Kali White VanBaale is an Iowa-based novelist, creative writing professor, and mental health care advocate. Find more of her work at kwhitevanbaale.substack.com (where this essay first appeared) and www.kaliwhite.com.

It’s legislative season again, and last month I was back at the state capitol in Des Moines to offer testimony at a House subcommittee meeting on proposed mental health care legislation advocates have been requesting for over a decade: increasing the number of inpatient psychiatric beds at each state mental health institute.

The Iowa House approved similar legislation a few years ago before the bill stalled in the Senate. Advocates are hopeful about the renewed interest in and support for it in the 2026 session.

Kali White VanBaale is an Iowa-based novelist, creative writing professor, and mental health care advocate. Find more of her work at kwhitevanbaale.substack.com (where this essay first appeared) and www.kaliwhite.com.     

This month, Governor Kim Reynolds signed several critical pieces of mental health care legislation, including House File 626, “an Act relating to continuity of care and non-medical prescription switching by health carriers, health benefit plans, and utilization review organizations.” This legislation has a long, contentious history at the Iowa capitol.

Why was this bill important enough to lobby for it year after year with no success? What exactly is non-medical switching?

Kali White VanBaale is an Iowa-based novelist, creative writing professor, and mental health care advocate. Find more of her work at kwhitevanbaale.substack.com (where this essay first appeared) and www.kaliwhite.com.     

In late January, the Treatment and Advocacy Center released an annual report, “Prevention Over Punishment: Finding the Right Balance of Civil and Forensic State Psychiatric Hospital Beds.” It says in part:

The number of state psychiatric hospital beds for adults with severe mental illness has continued to decline to a historic low of 36,150, or 10.8 per 100,000 population in 2023, with a majority of state hospital beds occupied by people who have been committed to the hospital through the criminal legal system. This strategy of prioritizing admission of forensic patients effectively creates a system where someone must be arrested to access a state hospital bed in many states.

Other key findings: