(Iowa Capital Dispatch) One of the most prominent issues in Iowa mental health care is the lack of available psychiatrists and behavioral health providers, especially in rural communities.
According to Mental Health Stats, an organization that publishes U.S. mental health data, Iowa on average has 25 available psychiatrists per 100,000 residents, which is 37.5% below the national average of 40 psychiatrists per 100,000 residents as of 2025.
Iowa also has a significant shortage of mental health providers, with one provider per 1,500 residents, which is lower than the national average of one provider per 1,200 residents.
Rather than waiting for statewide solutions, some Iowa communities have experimented with localized mental health models aiming to fill gaps in behavioral health treatment.
Iowa communities implement alternative mental health models
John Derryberry, the director of 43 North Iowa, a disability service organization in Mason City, said the organization’s “no eject, no reject” model has led to increased trust in the community’s mental health services.
“We don’t cherry pick. If we have a spot, we admit, and it really has produced a lot of trust here in North Iowa of sharing clients and working together,” Derryberry said. “A client does not get discharged until the entire care team feels they’ve achieved what they needed to or decided that we’re not the right match for the client to get healthy.”
Derryberry said he tracks a patient’s progress by the level of care they receive after discharge, community contributions and annual income, which contributes to the local economy.
“We track people going to a lower level of care or leaving services completely,” Derryberry said. “If someone has staff with them 24 hours a day and we lower that to 18 hours, they’re more independent, they’re healthier and we’re being more efficient with taxpayer money. Our clients made $2.4 million in salary last year, and so that money gets reinvested in the local economy. We’re tracking real data about people’s health and contributions to their community.”
Iowa Mental Health Advocacy co-founder Leslie Carpenter, who is also a long-time advocate for people with severe brain disorders, described 43 North as a “pocket of hope” in the state.
“We’re finding great hope over what’s happening at 43 North in Mason City, an agency that has several levels of care, ranging from a residential care facility, having homes to support community living and an employment agency within the organization,” Carpenter said. “They’re doing some amazing community collaboration, and their ‘no eject, no reject’ model is paying dividends for some of the most complex patients in our state.”
In 2023, Carpenter helped launch an outpatient treatment program and civil mental health council in Johnson County, saying that these programs have produced results for patients over the past three years.
Johnson County’s outpatient treatment program focuses on providing community-based treatment and long-term support for individuals with severe mental illness, aiming to reduce hospital admissions and emergency interventions.
“Across the first 52 participants, they were able to reduce emergency department visits by 85%, hospital admissions went down by 68% and hospital days went down by 97%,” Carpenter said. “Crisis stabilization days increased by 16%, which we were OK with because the crisis stabilization at our GuideLink Center is less traumatic, less expensive and a more therapeutic setting.”
Erin Foster, the director of the Linn County Mental Health Access Center, said collaboration among different providers to create a specialized plan for individuals is the “backbone” of the access center’s mission to treat patients effectively.
“Across the county, or in some of the more rural parts of Iowa, sometimes these programs don’t even exist,” Foster said. “The role of access centers across the state is to be a one-stop-shop for an individual who is experiencing a crisis.”
Although local programs have produced positive outcomes, advocates like Carpenter say Iowa continues to face workforce shortages and inconsistent access to care.
“What we hear from people is that they’ll take somebody to the hospital in the midst of a psychiatric crisis, but hospitals are turning them away because they don’t agree that the person is a danger to themself or others,” Carpenter said. “The other thing we hear is that somebody is ‘too suicidal,’ and they’re saying they don’t have enough staff to provide the right level of supervision.”
Advocates hope for more legislative action
Iowa has taken steps to address advocates’ concerns about statewide mental health access, as Gov. Kim Reynolds signed House File 2543 into law on May 2. The bill aims to make subacute mental health care more accessible.
The final version of the bill was changed significantly in the Iowa Senate, where specific provisions for insurance companies were removed.
Carpenter said two separate bills that would have allowed for hospitals to evaluate psychiatric deterioration, which is when patients stop their medications and their conditions are worsening, and require hospitals to perform a suicide assessment of patients who were admitted on a psychiatric commitment, did not pass the Senate.
Carpenter added that she is hopeful that these bills will pass during the next legislative session.
Ryan Crane, the director of NAMI Iowa, an advocacy organization that provides mental health support groups and education, said the organization takes part in lobbying efforts at the Capitol, where the goal is to educate legislators about mental health.
“Legislators may have somebody in their life who has been affected by depression or addiction, but they may not think of that as mental health,” Crane said. “In 2027, where we are likely to have some outgoing and incoming legislators, that would be a year where we will really focus on educating.”
Despite being hopeful about the trajectory of mental health care in Iowa, Foster said the stigma surrounding mental health is the number one reason people do not seek care, and having more conversations will only help reduce the stigma.
“Anyone can struggle with anything behavioral health-related, and anyone can find themselves in a crisis and need some additional help,” Foster said. “We are ready, waiting and willing to give you the help that you need, and so I think this mindset of, ‘It’s not anyone I know, it’s never going to be me, it’s those people,’ really does hinder the work that organizations are doing.”
