The University of Iowa
The University of Iowa News Services Home News Releases UI in the News Subscribe to UI News Contact Us


5137 Westlawn
Iowa City IA 52242
(319) 335-6660; fax (319) 335-8034

Release: Sept. 22, 2000

UI makes strides in IMPACT program to treat schizophrenia and related conditions

IOWA CITY, Iowa -- A University of Iowa Health Care outreach program that helps people with serious mental illnesses is successfully helping those individuals stay on their medication -- and stay out of the hospital. The program, which also helps train more health care providers to provide psychiatric outreach services, is becoming a model for mental health care outreach across the state.

IMPACT -- Integrated Multi-Program Assertive Community Treatment program -- brings a team of health care professionals to the homes of people in Johnson County with schizophrenia, bipolar affective disorder (manic depression) or schizoaffective disorder. Outcomes for the past four years show that patient involvement cuts hospital stays from 37 days annually to seven days after the first year in the program, then to four days after the second year and three days after the third year.

"We help people who have a history of repeat hospitalizations while receiving care via traditional mental health services," said Nancy Williams, M.D., UI assistant professor (clinical) of psychiatry and IMPACT clinical director. "The program saves dollars by reducing hospitalizations, but more importantly it improves people's lives."

Based on a model from the University of Wisconsin, the Iowa City program was started in 1996 by Gerard Clancy, M.D., UI associate professor (clinical) of psychiatry, and Betsy Hradek, a UI psychiatric nurse.

IMPACT physicians and nurses make regular home visits that encourage patients not to stop taking medications, a downfall that can lead to re-hospitalization. But there is more to IMPACT than just taking medications. Home visits by IMPACT counselors, social workers and occupational therapists serve a wide variety of functions to help people live independently. During these visits, patients can get help with basic living skills such as cleaning and grocery shopping, problem-solve daily stressors, or get assistance with finding a job.

IMPACT aims to provide leadership for spread of the model in Iowa, Williams said. In 1998, similar programs were started with UI involvement in Cedar Rapids and Des Moines. However, one barrier to getting the model adopted elsewhere in the state is finding trained clinicians. Currently, IMPACT involves students from the UI School of Social Work, the UI College of Education, and the UI Colleges of Medicine, Nursing and Pharmacy during their internships and elective coursework.

"A major problem with providing this type of care to people with serious and persistent mental illness is the lack of trained clinicians familiar with the model," Williams said. "By training more students, we hope to provide better services for the state. Involving students also helps bring new ideas to the program."

Ryan Carnahan of Mitchellville, Iowa, is studying for a PharmD. degree at the UI and recently completed a clerkship with IMPACT. Carnahan said he learned a great deal by working with the IMPACT staff and especially by working directly with the patients and answering their questions about medication.

Perhaps most important, he got to know the patients as people, playing basketball and baseball with them and enjoying pizza parties.

"I'm thankful to have had the opportunity for that kind of experience," said Carnahan, who is now an intern at Hartig Drug in Iowa City and plans to graduate next May. "It's something you can't get in a lot of places. It gives you a good perspective on how these illnesses affect people's lives and breaks down the stigma that surrounds mental illnesses."

Although Carnahan's IMPACT internship ended in August, he still keeps in touch with many of the patients and is organizing a group rock-climbing event.

Schizophrenia is one of the topics that will be addressed during this fall's UI Mini Medical School on "New Hope in Understanding and Treating Mental Illness." Williams will discuss schizophrenia, and Clancy will discuss clinical depression at 7 p.m., Tuesday, Sept. 26 in the Medical Alumni Auditorium of the UI Hospitals and Clinics.

Pre-registration is required to attend the program. Call toll-free (800) 691-2323 or, in Iowa City, 384-9988. To register online, visit the web site

University of Iowa Health Care describes the partnership between the UI College of Medicine and the UI Hospitals and Clinics and the patient care, medical education and research programs and services they provide.