During college, I volunteered at the John McDonald Residential Treatment Center in Monticello, Iowa. JMRT is a campus run by Four Oaks, a nonprofit dedicated to helping children in dire circumstances, often involving mental illness.

Four of the girls I met at JMRT had previously lived at Iowa Juvenile Home, a large correctional treatment center in Eastern Iowa. Despite a controversial history, IJH was the only public correctional treatment facility for girls in Iowa. Following an investigation by the Des Moines Register, Iowa’s legislature voted to close the facility by January 2014.

After the closure, the residents were tried in juvenile court and sent to facilities far from their families or tried in adult court and sentenced to correctional facilities for female felons. Some girls tried as adults were as young as 15. Patients who could not be tried at the time were sent to halfway houses or shelters, and patients with minor infractions were sent to private facilities like JMRT.

Those who I met at JMRT were getting the treatment they needed but were in an isolated town nearly 100 miles away from their previous placement in Toledo. At the time, in early 2014, most could only see their families once every six months.

The number of mental health beds fell again in 2015 with the closure of two state facilities in Mount Pleasant and Clarinda. Governor Terry Branstad defended the decision, saying the programs were unaccredited, failing to serve as many people as in previous years, and not worth the maintenance of a qualified psychiatrist.

Photo: Independence / Calyn Thompson/KCRG-TV9

This year, another mental health institute was slated to close in Independence. There are currently no residents at this facility, though Branstad’s opponents claimed there was government pressure to stop accepting patients long before the closure was announced.

Now, a study by the Treatment Advocacy Center ranks Iowa as 49th for number of beds per capita.

How did we get here?

Since the 1970s, there has been a push to deinstitutionalize mental health. New understanding of mental health has allowed most people with mental illnesses access to successful treatment within their communities. But community-based treatment cannot erase the need for inpatient care, especially by those with severe illnesses like schizophrenia.

This widespread reduction of mental health services has also caused an age and gender disparity.

The lack of options for children with mental illnesses is difficult to combat, according to Rick Schults, Iowa DHS’ top administrator for mental health: There's not very much good, solid data across the nation that you could use to say, 'This state is better than that state at providing children's mental health services.'”

Girls are also at a disadvantage: while IJH is closed, the counter-part facility for boys is still running.

Experts state that coordinated care is the best way to address the gap in services since a complete legal overhaul is likely still years away. YSS, a partner organization with FLIA, is at the forefront of coordinating care for youth in central Iowa.

YSS doesn’t operate its own facility but does offer individual counseling and referrals to psychiatric medical institutes for children like Orchard Place and Lutheran Services in Iowa.

YSS is also heavily involved in prevention of mental health crises. Inpatient care will always be a need, but, for many children, early treatment can prevent serious concerns in adulthood. YSS provides intensive outpatient treatment, medication regulation, and family counseling.

We can’t bridge the gap until more beds are open, but we can advocate for children who have mental illnesses and those who have fallen through the gaps. It’s time for an overhaul, but we have to focus on what we can do right now.