouble finding stable, appropriate places for children.

“This mother is one of many moms,” Mathis said.

Mathis, who is communications chief for Four Oaks, an agency that provides mental health services and residential treatment in eastern Iowa, says that's likely to continue until the Legislature acts.

“We may not be able to serve those children in a way they need to be served. There’s no excuse for it,” she said.