(Iowa City Press-Citizen "Our View," July 17, 2009)
Overwhelming communication problems have plagued relationships between law enforcement agencies and hospitals in Iowa long before Mark Becker allegedly shot Ed Thomas last month. But those problems have raised a number of very difficult and high-profile questions since Becker, who had been recently released from psychiatric care at a local hospital, allegedly walked into Aplington-Parkersburg High School and shot the school's beloved football coach.
Officials from the Black Hawk County Sheriff's department want to know why Waterloo's Covenant Medical Center didn't contact them before the release so they could charge Becker with other crimes.
Officials from the hospital want to know, if law enforcement officers thought Becker was a danger to himself and others, why they didn't fill out the proper paper work or seek a court order to ensure the hospital could notify them before Becker was released.
Court documents show Becker, who has pleaded not guilty to the charge of first-degree murder, intends to use insanity and diminished responsibility defenses in his trial. At the same time, Iowa Ombudsman William Angrick has launched an investigation to determine what happened with Becker's release and whether policy changes are necessary.
Similar questions were raised in Johnson County after a homeless man, Sonny Iovino, froze to death underneath the Benton Street bridge in the early hours of Nov. 7, 2007. The reports of Iovino's belligerent and erratic behavior in the days before his death made it difficult for agencies to help him. He had been released from the Veterans Affairs Medical Center. He refused to stay at Shelter House. And the Sheriff's Department didn't take him into custody, in part because he had a note explaining he was in need of medical attention.
Both cases -- Iovino's and Becker's -- provide worst-case examples of the quagmires that open up nearly everywhere mental illness crosses paths with the justice system. And those quagmires get even deeper in the more rural areas of the state where Iowa's shortage of psychiatrists is even starker. Smaller sheriff's departments are stretched dangerously thin when they have to devote officers to monitor people waiting for hours or days for an evaluation. And smaller hospitals are ill-equipped to provide security for patients facing criminal charges.
"The jails and the prisons are still the largest mental health care givers and providers in the state," Johnson County Sheriff Lonny Pulkrabek said. "It shouldn't be that way."
Even with Johnson County's mental health diversion program, Pulkrabek said, the jail still has to house the mentally ill who are such a danger to themselves and to others that the local hospitals can't handle them.
"The jail is the dumping ground," Pulkrabek said. "Even if we can't manage them very well, we don't have the option to say, 'No, weren't not going to take them.'"
Some progress was made during the recent legislative session to show lawmakers how dysfunctional the system has become. The Iowa state Sheriffs and Deputies Association lobbied for a bill that would have set a specific amount of time a hospital had to evaluate a patient under court order and would have imposed penalties for institutions or individuals who failed to comply. The provision didn't get far, but it spurred representatives of the association to agree to meet with the Iowa Hospital Association next month to see if the two groups can find some common ground.
Hopefully law enforcement, hospitals, mental health providers and lawmakers have learned just how important it is for them to find more common ground. Otherwise, far too many people will find themselves sinking in more and more quagmires.