After years of debate, state officials are moving ahead with the most fundamental change in the state's mental health system in more than a century.
Department of Human Services director Chuck Palmer said in an interview with The Associated Press that he expects legislators to approve the change, which will lead to a uniform system rather than services that now vary from county to county.
"I think you'll have a much better set of services, a fuller set of services, and they'll be available across the state," Palmer said. "Right now what you get depends on where you live and the capacity of the county, in terms of organizational capacity or financial capacity."
Lawmakers and state officials have discussed an overhaul for four years, and last year they took a giant stop forward when they voted to end the current system within a year.
Officials said the current county-based system worked relatively well in large counties, but some small-population counties had trouble meeting the demand for mental health.
"The question becomes shouldn't every Iowan have a right to a certain core set of services? And that not be dependent on where they live?"
The proposal before the Legislature would set out a five-year path to a system with statewide standards for mental care to be administered by regional organizations.
The five-year cost of the effort is projected to be about $133 million, with a big first-year bill of $47 million.
Sen. Jack Hatch, a Des Moines Democrat who helped devise the new system, said funding should be available, even at a time when lawmakers are face with a tight overall state budget.
"Budgets are all about priorities, and this is the highest priority of the Legislature, the House and the Senate and the governor," Hatch said. "We shouldn't be manufacturing a budget squeeze on a project that affects people dramatically."
Rep. Dave Heaton, R-Mount Pleasant, noted the proposal followed a series of meetings held by lawmakers across the state.
"We've heard from all the groups. We've had input from hundreds of people," Heaton said.
Some issues still must be resolved, including how counties will be represented in the new system and specifically how funding will be handled. But Heaton said he's confident the bulk of the plan will be approved this session.
"I have confidence that about 90 percent of it probably will pass and the other 10 percent is up for discussion," said Heaton.
It's unclear how many people now use the mental health system because Iowa's 99 counties are in control and no one has gathered data from each jurisdiction. Heaton noted, however, that he thinks most people know someone who is dealing with mental health issues, and many use government services.
Palmer said some county officials are hesitant to change the system, but most people involved and come to an agreement that the new system was needed.
Hatch also said the time is right to make the change, noting that more people have grown frustrated with a system they see as expensive but not coordinated.
"People didn't feel like the system we had was providing services. It's expensive, it's piecemeal," said Hatch. "There is a consensus to create a statewide system that's regionally managed but locally administered."