Rep Ann Meyer: How A State Lawmaker Builds Mental Health Support That Works

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one story at a time. I'm hi, I'm Tony Mantur.
Welcome to Why Not Me? Embracing Autism and Mental Health Worldwide.
This is our special event crafting justice, empowering autism and
mental health through legislation. Joining us today is Iowa State
Representative And Meyer. She's a passionate advocate for health and
human services as a registered nurse and chair of the
Health and Human Services Committee in Iowa's House District eight.
Representative Meyer brings a wealth of experience to the table,
championing policies that support individuals with autism and mental health challenges.
She's here to share her expertise on crafting impactful legislation
and offer insights on how we can unite to support
those that are desperately in need of help. It's a
pleasure to have her join us. Thanks for coming on.
Sure my pleasure, Yes, mine as well. So I understand
that you are a huge mental health advocate. Could you
expand on that sum.
Yes, I am so. I originally ran for office back
in twenty eighteen. So my background is, I'm a nurse.
I worked for the community college. I taught at the
clinicals at the bedside in the local hospital. And I
complained to my state senator, who was a friend, that
I didn't like some of the things I saw in
the hospital as far as regulations and taking people away
from the bedside, and so he just suggested, well, maybe
you should run for Iowah House representatives. And I was like, no,
I'm not going to do that. I approached him again,
he said, well maybe you should run again, not addressing
my issue. So my background is not mental health care,
it is, you know, adult healthcare. But when I was
knocking on doors, you can't believe how many people I
ran into that would sit and talk for twenty or
twenty five thirty minutes to a stranger the situations they
were having in their family and how sad and dire
the situations were, and they didn't feel they were getting
enough help.
So, while I was still focused on healthcare.
That really became a major focus of my work in theatre.
Yes, it is amazing. I don't have anything to do
with autism or mental health. I knew nothing about it
until I started this podcast. The amount of people that
will come on and tell me their stories and their journeys,
Like you said to a stranger, it's pretty amazing. It
just goes to show you that what they're going through
and the issues they have is still not addressed. That's
why they're willing to come on a podcast like this
and talk about it. So when you got elected, what
was one of the first things that you tried to
do so that you could help those people out that
you had seen.
What I found from people reaching out is we just
don't have enough access to care.
I mean people were waiting. If you have a.
Mental health crisis, you can't wait six months for an appointment.
So you know, honestly, your first year in the legislature
is fast and confusing. My leadership changed at the end
of twenty nineteen. Our speaker, Speaker Pat Grassley, he had
a situation in his district and where he grew up,
where a high school coach was shot by a shot
and killed by one of his former students. This was
everything that I was talking about was well supported by
the Speaker. So twenty twenty nineteen and twenty twenty were
my That was my first term. Twenty twenty one, I
was named the chair of Human Resource, which was Human
Resources back then now it's Health and Human Services, same committee.
I started seriously talking to him about what we need
to do to address the mental health crisis, and he
was completely one hundred percent supportive, as was everyone in
the legislature.
Because there's not a district in.
Iowa that our representatives have not heard about problems, whether
it's from families, but more importantly through not more importantly,
no one's more important than the family, but law enforcement.
All of their time is a lot of their time
is consumed with addressing mental health issues every day, and
sometimes it's the same person every day. They get calls
for the staff in the emergency room. Patients were just
backed up in the hallways because there was no place
to there.
Were no beds open. We have a hospital right now.
We have a forty nine bed hospital here in Fort Dodge,
and we did have a mental health unit when I
was practicing that closed in two thousand and eight.
That turned out to be a big loss our area.
I have former House of Representatives Patrick Kennedy and Tim
Murphy that have joined me to be part of the series.
They have their ideas and thoughts on what they think
should happen to may change. Everyone has a different approach
on what they think needs to happen for change. What
are your thoughts on the fundamentals that need to be
done to make this change so the people that need
it can actually get the help.
I think the most important thing is access to care,
and I think that there's a lot of different levels
of that. I think the number one issue is increasing
our providers. We've got to have more people to provide
the care so the patients can get in to see them.
That's one.
Definitely, more providers. As much as people don't like to
hear that patients do need probably more than thirty days treatment.
There are people out there that do you can't cure
mental illness, especially severe cases, in thirty days and just
expect the problem to be taken care of. So the
first thing we worked on we did a package of
four things. Back in I believe it was twenty one.
We increase the amount of training for psychiatrists. Iowa was
one of the lowest ratio per capita for psychiatry, so
we at University of Iowa, which is our taxpayer funded
medical school, we added twelve residencies for psychiatry and we're
just you know, that was four years ago when I
think that legislation passed. We're just now getting up to
the point where we're starting to fill those residencies because
it takes so long to get the federal red tape
to approve a graduate medical residency, So those are filling
up again. Once you get into the residency, you're still
going to need three or four more years before we
start putting out the doctors. We increased the amount of
loan repayment because we want to make sure that if
someone graduates and they are willing to practice in Iowa
as a psychiatrist or even a therapist, we want to
make sure that we're giving them incentives to stay in Iowa.
I mean, you said, you live in Nashville and you've
got some pretty good attractions and some pretty good weather.
We don't.
I mean, we're in Iowa. Iowa is a great quality
of life. We you know, know traffic, but we do
have to provide financial incentives to recruit people and retain people.
So we did that.
So I'm originally from Maine and I was talking with
somebody just the other day and they said, that's a
psychiatry issue is tremendously lacking in Maine. Now, Maine has
kind of the same thing that they're a out of
the way state. They're more rural, not a lot of cities.
Sounds to me like you've got a similar situation there.
So that's one step in getting them to practice there.
What's the next step to make it really work so
that you can see that difference that you're putting into
it that's rewarding for everybody.
Well. Quality of life overall in Iowa is important. We
have lowered our income tax rate. We are now down
to a flat tax of three point eight, so that's.
More financial incentive.
The state invests a lot in the counties, especially the
county that I live in, not just especially. Other counties
are doing the same thing, but I can only speak
to my county. Webster County puts a lot of investment
into quality of life, you know, trails, outdoor activities for families,
indoor activities for families. But quality of life is very important.
So we talked about you know, we came from the
Detroit area and we lived fifteen to twenty miles from
both of my husband's hospitals, and he was driving an
hour and a half each way to and from work.
We don't have that here.
In Fort Dodge, which is a town of about twenty
six thousand.
I'm six minutes from the hospital here. My son was
in school.
He could leave in the middle of the day if
he wanted to for twenty minutes or a half hour
for a program. There was never a parent teacher conference
he had to miss. So that type of slower quality
of life I think is important.
I totally agree with you on the quality of life.
When you work in legislatures, it takes seems like the
clock ticks and nothing happens lots of times. How do
you speed that clock up so that some of the
things that you've put in place are a starting point
to help, but there are other things that you need
to do to open that door to broader things. So
how do you go about doing that?
It is a tour.
We introduced several good pieces of legislation, and I think
that you came to me through our in my opinion,
our number one mental health advocate in the state, if
not the country. She is always working for and she
works from personal experience because of the experiences she's had
with her son who is affected. She is literally tireless
and the best. We meet throughout the session, but when
we're meeting during the session, it is mostly just to
make sure we're reaching out to all of our members
to make sure they understand the legislation.
For instance, Ali.
Will tell you about a bill that I think could
have made a great deal of difference, and it passed
through the House unanimously.
If the Iowa House was ruling the world, it would
be great.
But we also have to work with the Senate, who
does not have my counterpart right now in the Senate,
and my counterpart last two assemblies in the Senate, I
did not have the healthcare experience, and I don't think
they had the issues in their family. So one piece
of legislation that I'll highlight that Leslie brought to us
this year was.
Something they're doing in other states.
It talks about after commitment, whether you're being committed for
mental health issues, that when you're committed, when it comes
down to commitment, remember it's a physician examination, it is
a court hearing, they're committed to a facility, and then
they're discharged.
I'm not saying that every.
Facility does this, and I especially don't think our state
facilities do this, but I have heard tell even in
my own town, that sometimes patients are just what we
call streeted after discharge, meaning they hand them their paperwork,
they hand them their phone numbers to call to make
follow up appointments, and there's no formal follow up to
actually make those appointments. This mandated that, this mandated everyone
who was discharged after a commitment was going to be
case managed either by our Medicaid program MCOs, which everyone
in MCO has a case manager, or our new behavior
Health system in the state, which that is supposed to
be coordinating care so everyone.
Throughout the state gets the same care. Past the House,
like I said, past.
Subcommittee past that regular Committee past. The House unanimously brought
it to the Senate. Talked to the Senator, He's like, yeah,
that does sound like a good idea. We made a
few changes to make it more palatable. We it initially
said also give them thirty days medication the hospitals, and
actually my husband told me we can't really discharge them
with that amount of medication because medications change.
So how did that affect the bill?
We actually took that part out because we do think
the case management is the most important part of follow
up care to make sure or that people can get
their medications, and medications can be paid for three they're
paid for by Medicaid, they're paid for it by private insurance,
and if they're not covered by either one of those, then.
That's when our state system kicks in.
Working with the Senate, as the Senator said, this would
be he likes it. We adjusted it to make it
more palatable, and it did not make it through their
what's called the legislative funnel over in the Senate.
So now I serve as the HHS Budget Chair.
If we have really good legislation that has been vetted
by the House and everyone agrees on, I would like
to put that legislation in our budget bill. And I
know everyone likes clean bills, but sometimes you need to
teck that kind of stuff on. It didn't make the
cut with my counterpart. And then there's a final bill
of the session. It's called standings and what people refer
to it as as a Christmas tree. Any policy that
didn't make it through, everyone wants to stick it in
the end of the years standings bill. I told my
leadership that was my number one priority is to get
that one bill through Standings, and because of whatever's going
on in the Iowa Senate right now, it didn't pass.
So the first year was introduced. A lot of bills
don't make it through on the first round. I will
go back and make that my first priority next year.
But I do think that follow up care is most
important thing when we're talking about patients.
When you run into people that don't understand because they
just don't have that lived experience, how do you gently
nudge them, twist their arm, whatever you need to do
to get them to understand that this bill is one
that not only covers your area, but it also covers
people in their area as well. If they can't get
that follow up healthcare they need. One of two things
is going to happen. Number one, they end up on
the street, or number two, they could end up incarcerated. Now,
if you look at just the sheer numbers, either one
of those things happen, it can cost the taxpayers millions
and millions of dollars. So why can't they just see
the numbers and then go from there to make this
thing right?
And that's exactly how I address it. When I can't
get the healthcare portion of it. I talk about their sheriffs,
and I talk about their law enforcement.
What are you hearing from them?
I try to have their law enforcement in their district
specifically reach out to them.
Just like you said, that's what we're looking at.
What would affect their lives, what would they consider important
to their constituents. I think the law enforcement part is
a big part of that, So I'll always.
Go toward that next.
And then back in twenty nineteen in Port Dodge, we
had a tragic incident. One of our Lutheran pastors, fabulous guys,
supported law enforcement. He was their chaplain for both fire
and police department, did ride alongs, tried to keep them.
His heart being in law enforcement.
Yeah, it is.
He was in his church. It was five in the afternoon,
the door was locked. Someone knocked on the door. He
went out and opened it and it was a man
who the police knew who murdered him with the hammer,
and he just a strong, strong person in our community.
The police knew based on the camera. They knew who
it was because there was a camera at the door.
They went right to his apartment and arrested him. This,
in my opinion, could have been prevented with and nothing
against the police officers, but this man couldn't get the
help that he needed. And his mom said, I have
been trying and trying to get help through the system
for years before twenty nineteen, and this was the outcome.
So that's what I try to impress on people who
are not in healthcare. I always try to adjust it
through the law enforcement system, because again, all of our
districts have.
Issues like this.
Maybe not that one severe, but there are severe issues
out there like that. So that's how I try to
put it in their perspective.
Yeah, that's tough. I'm sure that can be difficult to
get across. Now, what about homeless do you have a
lot of homeless in your area. It's my understanding that
a high percentage of homeless have mental illness happening.
Yes, we do in Fort Dodge. I really can only
speak for our area, and I'm.
Not sure how prevalent homelessness is in the more rural areas,
and remember Iowa is more of a rural state. But
in our town, we have a great homeless shelter. It's
run very well, but it has rules. What goes hand
in hand with mental illness is substance abuse, and those
rules are you can't drink, you can't use drugs in there.
And so they choose not to have that bed and
those meals and that support, they'll be on the street.
Yeah, we do have an issue with that.
Now, when you're dealing with legislation, you have a set
back like this, what becomes of it? You mentioned that
you were going to try to reintroduce it next year,
So is there any way to make that clock tick
a little faster? Like you said earlier, these people that
need help, they can't go months and months without some
sort of support. If they don't get that, they can
spiral downward, and unfortunately that's when bad things can happen.
We have to find some way to have a plan
B that will give them a cushion. What's the next steps?
How do we go about getting that done.
There's not a whole lot I can do over the
interim except work with the other legislators and have our
advocates work with the other legislators to make sure they
understand what the issue is. And it's rare that a
bill that is introduced in the same session makes it
out of that session. It takes some more education, and
we'll keep doing that and I will keep working on that.
Although I will say back when we started in twenty
twenty one, when we increased the residency programs. During that year,
we also increased intensive psychiatric care rates to encourage hospitals
to take more patients. We do have empty beds in
the hospital. We just hear from our hospitals that they
don't have the staff to take care of them. So
we've got to build that foundation up and which we are,
which we have been for years.
That's it.
I think it's just more education and across the actually
across the rotunda.
It was supported unanimously.
And I think the reason it was supported unanimously is
because everyone in our Chamber has heard of these issues,
whether it's from families, hospitals, or law enforcement.
It's just more education, more people talking about it. On
that same bill next year, what would you like.
To tell the listeners that you think is very important
that they hear and understand. The unfortunate part is you
have a lot of people out there that just do
not understand how our government works. Lots of times they
will think that our government isn't working, that you're not
doing anything, when in reality, you're doing everything that you
can to pass laws that can help those that need
the help. So what would you like to tell them
so they can understand the process of what you're trying
to do to help those that you represent.
I'd like to tell them to reach definitely, reach out
to your legislator who is in your district, who do
you have the relationship with, even going back before that,
if you've got any issues, even if you don't have
an issue, make a connection with your local legislator, because
I know in Iowa we're all very accessible. I'm assuming
in the Midwest region it's the same. Establish that relationship
and then when you address them with the problem, they
know who you are and they can speak to their
legislator about that, and they have better luck with that.
I also think it shouldn't be just a mass email
to all of the legislators. I think it should be
I think personal stories help the best.
I am always.
Willing to meet with constituents during the interim, So we
just finish our session yesterday morning at six point thirty.
This is a part time job. It is a full
time job for most of us. We meet all year
round with constituents. That's where our legislation comes from. Basically,
that's where they address the problems. If we can address
the problem in back channels with the department, you know,
change some rules or you know, without legislation, Yeah, we'd
love to do that. But when we try that and
it doesn't work, then we have to write legislation. I
think the most important thing is to develop a relationship
with your legislator, and even if you are approaching them
with a problem for the first time, make it personal,
share their personal stories. Not like Iowa, it just doesn't
have enough bedforst like patients. Well, we all know that
we don't have enough. So I think that personal reach
out is good. I think a zoom meeting, a phone call.
Those are the things you can do. I always tell
people my cell phone is what's on the legislative website.
You can call me anytime. I will always call you back.
I think that's really good. Now, when you get into
some states, in some areas, you have assistance gatekeepers, so
to speak, you never can get in contact with your representative.
So how do you get past that and how do
you do that so you can form that relationship?
Okay, As an Iowa legislator, we don't have any gatekeepers.
We have a clerk during session that schedules meetings for us.
When I say meetings, I mean legislative meetings, Like they
schedule our committees and our subcommittees, and they do that
kind of thing. They may write our newsletters. I always
write my own newsletter. Honestly, in Iowa, we don't have that.
I don't think they have that in a break. I'm
not sure about Illinois. I'm honestly not sure about other states.
You know, when you're full time.
I think in Michigan are they full time in Michigan
and they do have local offices, I think you can
still request a meeting or a phone call with that person.
Because we are the closest thing.
The local legislators, state and state reps and state senators.
We're the closest thing you can do starting the ball rolling.
Yeah, that makes total sense, because when you start talking
with the US representatives, House and senators. I've heard that
it can be a total nightmare.
That's the situation you were talking about. You don't talk
to your federal legislator. You talk to their subject expert
staff on that which I.
Don't mind that. I don't mind doing that, but I
want results.
Usually our local or our federal legislators in Iowa have
town halls all throughout out the state, so if you
really need to reach out to them, and what honestly,
they will probably do. They do have a lot more
constituents to take care of. They'll say, Okay, I'm going
to give you to Mike. He is my health and
human services policy experts. Give him your information and he
will get back to you with the information.
Another thing about Iowa state legislator, I will say, we
do write a lot of bills.
They most of them don't make it over the finish line.
But our year is filled with constituent work. I think
that's the most important work we do. Is constituent work.
If you are having a problem with getting your mental
health services covered by Medicaid or anything stayed insured, we
would be your first person to call and help with that.
Well, this has been great, tremendous information, great conversation. I
really enjoyed it. Thanks for taking time to be on
our show today.
I appreciate that. I appreciate you getting the word out
to everyone. It's my pleasure.
Thank you, It's been my pleasure. Thanks again. Thanks for
taking time out of your busy schedule to listen to
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