The state of Nebraska has faced a situation most parents can’t comprehend.
At last count 36 children, ranging in age from 20 months to 17 years, were left at Nebraska hospitals under the auspices of a vaguely written and short-lived "Safe Haven" law.
The Nebraska law, which was signed in February and became effective in July, was to be the last, given that all other states had already enacted similar legislation. During debate, however, Nebraska lawmakers took a unique slant.Instead of attaching an age to the law – ages that some lawmakers deemed "arbitrary" – the legislators opted to write the law so that any "child" could be handed over to the state at designated drop-off points, such as hospitals, without any legal recourse against the child’s guardian.
As a result, parents drove several hundred miles – from as far away as Miami-Dade County in Florida and Pima County in Arizona – in order to leave their children with state officials in Nebraska. Although Nebraska lawmakers have since re-written the law so that only infants 30-days-old or less are covered, the legislative gaff has potentially shined a light on a national crisis.
According to statistical information on 34 of the children released by the Nebraska Department of Health and Human Services, the children left in Nebraska come from various socio-economic and ethnic backgrounds. Twenty-two are considered white, 11 are considered black and one is Native American. Twenty of the 34 children are between the ages of 13 and 17.
They have three things in common.
1) Thirty-two of the children resided in or near an urban area.
2) Thirty of the children were living in a single-parent home.
3) Thirty of the children had previously received mental health services,
with 11 of those receiving treatment above an outpatient level.
This last statistic does not surprise George Estle, executive director of Tanager Place, a private nonprofit organization in Cedar Rapids that provides services to children and families experiencing social and psychological needs.
"If we would have had this same law in Iowa, the same thing would have happened here," Estle said. "I suspect that if we really look at the kids
who are being dropped off in Nebraska – particularly the adolescents – many of those will be young people who have serious emotional problems. My hunch is that parents are utterly frustrated at not being able to access services. So, they are using that law as an act of desperation because they can’t get services."
Such was definitely the case for former Iowa resident Carrisa Gatley, a single parent who has an 11-year-old son with severe mental disabilities. She hasn’t left her kid in Nebraska but she admits she could imagine it.
"Shortly after [our son] turned 3, my husband left," Gatley said in a telephone interview Wednesday. "I didn’t blame him. I actually envied him – that he could escape the hell that came with trying to deal with everything."
Gatley said it wasn’t just her son’s violent episodes, which have become increasingly dangerous as he’s grown older, but the constant and often depressing task of fighting with the insurance company, medication changes, food restrictions and trying to locate service providers.
"We left Iowa about six years ago because there were no doctors available in our area," she said. "Now we live in an urban area where services aren’t plentiful, but adequate. At least I know that when there is a really bad day, I’ll have someone to turn to – someone who helps us through the rough spots. Without that support, I might very well have also made the drive into Nebraska."
Estle, who does not know the Gatley family, said he can understand the frustrations of parents who live with children afflicted with mental illness. He said he sees parents every day who are frustrated and desperate to find help for their children.
And that frustration doesn’t end with parents. Care providers – the few that remain – have difficulty placing the children who graduate from acute-care facilities, such as the handful available in hospital psychiatric wards or in the Tanager Place long-term care program.
"Years ago, when the state of Iowa decided to carve out the mental health care portion of Medicaid, they gave it to a for-profit-based care company," Estle explained. "What happened immediately after that was the reduction of
the number of acute-care beds available. So, what you saw was a very rapid decline in the hospital-based beds for kids in the state."
Estle said that while such changes have resulted in fewer psychiatric beds for patients of all ages, the cuts in the number of psychiatric beds for children has been most severe.
"Those [programs] that are left struggle," he said. "For example, St. Luke’s Hospital in Cedar Rapids has inpatient beds for children, but they often struggle with kids they can’t move to another level of care because those needed services don’t exist."
When that happens, the children often leave the hospital in their parents’care – whether or not the parents are in a position or have the resources to continue the child’s treatment.
"It’s the same problem we have with our long-term psychiatric medical institution," Estle said. "We can treat kids, but then we need to be able to move them to lesser levels of care. Those lesser levels of care really just
aren’t available. Because of this the whole system gets kind of jammed up, if you will."
Parents who hope their children will have access to outpatient services once they’ve left an acute-care facility may find that such services are limited, if available at all.
"For those who live in Cedar Rapids, we have a full-time child psychiatrist on staff here at Tanager Place to do outpatient care," said Estle. "I think one of the private psychiatric groups has a couple as well. But that’s it.
If you want a child psychiatrist, those are the only ones available. Across the entire state, there are only a handful of child psychiatrists available. It’s just a real problem of shortage of services and shortages of professionals."
Iowa isn’t the only state that is coming up short when dealing with mental health issues for children, according to Estle.
"I really do think that what has happened in Nebraska is symptomatic of a bigger problem," he says. "It’s a problem that we have in Iowa and a problem that is in many other areas of the country. If you look at what is available to those suffering with mental illness in our state, it basically comes down to some traditional outpatient care that varies sporadically across the state. There are a few inpatient and acute-care beds left, but not many.
There are far fewer than there used to be. There are some programs like Tanager across the state, but that’s about it. There’s nothing else out there."
The situation is especially dire in the Midwest, where the population is less dense and there are fewer opportunities both for care and for training.
"In the state of Iowa you have one residency program available at the University of Iowa. That’s it. One program with limited slots," Estle said.
"And then, quite frankly, the reimbursement in Iowa for those professionals is really low. So there is really no incentive for those folks to stay here or come here."
Although the state Legislature has acknowledged Iowa has a crisis in relation to the availability of psychiatrists and psychologists, Estle isn’t seeing much movement at a state level to correct the system’s deficiencies. The reimbursement given to the Tanager Place psychiatric medical institution
for children – a total of $167 a day – is the lowest in the nation. Estle does believe the mental health system in Iowa can be fixed, but it will take actions by a state Legislature that has previously been unwilling to act and now has the added pressures of flood recovery and budget shortfalls.
"We’ve not done much in the state to develop a good system of care for kids with mental illness," he said. "I think that’s what we have to do first. We have to design and fund a good system of care in Iowa, and we’ve got to figure out a way to attract professionals to staff it."