The Issue: Providers of mental health services across the State of Iowa face funding shortages and many have had to shut down.
Local Impact: Hope Wellness Center is run by Genesis Development and offers a “safe space” and mental health services in Dallas County.
Hope Wellness Center is Dallas County’s own “safe place,” a location which offers aid to those struggling with a mental health crisis. While many mental health facilities have shut down due to budget issues and expenses, a non-profit agency called Genesis Development has allowed Hope Wellness Center to flourish.
With a year already in the books, the center originally formed as a collaboration unit between the Heart of Iowa Community and Genesis Development Mental Health Services. Previously, the Woodward location was a nursing home.
Today, the facility houses two units for patients: a Transitional Living Center with seven rooms, and a Crisis Center with nine rooms. According to information provided by the Hope Wellness Center, patients must fit the following criteria to stay: they must be 18 years or older, be experiencing psychiatric symptoms, they must admit themselves voluntarily, and must not have an active plan to harm themselves or others.
Patients attending the crisis unit typically stay at the facility anywhere from three to five days.
“This location will help people who are acutely suicidal, maybe have vague suicidal thoughts, and they can come here and eat three good meals a day, they’ll get medication, see a therapist every day, and three to five days later, typically they’ll go back to their home,” said Kirk Bragg, Director of Hope Wellness Center.
The transitional wing includes rooms with a dorm fridge, sink, microwave, as well as access to breakfast as well as Hy-Vee catered meals for lunch and dinner. The typical stay ranges for the transitional living as those who stay often are trying to get back on their feet.
Staff members include eight therapists, one doctor, and two nurse practitioners, all of whom can be found at the second floor of the Dallas County Hospital in Perry. In addition, a therapist is on site at the Hope Wellness Center, along with a weekend therapist. The Hope Wellness Center resides as a safe place those can go to if they are in need.
“There’s a whole career these days called Suicidology,” Bragg said. “Suicidologists have isolated that one of the biggest barriers to preventing suicide is because people can’t get in fast enough.”
Since it’s opening, the facility has seen up to 3,000 patients, with staff members sometimes scheduling up to eight or nine patients a day.
“One of the conclusions is that people will die while on waiting lists because you can live in a community that has a lot of services on paper, but if you can’t get into them, what good are they?” Bragg said.
Patients benefit as the facility ensures a short wait time before they are seen by someone.
“Sometimes they’ll [patients] do an intake but then the wait to see a doctor is weeks or months,” Bragg explained. “Our situation is if somebody calls, we’ll see them within 10 days, and then we can get them to a doctor within 10 days of that.”
In addition, outreach for mental health has expanded, reaching out into school districts such as Perry.
Some of the exercises include play therapy, a technique which allows “trained mental health practitioners to assess and understand children’s play,” according to information provided by Genesis School Based Mental Health Services.
“With working with kids and teenagers, they’re impulsive and if they have some connection with somebody, chances are they might reach out before they do something terrible,” Bragg said.
Support from Genesis Development has allowed Hope Wellness to grow as a facility. In addition to Woodward, Genesis has offices in the following Iowa-based locations: Adel, Belle Plaine, Boone, Grinnell, Guthrie Center, Indianola, Jefferson, Perry, Pocahontas, Storm Lake, Toledo, and Winterset.
“If we were a freestanding mental health center, we would probably be closed because it’s difficult for these agencies to make it,” Kirk Bragg, Director of Hope Wellness Center said. “So as those (mental health facilities) closed, we’ve grown because those patients had to go some place.”
Funding and Legislative Efforts
Genesis Development has a budget of almost $20 million. About 66 percent of that budget comes from Medicaid, albeit in a few different forms.
“We were bringing in about three million dollars off of the four work centers we had,” said Genesis Development CEO, Terry Johnson.
Due to the “federal push” and the success of the staff at Genesis Development in finding people jobs in the community, they have closed two of their work centers while keeping the other two work centers open.
“The other two remain open primarily due to the fact that we have a few people who have not found jobs in the community or have chosen to work at our businesses, such as our laundry room in Indianola or our corrugated box plant in Jefferson,” Johnson said.
Johnson said it is difficult to find better-paying jobs in the community than the ones offered at their work centers, although getting them jobs in the community is still the goal. Because of this, the income from those work centers has been and continues to drop.
In addition to Medicaid dollars, Genesis Development also receives funding from private insurance, primarily for their behavioral health services. They also receive grants that range from a “couple hundred dollars” to “over a million” for their services.
“The regions then turn to private organizations like Genesis to provide the services and, many times, will provide start-up grants to get the services going,” Johnson said.
Johnson said that they receive “very little direct funding” from the State of Iowa, but that they do match Medicaid dollars.
The allotment of the funds they receive depends on the use of service at each location in each community. If they receive a donation for a specific program, those funds will be given directly to that specific location.
Genesis Development, just like other organizations like it, have always faced a shortage, Johnson says. He said that this is due, in part, by the State’s legislative priorities.
“Education and economic development have always rated very high on Governor Branstad’s agendas,” Johnson said. “While mental health services have not been ignored, they have not been a strong priority. The change to managed care for our services was about saving the state money, not for improving services.”
When Genesis faces shortages, they must also make decisions and set priorities for the services that they provide. While there is a tremendous need for their services, Genesis cannot “be everything to everybody.”
“We are under constant scrutiny and continue to meet very stringent policies, standards, rules and regulations for our field, which increase costs for services without increasing the availability of those services,” Johnson said. “The healthcare field is the second most regulated industry in the nation, only behind nuclear energy.”
U.S. Sen. Joni Ernst (R-IA) visited Hope Wellness Center in April and spoke with employees and those receiving services as a part of her annual 99-County Tour. This was their chance to leave a good impression with Ernst in hopes that she will take some ideas to Washington, although Johnson wonders how someone so busy, who had visited two other sites the same day, will remember a program in Woodward, Iowa.
Additionally, Johnson said that State Legislators hear from him and Genesis Development “regularly” throughout the year, and especially prior to and during the legislative session.
“Due to the Managed Care situation, we have been extremely busy with at least two of our legislators to advocate for the people we serve,” Johnson said. “However, few legislators understand our mental health system of services, so it is difficult for them to understand the needs of the people we serve.”
Johnson said that because of the concern with costs and funding, many people they serve are “left behind” and do not have strong voices to be heard. That’s where Genesis Development advocates on their behalf.
“We are looked upon as mercenary due to the fact that our vocation is in the field and therefore think that we are self-serving,” Johnson said. “This could not be further from the truth.
“Our mission is to provide opportunities, choices, and supports to people with disabilities. We are not valued for the work that we do. We do not have highly paid staff. We are under an increasing pressure to do more with less. Increased regulatory issues have pointed out our inadequacies in staffing levels to report on these regulations.”
Johnson mentions that the work they do at Genesis Development is not easy and that not everyone can do it. He states that their staff members are dedicated to the people they serve and to Genesis’ mission.
“We cannot ask for anything more than that.”