Attention to mental illness in Iowa has focused on a recent rural Iowa murder trial where the defendent pled "not guilty by reason of insanity."
But one high-profile criminal trial does not represent the scope of mental illness, or the diverse diognoses that the National Institute of Mental Health say affects an estimated 13 million American adults -- or approximately 1 in 17.
In Iowa, a minority are cared for in the four state mental health institutions. Most are treated in their own community where experts say in most cases, is better for the individual and more economical for counties and the state.
A case in point can be seen in Fort Dodge.
Eric Barton: "I'm psychotic. Well, that's what it says in my, my profile."
Melody Ruddy: "Around 2005, I got really mentally sick, heard voices and stuff."
Michael Ackerman: "I just started to believe that there were all kinds of word games that were being played with me, with the initials on the products that I was placing onto the conveyor belt. That there were hidden messages being taught to me."
Michael, Eric and Melody have struggled for years with chronic mental illness. Medications and their numerous trips to the hospital may have helped, but did not keep them stable enough to live long-term on their own.
What has helped is frequent and continual contact with the staff of a community-based program that makes house calls. They remind clients to take their medication. They also offer counseling and help with activities of daily living.
Melody Ruddy, "Oh they do so much. They help me with my meds. They help me with my diabetes. They also take me grocery shopping. They help clean my apartment and help me get an apartment. Because I don't think I could do that on my own."
Kim Chase, Registered Nurse: "One benefit of seeing folks on a consistent basis is if there are problems that are starting to occur or if they're having more difficulties we can intervene sooner."
Kim Chase is a registered nurse in Webster County's Assertive Community Treatment program the county calls "ACTION". It is one just 5 such programs in the state that all totaled, serves a some 250 Iowans.
Deb Delp is a certified psychiatric nurse and is the Team Leader for the ACTION program with offices in Fort Dodge.
Deb Delp, Team Leader "Assertive Community Treatment is the most intense outpatient service that people can receive. We have six staff. We have a vocational specialist, we have a substance specialist, we have psychiatric nurses."
The ACTION staff meets everyday to discuss the status and progress of every client. On this day, that meant discussion of 38 clients.
The cost to start up this one-stop service provider was $500,000.
Irene Blair, Webster County Community Services Director says the county paid half with the other half coming from the state.
But, she adds the ACTION program has proven cost effective. By treating people in their homes instead of a hospital, residential or institution setting the county's per-person cost has decreased dramatically.
Irene Blair: "We pay $1,100 a month for the program. If we're looking at residential, we're looking anywhere from 3 to $4,000 dollars a month. It plays a big role in keeping people out of hospitals."
Keeping people in their homes is working, according to a study funded by the Iowa Department of Human Services and conducted by the University of Iowa.
Prior to entering the program, the annual average hospital stay per patient was 19 days. After entering, the annual average stay was four days.
The annual average number of days spent in a residential facility or state mental health institution went from 57 days – to three.
Deb Delp, Action Team Leader: "IT has proven to increase satisfaction in the client's life. It also shows that we, we can help decrease substance abuse. We have better outcomes with folks getting jobs and maintaining those jobs. We have fewer folks that are homeless."
Michael: "If the Action program wasn't around I would really struggle to make it because when, when people struggle with mental health issues sometimes their friends even their family will abandon them. So you really don't have anybody to turn to and the Action program helps me with, with having a relationship, a friendship and day to day living skills and coping."
Mike Ackerman and many others -- whether in the Action program or not -- also seek support from each other at this county-sponsored drop-in in downtown Fort Dodge. It is operated by and for those with chronic mental illness.
Eric: "I have bad influences everywhere else I go and this place is a really, has really good influences in my life."
Melody: "They help me social wise and get friends, you know, and people to talk to."
Mike: "It's just like a friendship you would have at a coffee shop or something only its with people that mental illness and once in awhile the conversation turns to that but not very often."
Webster County has several resources that work for many of its residents with chronic mental illness.
But Irene Blair makes it clear that these community resources cannot replace state mental health institutions or other forms of 24/7 residential care for those with very serious conditions.
Irene Blair: "Our community hospitals, can take people for a short period of time but when someone needs maybe 2,3,6 months of, of 24 hour care, we really look to our MHI for those services."