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

We talk with Iowa State Representative Ann Meyer about how mental health legislation gets built and why access to care still fails families in crisis. 

We dig into provider shortages, the fight for mandatory follow-up after commitment, and how constituents can move lawmakers with personal stories and local relationships. 
• her path from nursing to the Iowa House and why constituent stories changed her focus 
• why access to mental health care breaks down during a crisis and what “waiting” really means 
• the provider shortage problem and steps to grow psychiatry and therapy capacity 
• incentives that help recruit and retain clinicians in rural states 
• why 30 days of treatment is often not enough for severe mental illness 
• the case management follow-up bill that passed the House then stalled in the Senate 
• how law enforcement and ERs absorb the cost when the system fails 
• homelessness, shelter rules, and the overlap with substance use disorder 
• how to speed change through education, budgeting strategies, and persistent advocacy 
• why reaching out to your state legislator works and how to do it with a personal story 
If you know someone who has a story to share, tell them to contact us at why notme.world. 
One last thing spread the word about why not me. 

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Transcript

Welcome And Event Setup

SPEAKER_00 0:06

Welcome to Why Not Me, embracing autism and mental health worldwide. Hosted by Tony Mirator. Broadcasting from the heart of Music City, USA, Nashville, Tennessee. Join us as our guests share their raw, powerful stories. Some will spark laughter, others will move you to tears. These real life journeys inspire, connect, and remind you that you're never alone. We're igniting a global movement to empower everyone to make a lasting difference by fostering deep awareness, unwavering acceptance, and profound understanding of autism and mental health. Tune in, be inspired, and join us in transforming the world one story at a time. Hi, I'm Tony Mantor. 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 Ann 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 8, 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.

unknown 1:57

Sure.

SPEAKER_00 1:57

My pleasure. Yes, mine as well.

Why She Entered Public Service

SPEAKER_00 2:00

So I understand that you are a huge mental health advocate. Could you expand on that some?

SPEAKER_01 2:06

Yes, I am. So I originally ran for office back in 2018. 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 Bio House representatives. And I was like, no, I'm not going to do that. I reproached him again. He said, well, maybe you should run. Again, not addressing my issue. So my background is not mental health care. It is uh, you know, adult health care. But when I was knocking on doors, you can't believe how many people I ran into that would sit and talk for 20 or 25, 30 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 health care, that really became a major focus of my work in the legislature.

SPEAKER_00 3:05

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?

The Real Crisis Is Access

SPEAKER_01 3:38

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 2019. Our speaker, speaker Pat Grassley, he had a situation in his district where he grew up, where a high school coach was shot by and shot and killed by one of his former students. This was everything that I was talking about was well supported by the speaker. So 20, so 2019 and 2020 were my, that was my first term. 2021, I was named the chair of human resources, which was human resources back then. Now it's health and human services, same, same committee. I started seriously talking to him about what we need to do to address the mental health crisis. And he was completely 100% 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 um, 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 49-bed hospital here in Fort Dodge. And we did have a mental health unit when I was practicing that closed in 2008. That turned out to be a big loss for our area.

SPEAKER_00 5:31

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?

Training More Providers And Incentives

SPEAKER_01 5:58

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 30 days treatment, there are people out there that do. You can't cure mental illness, especially severe cases, in 30 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 21. We increased 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 12 residency slots for psychiatry. And we're just, you know, that was uh 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, no traffic, but we we do have to provide financial incentives to recruit people and retain people. So we did that.

SPEAKER_00 8:04

So I'm originally from Maine, and I was talking with somebody just the other day, and they said that the 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?

SPEAKER_01 8:33

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 3.8. So that's more financial incentive. The state invests a lot, and 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 15 to 20 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 26,000, 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 20 minutes or half hour for a program. There was never a parent-teacher conference he had to miss. So

Follow-Up Care Bill And Senate Roadblock

SPEAKER_01 9:33

that type of slower quality of life, I think, is important.

SPEAKER_00 9:37

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?

SPEAKER_01 10:00

It is a chore. 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 uh my counterpart right now in the Senate, and my counterpart last uh 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 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, and 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 an 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. Passed the house, like I said, past subcommittee, passed the regular committee, passed the house unanimously, brought it to the Senate, talked to the senator. He's like, Yeah, that that does sound like a good idea. We made a few changes to make it more palatable. We had initially said also give them 30 days medication, the hospitals. And actually, my husband told me we can't really discharge them with that amount of medication because medications change.

SPEAKER_00 12:50

So, how did that affect the bill?

SPEAKER_01 12:52

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 that people can get their medications. And medications can be paid for. They're either paid for by Medicaid, they're paid for 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, yes, the senator said this would be uh 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 do need to tack 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 is as a Christmas tree. Any policy that didn't make it through, everyone wants to stick it in the end-of-the-year 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 it 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 the most important thing when we're talking about patients.

SPEAKER_00 14:23

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 health care they need, one of two things is gonna 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?

Making The Case With Public Safety

SPEAKER_01 15:11

And that's exactly how I address it. When I can't get the health care 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 2019 in Fort Dodge, we had a tragic incident. One of our Lutheran pastors, fabulous guy, 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.

SPEAKER_00 15:59

Yeah, it is.

SPEAKER_01 16:00

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 a 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 2019. And this was the this was the outcome. So that's what I try to impress on people who are not in the healthcare. I always try to address 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.

SPEAKER_00 17:06

Yeah, that's tough. I'm sure that can be difficult to get across. Now, what about homeless? Do you have

Homelessness And Substance Use Reality

SPEAKER_00 17:12

a lot of homeless in your area? It's my understanding that a high percentage of homeless have mental illness happening.

SPEAKER_01 17:19

Yes, we do. In in Fort Dodge, and I can 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.

SPEAKER_00 17:56

Now, when you're dealing with legislation, you have a setback 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?

SPEAKER_01 18:37

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. Uh, it just 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 2021, 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

What People Can Do To Help

SPEAKER_01 19:17

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 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.

SPEAKER_00 19:49

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?

SPEAKER_01 20:23

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 a 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 legislatures. I think it should be uh, I think personal stories help the best. I am always willing to meet with constituents uh during the interim. So we just finished our session yesterday morning at 6:30. 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, I oh, it just doesn't have enough bed for psych 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.

SPEAKER_00 22:17

I think that's really good. Now, when you get into some states and some areas, you have assistants, 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?

Reaching Legislators Without Gatekeepers

SPEAKER_01 22:38

Okay. As an Iowa legislator, we don't have any gatekeepers. We have a clerk during session that schedules meetings for us. And 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 Nebraska. 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 to starting the ball rolling.

SPEAKER_00 23:30

Yeah, that makes total sense. Because when you start talking with the U.S. representatives, House and Senators, I've heard that it can be a total nightmare.

SPEAKER_01 23:39

That's the situation you you were talking about. Uh, 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 all throughout 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 gonna give you to Mike. He is my health and human services policy expert. Give him your information and he will get back to you with the information. Another thing about Iowa State Legislature, I will say we do write a lot of bills. They don't 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're having a problem with getting your mental health services covered by Medicaid or anything state insured, we would be your first person to call and help with that.

SPEAKER_00 24:47

Well,

Closing And Listener Invitation

SPEAKER_00 24:48

this has been great. Tremendous information, great conversation. I really enjoyed it. Thanks for taking time to be on our show today.

SPEAKER_01 24:57

I appreciate that. I appreciate you getting the word out to everyone. It's my pleasure. Thank you.

SPEAKER_00 25:03

It's been my pleasure. Thanks again. We hope you enjoyed it as much as we enjoyed bringing it to you. If you know someone who has a story to share, tell them to contact us at why notme.world. One last thing spread the word about why not me. Our conversations, our inspiring guests that show. You are not alone in this world.