Video: How one law is keeping the mentally ill from getting the care they need

September 25, 2019

Across America, mentally ill people can’t get the care they need because one law is standing in the way.

Two new videos out today from the Goldwater Institute show how patients are suffering because of state certificate of need (CON) laws, which block competition in the healthcare market and prevent the creation of much-needed treatment facilities:

• “NEED” puts the spotlight on the dire situation in Iowa—one of 38 states that currently have CON laws on the books. Through interviews conducted across the state, the video shows that there are simply not enough mental health facilities available to meet the clear patient demand in Iowa—and CON laws are to blame.
• In “Certificate of Need Laws Explained,” Goldwater National Investigative Journalist Mark Flatten—who has extensively researched and written about the negative effects of CON laws on mental health treatment options—discusses the history of these laws and how they don’t work for people in need of care.

CON laws require that any would-be healthcare provider get approval from a state regulatory board to build a new treatment facility or expand an existing one. States began passing such laws in the 1970s, based on the theory that limiting the number of medical facilities would help keep costs down. But in reality, CON laws protect existing medical providers by limiting competition, contributing to higher healthcare costs, lower quality care, and restricted access to needed treatment.

Among those who have suffered consequences is Jared, whose story is featured in the “NEED” video. One day, Jared, an autistic and mentally challenged man in his early 20s, attacked his mother for no apparent reason, and police were called. Jared’s mother watched as her mentally ill son was thrown into a squad car and transported to jail. Why jail? Because in Iowa, there is a shortage of mental health facilities that can take care of a person in crisis—a person like Jared. And yet, when a private company tried to open a new mental health hospital in Iowa, it was delayed for more than two years because existing providers used the state’s CON law to block the new facility. Police officers are forced to crisscross the state to transport mental health patients to facilities to get the treatment they need. But the time and financial commitment for such trips can be too great for small sheriff’s departments to bear. That means that often, the safest place for someone having a psychotic episode is in a jail cell.

The American Medical Association calls CON laws a “failed public policy” and has advocated for their repeal. Yet despite the demonstrated damage CON laws do to Americans who need care, they’re still on the books in dozens of states.