(Story Credit to Kelly Page for IowaWatch.org)

DES MOINES, Iowa – Iowa does not have enough psychiatrists, psychologists, therapists or other mental health care providers to handle an increasing need to care for farmers dealing with relentless flooding this year, several mental health experts IowaWatch interviewed warned. Many health care specialists don’t want to work in small, rural areas for reasons ranging from a lack of local resources to seeing few options for personal growth that comes from cultural events or entertainment, the interviews revealed.

The result is that people who need mental health care immediately have a difficult time getting it, a problem in the parts of rural Iowa hit this year by devastating flooding. “We turn people away every day because we don’t have available appointment slots. We do a lot of referring to other agencies,” said Susan Ecker, director of Waubonsie Mental Health Center, which has locations in Fremont, Page and Montgomery counties in southwestern Iowa, all hit hard by the flooding.

“There is no competition between service agencies in our community because all of us combined cannot handle the volume of people that are seeking service. “Fifty of the 59 Iowa counties designated as disaster areas because of flooding this year also have been designated by the U.S. Health Resources and Services Administration as having inadequate mental health care. In all, 86 of Iowa’s 99 counties are designated mental health professional shortage areas because they do not have an adequate number of providers for the number of people living in those counties.

Some of the counties hit hardest by flooding are not targeted by national programs that encourage young healthcare professionals to work in the rural U.S. with incentives like student loan forgiveness, scholarships and grants. Many mental health professionals still feel a strain on mental healthcare resources in heavily-flooded counties even when provided these incentives, interviews revealed.

For many, their caseloads become too large to handle adequately, leaving them with an ethical dilemma of taking on more clients at the expense of others they already are seeing. Meanwhile, patients in these underserved areas rely on therapists who get shuffled to multiple locations during the week. Patients have to wait five to six weeks to be seen if not needing urgent care – one to two weeks if they do, health care professionals said in interviews.

Alecia Dougherty, clinical supervisor at Plains Area Mental Health Center, which covers a wide patch of northwest Iowa, said some patients are on their second or third therapist in one to two years. She said switching therapists, especially after building a therapist-client relationship over the course of years, can be traumatizing. “Turnover is probably the biggest barrier to getting good services to people in this area,” Dougherty said. “It affects community coalitions, it affects clients.”

Clinicians at Plains Area Mental Health Center move to places like Sioux City or Des Moines after starting in the smaller, rural areas Plains Area serves, Dougherty said. “I have actually two clients on my caseload right now who saw their previous therapist – one of them saw her for nine years, the other one saw her for 13 years – who were honestly traumatized by having to start seeing me. So it was a major setback for their treatment.”

Ecker works in Clarinda but lives on a farm near Elmo, in northwest Missouri just south of the Iowa-Missouri border near where she grew up on a rural Big Lake, Missouri, farm. Both areas sustained serious flooding this year. She said she feels connected to her community. Her husband, Terry Ecker, is a farmer. “I’ve lived here all my life. This is home to me. It makes me really sad that there’s this disaster in the community, and there’s such a great need, and I don’t know how to employ therapists to meet those needs,” Ecker said.

Unmet demand for mental health care services in disaster-ridden, rural regions in the state are part of a larger problem in Iowa, mental health care advocates said. “We don’t have psychiatrists, psychologists, nurse practitioners, therapists, clinical social workers,” Peggy Huppert, executive director of the Iowa chapter of the National Alliance on Mental Illness, said. “It goes all the way down the line. We just don’t have enough.”

Even if enough care providers were available, barriers exist in linking farmers, whether they are in flood zones or not, to mental health care services, the IowaWatch interviews revealed. Financial difficulties, transportation issues, time constraints and limited internet access, but also many therapists’ lack of understanding of agriculture and a stigma attached to mental healthcare in farm communities also make it difficult for farmers to get the help they need when confronting stress and behavioral health issues.

“I guess that agriculture’s a tough job anyways, but this year is probably a hundred times more stressful than a typical year,” said Corey McIntosh, a fifth-generation farmer near Missouri Valley, Iowa, on the western side of the state, which has had some of the worst flooding from the Missouri River. “I’d say a lot of the people around here are probably experiencing, you know, certain levels of depression.”

McIntosh’s farm has flooded twice this year. Although he is not seeking counseling, he said it would be difficult if he were because he would not have time to do it.

He sees more flooding in the future. “It can’t be denied that we’re experiencing more extreme weather events,” he said. “The Corps of Engineers recognizes that climate change is happening but they have yet to start planning for it.”

MENTAL HEALTHCARE DILEMMAS IN SHORTAGE AREAS

Eight of the counties hit by flooding have not received designation by the national Health and Resources Service Administration as mental healthcare provider shortage areas (Cass, Dallas, Fremont, Mills, Montgomery, Page, Polk and Pottawattamie). This designation can have importance for healthcare providers in rural areas because the National Health Service Corps uses the administration’s designations to decide where to help clinics provide financial recruiting incentives to bolster rural healthcare systems.

Though a recruiter at one clinic IowaWatch spoke with said the clinic used the National Health Service Corps program as part of a more robust recruiting strategy that produced helpful results, many others said the program is not the complete answer when attracting mental healthcare providers to rural areas.

Ecker, from the heavily-flooded southwest of the state, practices in counties that previously had been declared a shortage area but lost their designation for reasons she said she does not fully understand. She said National Health Services Corps helped Waubonsie Mental Health Clinic for many years but that has changed. “Every few years, they rewrite the different areas. And our rating scale changed somewhat by a point or two,” she said.

Dougherty said Plains Area Mental Health Center employees continually feel understaffed and are fighting high turnover rates, even with Service Corps funding and employment benefits such as numerous health insurance policy options and pay that is 7% higher than the state average.

Dougherty blames high turnover and a perceived unattractiveness of rural communities, in part, on colleges failing to prepare students for the specific needs in rural areas. She said she has seen employees straight out of school quit the profession within their first few weeks because the work was too challenging.

“A lot of treatment models are set up for urban areas – I would say most of them, to be honest – and then we try to implement them in rural Iowa, because they have such good outcomes,” Dougherty said.

Despite widespread challenges with recruiting mental healthcare professionals to rural America, employees at one clinic IowaWatch spoke to said they have doubled their staff in the past year and are expanding services. The clinic is Crossroads Behavioral Health Center in Creston, Iowa, in a region that also has experienced heavy flooding. Last November, it hired human resources and marketing director Macie Blazek, who has a recruiting background.

Crossroads provides employees some of the same financial incentives as other clinics: service corps backing and what Blazek called a good retirement program. The clinic additionally pays for an independently-licensed therapist to supervise a clinic therapist’s first two years in practice. This process can be a financial drain on therapists if they have to pay it.

Many mental healthcare clinics do not have full-time recruiters. “We’re still hiring several positions, currently,” Blazek said. “And so even though we feel like we’re in a good place right now, it’s something we still kind of have to keep working at.”

Here is the latest Iowa news from The Associated Press at 3:30 a.m. CDT

DES MOINES, Iowa (AP) — Former Iowa Department of Human Services Director Jerry Foxhoven says he was unexpectedly asked to resign by the governor last month after he objected to the governor’s request that he continue paying the salary of a woman moving from his department to the governor’s office. Foxhoven, who gained national attention last week after The Associated Press reported on his admiration for the late rapper Tupac Shakur, says he declined to approve paying the salary of Elizabeth Matney.

CEDAR FALLS, Iowa (AP) — An El Salvador national has been arrested and charged with kidnapping after police say he snatched a teenage girl from an eastern Iowa yard, dragged her into a house and tried to sexually assault her. The Courier reports the incident happened Tuesday afternoon in Cedar Falls. Police have charged 43-year-old Saul Santos Vasquez-Martinez with second-degree kidnapping and assault with intent to commit sexual abuse.

CEDAR RAPIDS, Iowa (AP) — Federal prosecutors for Iowa say a 35-year-old Cedar Rapids man has been sentenced to 40 years in prison for sexually exploiting a child and for having child pornography. John Hunt was sentenced Tuesday in Cedar Rapids’ federal courthouse. Prosecutors say Hunt pleaded guilty in October to the two counts.

MADISON, Wis. (AP) — Wisconsin Department of Natural Resources Secretary Preston Cole is telling wildlife officials attending a multi-state conference on chronic wasting disease that they need to talk to each other and come up with a regional approach to slowing the disease. Representatives from wildlife agencies from an array of Midwestern states are gathering Wednesday and Thursday in Madison to discuss CWD.

DES MOINES, Iowa (AP) — A former Iowa state official, whose affinity for lauding rapper Tupac Shakur to colleagues drew attention after he was unexpectedly asked to resign, said Wednesday he had objected to the governor’s request that he continue paying the salary of a woman moving from his department to the governor’s office.

Jerry Foxhoven confirmed to The Associated Press that he declined to approve paying the salary of Elizabeth Matney, who left DHS on May 17 to accept a job as Gov. Kim Reynolds’ adviser on health policy.

Documents obtained by AP from the governor’s office show a memorandum of understanding between the governor’s office and DHS was signed more than a month later on June 19. It indicates Reynolds’ office was to bill DHS for wages and salaries from May 17 through June 30, the end of the current fiscal year.

It is signed by Reynolds’ Chief of Staff Sara Craig. The document was initially drafted with Foxhoven’s name , which is crossed out and replaced in handwritten script with the name of Gerd Clabaugh, the interim director of DHS named by Reynolds to replace Foxhoven. Clabaugh signed it.

Foxhoven was asked to resign on June 17. He has declined to say why. Reynolds has only said she asked him to leave for several reasons and she wanted to go in a new direction. Spokesman Pat Garrett said Foxhoven never raised an objection to paying Matney out the DHS budget to the governor’s office. He said the document was prepared before Foxhoven left but not signed until after Clabaugh was interim director.

When asked Wednesday if he objected to paying Matney out of his department’s funds, Foxhoven replied: “Yes, that’s what they got their own appropriation for.”
He declined to specify if it had any bearing on his departure.

CEDAR FALLS, Iowa (AP) — An El Salvador national has been arrested and charged with kidnapping after police say he snatched a teenage girl from an eastern Iowa yard, dragged her into a house and tried to sexually assault her.

The Courier reports the incident happened Tuesday afternoon in Cedar Falls. Police have charged 43-year-old Saul Santos Vasquez-Martinez with second-degree kidnapping and assault with intent to commit sexual abuse. His bond has been set at $500,000. Court records say Vasquez told immigration officials he is in the country illegally.

Police say the girl was outside with a child she was babysitting, when Vasquez grabbed her and pulled her into a home. She told police that, once inside, he forced her against a wall and began to fondle her. She fought back, escaped and called police. Investigators say she and Vasquez did not know each other.

CEDAR RAPIDS, Iowa (AP) — Federal prosecutors for Iowa say a 35-year-old Cedar Rapids man has been sentenced to 40 years in prison for sexually exploiting a child and for having child pornography.

John Hunt was sentenced Tuesday in Cedar Rapids’ federal courthouse. Prosecutors say Hunt pleaded guilty in October to the two counts.

As part of his plea agreement, Hunt admitted that, between 2015 and 2017, he persuaded a minor send him sexually explicit images, then threatened to distribute the images in an effort to get more such images. Investigators say Hunt also had child pornography that included images of prepubescent children.

DES MOINES, Iowa (AP) — A former state executive unexpectedly asked to resign by the governor last month says he had objected to the governor’s request that he continue paying the salary of a woman moving from his department to the governor’s office.

Jerry Foxhoven, who gained national attention last week after The Associated Press reported on his admiration for the late rapper Tupac Shakur, says Wednesday he declined to approve paying the salary of Elizabeth Matney. She left DHS on May 17 to accept a job as Gov. Kim Reynolds’ adviser on health policy.

Documents obtained by the AP from the governor’s office show a memorandum of understanding was signed on June 19, two days after Jerry Foxhoven was asked to resign. His name appears on the document but is crossed out and replaced by interim director Gerd Clabaugh, who signed it.

A Reynolds’ spokesman says Foxhoven never raised such objections to her office.

Foxhoven was asked to resign on June 17. He declined to specify that it was the reason for his departure but confirmed he objected to paying Matney out of DHS funds.

The Atlantic School District’s Board of Education held about two-hours of sometimes passionate discussion with regard to the District’s Athletic Facilities, the costs for which, as it currently stands, is running over budget. The Board met with Tom Wollan from FRK Architects, who discussed issues regarding the topography of the Trojan Bowl, and other facilities’ matters. Following the discussion, Board members Ali Bruckner said “I think we asked them to look at cost savings if the removed some retaining walls and slopes….” Board President Josh McLaren chimed in with “The potential for cost savings,” and Vice President Kristy Pellet said “The cost is…the overall project (cost) is high, and we’re making our way to ‘value engineer'” the project. She said they’re not looking to make major changes to the Trojan Bowl itself.

As it stands now the timeline is for a pre-bid meeting to take place Aug. 31st, with a bid date of Sept. 19th, a Public Hearing and awarding of Project on Sept. 23rd. Demolition with regard to certain aspects of the Trojan Bowl would begin in October or November, following the football season, and occupancy by Sept. 2020. The High School Track project would begin in May or June 2020, along with the field and all other elements, with occupancy by April, 2021. That timeline is subject to change, depending on the final decisions made with regard to the Atlantic Athletic Facilities, as it relates to cost.

The Board, Wednesday, approved of a bid for Middle School Chromebooks and peripheral tools in the amount of $137, 742.50 from 2ndGear. The price includes 350 Dell 3100-series laptop computers, carts, cases and licenses. The cost will come out of the District’s SAVE fund.

The Board will approved Contract Recommendations for: Henry Hallgren, HS Government Teacher; Mandi Bauer and Emma Bireline, TLC Mentors; and Alex Bales, Drama/Fall Play Co-Sponsor along with the late addition of Brian Guy as custodian. They also approved two resignations: Andrea Halterman, WA Para, and Nick Sandbothe, Mechanic.