Blood on His Hands: Casualties of Branstad’s War On the Mentally Ill

By Crystal Defatte

I went to my psychiatrist today, just a normal check in to let her know my meds are working fine.  I was waiting in the lobby, minding my own business, when two women frantically came in.   One of the women explained to the receptionist that her daughter was in the middle of a nervous breakdown and needed to be seen.  I couldn’t help but to listen in; I knew where this was going but I hoped that I was wrong.

The receptionist asked if her daughter had an appointment.  The woman replied that she did not.  The receptionist asked if she’d ever been seen there before and my heart sank as I heard the woman say no.  The receptionist then told her what I knew she’d tell her, that she could set up an appointment but in the meantime she’d have to go to the emergency room.  The first available appointment was in April.  Five months away.  April.

But hey, she can go to the emergency room and get help there, right?  Wrong.  An emergency room physician won’t prescribe psychiatric medications because a patient has to be regularly seen in order to monitor for side effects and medicinal efficacy.  I know this because I was this woman, less than a year ago.

I moved to Iowa the weekend after Thanksgiving.  I had just seen my psychiatrist and had enough of my medication to last me through December.  When we moved my partner was a full time student at Palmer Chiropractic School and wasn’t working and I had no job set up yet so we had to get on Medicaid, at least until I could find work.  It took until the middle of December to get on Medicaid.  At the beginning of January I called my psychiatrist in Wisconsin so she could send in a refill for my medication, but I quickly learned that Iowa Medicaid wouldn’t pay for my meds because the prescription was written by an out of state doctor.  I started to panic, but I figured now that I was insured I’d be able to get a doctor here and have my meds within a couple of weeks.  Surely I could survive that long without them.

Then I learned that Iowa was going through Medicaid privatization, and it was going to mess with everyone’s billing.  They wouldn’t even look at scheduling anyone new who was on Medicaid until after the switch over in March.  The first available appointment after that was in June.

Within a couple of weeks I felt myself begin to crack.  The feelings of despair and isolation that come with the territory of being bipolar came creeping in like a dark fog slowly engulfing me.  The panic that comes with my anxiety disorder made me feel like I wanted to jump out of my skin.  My personality disorder made me feel like the only way to deal was to harm myself.  I was losing myself to diseases I came by honestly; that perfect storm of screwed up genetics and the kinds of childhood trauma they make tragic Lifetime movies about.

After dozens of calls I was able to find a counselor who would take me on February first.  She couldn’t prescribe meds though and without them talk therapy wasn’t enough.  She suggested I go to the emergency room, the very same advice the woman today was given, and I did.  That’s when I learned they wouldn’t prescribe my meds either.

Dealing with mental illness while in crisis mode is like hanging off a cliff.  You want to hold on.  You know you’re minutes away from dying as you feel the mental equivalent of your arms starting to shake from fatigue.  You’d do anything to pull yourself up but it feels impossible.  Eventually you feel like the best idea is to just let go.

That’s when I started researching the most painless way to die.  I don’t want to give anyone ideas, but it turns out the best option was helium toxicity, and I started to research the right grade of helium and where I could order a tank from.  Before ordering I frantically called the psychiatrist’s office and tried to get an earlier appointment.  I was crying hysterically while begging to be seen.  Unfortunately with the shortage of psychiatrists in Iowa, there was nothing that could be done.

In a perfect world I could have gotten a bed at a mental health institution, prescribed meds there, and be held until I could be stabilized.  Except in the world of Governor Branstad’s war on the mentally ill, beds at institutions were already scarce (for example, out of the 78 beds in the facility in Mt Pleasant only nine were allocated for acute psychiatric patients) and are even scarcer now due to Branstad closing two of the four mental health facilities in Iowa just this month.  To justify the closures, Branstad noted that a consultant hired by the state in 2009 recommended closing the institutes at Clarinda and Mount Pleasant.  A separate state task force disagreed, however, saying that none of the institutions should be closed until suitable alternatives in the community were set up and running. But Branstad said that there are alternatives at the University of Iowa and within community mental health programs. He also noted that state prisons and other facilities at the Mount Pleasant and Clarinda state campuses would remain in operation.  (Petrowski)  Even before the closures occurred there was obviously a lack of suitable alternatives, and now this woman I heard of today would be even more hard pressed to find the help she needs.  Then again, she can always get herself sent to prison if she really needs help.

According to the National Alliance on Mental Illness, 4.1 percent of Iowans — or about 123,000 people — have a serious mental illness. A 2015 report indicated that Iowa ranked 47th nationally for its general fund spending on mental health services. (Boshart)  Branstad has said in the past that he’s even open to closing the remaining two mental health facilities, yet the governor claims to care about reforming the mental health system here.  If we can’t be treated in a doctor’s office, an emergency room, or a mental health institution, what are we supposed to do besides fall off that proverbial cliff?

Obviously my story has a happy ending.  My counselor was able to label me a critical patient and fight for me to get into the psychiatrist’s office sooner.  The same provider that told me (while I cried and begged) that I couldn’t be seen until June suddenly could see me by the middle of February.  This gave me renewed strength to hold on long enough to get my medications and wait for them to kick in again, and I am once more a relatively functional human being.

I hope the woman I heard of today finds someone to advocate for her the way my counselor advocated for me, because if her mental breakdown is anything like mine, she won’t make it until April.  Her blood and the blood of others like her who won’t be able to find help in time in a mental health system devoid of funding and providers will be on the hands of Governor Branstad.  I hope it keeps him up at night.


Works Cited
Boshart, Rod. Globe Gazette. 30 July 2015. 17 November 2016 <;.
Petrowski, William. The Des Moines Register. 26 January 2015. 17 November 2016 <;.



  • I just recently got out of the psychiatric locked unit. Every where was full and they sent me to Ottumwa. I had no support system. They didn’t prescribe me meds because of all of the meds I have been on and the sensitivity I have with side effects. Literally, all they did was keep me on 15 minute watches.

    Since getting out I have struggled to find someone to take me as a client. The University of Iowa wants to define me as a new patient because I hadn’t been seen in that particular clinic. Which then means they can’t see me until April. I have medical insurance through work and some places don’t take it.

    The mental health system here in Iowa is zilch. It is scary that Brandstad is doing what he is. It is like he is saying – we aren’t important.


    • I’m so sorry to hear about that. I’ve spent time in a facility when I was much younger and I know how hard that can be, especially when it doesn’t feel like its helping. We are important, don’t forget that. I hope you find a good level of care soon.


  • The Ankeny chapter of AMOS (A Mid-Iowa Organizing Strategy) has taken up Mental Health as its action project. I will forward this essay to its leaders.

    Liked by 1 person

  • Unfortunately, To be an Iowan child with a mental health challenge is even worse. After a 9mon. wait to be seen at the UofI we were told more testing was needed and the next apt. open was in 10 mon. We made that apt. but went to Mayo. Got in and out with in a week, diagnosis and meds in hand. 19 months in the life of anyone is a ridiculous time to wait, especially more so for a child.


    • This mother was a little older, so I assume her daughter was an adult, but she never came in so I don’t know. I can’t imagine what it’s like as a parent to have to watch your child suffer from mental illness. I’m glad your child was able to get the necessary care.


  • I am sorry you had a difficult time after moving to Iowa, but very surprised more planning didn’t go into your move. As a consumer and past provider of mental health resources I can’t imagine moving without finding continuing care. The difficulties and backlog are not that different in WI.

    In describing your situation you probably would have necessitated a voluntary hospitalization for a very short time. Speaking of utilizing one of the state beds is somewhat of a misrepresentation.

    I wish you the best and if you move again please secure a new provider before move and talk to current provider about covering the transition with three months of scripts.


    • My insurance in Wisconsin wouldn’t cover more than a month at a time, and I couldn’t set up with a new provider until I had insurance here. Cracks in the system.


      • If you chose to move you have to expect there to be cracks. Would have happened with private ins that freq has a 90day waiting period, medical illness or psych. You had an option to pay out of pocket and have meds. Those issues will never change.


      • The fact that I was on Medicaid should tell you I didn’t have an option to pay out of pocket. I left a job that paid less than $12 an hour and I have three kids. There was no way I could pay out of pocket. I don’t know if you’re taking this personally and getting defensive or if you just have disdain for those with low incomes or mental illness, but excuses are inferior to solutions. You said you work in the field; perhaps you should work on being a force for change instead of making excuses? I had no knowledge of any other options, you being in a position of more knowledge of the system should probably be helping instead of arguing and blaming.

        Liked by 1 person

  • The mental health care delivery system I have experienced in my lifetime here in Iowa is insufficient,
    inefficient and as in your situation, at times effectively inhumane. I haven’t lived anywhere else to know if there is better, though. I will say I have better luck treating my long term “physical” illness (asthma) than mental health issues, (by their very nature more difficult to treat, not sure). Even with the best insurance.

    The mainstream media doesn’t cover this story coherently enough.
    Our governor is quite sly about pushing his Republican agenda through. Instead of improving a struggling system of delivery for mental health care, for example, he makes it worse. By stating that localized treatment in communities is more modern and appropriate, he tells a half truth. He is creating confusion in the general public by equivocating 21st century and 19th century mental health institutions. He sets the system up to fail so that he can privatize it.

    I bear my psychological pain as I don’t trust the system here and haven’t experienced better. I am lucky enough to remain functioning, but wish I could do better. I did try to admit myself once, and was told that unless I was an immediate danger to myself or others, I was on my own. So I suffered for 2 weeks with horrible pain and anguish caused by depression, and survived. Every day was excruciating by the minute and because it was a mental health issue, I couldn’t really share it with friends. It was horrible, and I wouldn’t wish it on anyone. Crisis lines have helped me more than psychiatrists over the years. I tell myself that suicide is not an option during bad times of the year, and my bad times pass. I am lucky in this regard, and unlucky as well, I always wish there were better options for help. Perhaps I would pursue them if they were more readily available. So there you go, Mr. Branstead and Wellmark insurance, you save some money on me, but what is the real cost? We have to stand up for this issue.


    • Your story and my own are far too often happening and yet go untold. We need to start making our voices heard. I can’t suffer in silence anymore. I still have my bad days, but I have my good days too. Some people won’t have anymore days due to our broken system. We have to speak out for them and for ourselves. Stay strong and find someone to talk to when you can’t.


    • Broadlawns has taken over the Polk county mobile crisis team. They have nurses who can go to homes and assess people in crisis and help get them help. We have expanded services so that we can see patients almost 24 hours a day


  • I work in the field and it is just as infuriating as one might believe. We can only help those who are brought in and admitted into our inpatient units. How can we help those who need it when we only have so many beds and some of our patients await long term placement but their social worker or caretaker can’t find a bed in this goddamn state because our governor closed them down? It pushes others back who need to be seen asap and sometimes people wait days and days. It breaks my heart. Everyone is entitled to healthcare, correct? Why is mental health any different?


    • It’s got to be hard knowing you can help but you’re being limited by someone who will never understand what he’s really doing with that stroke of a pen. Thank you for the work that you do.


  • Oh sure Denise Counsell, it’s all her fault.


  • I agree with Kayla. I also work in the mental health field. I worked with a client with acute psychotic symptoms who was in so much pain that they agreed to go to Broadlawns for inpatient treatment (diagnosis, medication management, stabalization). This person took the huge step of courage to present to the emergency department. Because there were no beds available, the person was given two antipsychotic med injections, a few minutes on a cot, and then let go. No referral to counselor or psychiatrist, no follow up appointment offered. What a dehumanizing experience. Many Americans fear a nationalized, single-payer health system because it might ration healthcare. That is exactly what happened to this person. Unless we time our psychiatric crises appropriately, we risk deterioration and even death. Would this happen to a victim of an auto accident? Or if it had been a member of the Governor’s family?


  • Pingback: It’s been an honor… | Progressive Voices of Iowa

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