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Foxhoven: Counties Can Move Mental Health Regions As Long As Core Services Stay Intact

These are the current mental health regions in Iowa.

The head of Iowa’s Department of Human Services says the state’s regional mental health system is working, despite some counties leaving their regions and joining others. In Iowa, counties group together to manage and deliver their own mental health and disability services.

Before July 2014, each county was in charge of its own mental health services. DHS Director Jerry Foxhoven says smaller counties couldn’t provide all the services they needed, so the state had them work together.

Foxhoven was in Sioux City last week to talk about the state's child welfare system, but spoke with Iowa Public Radio and Siouxland Public Media after about the state's mental health system. The regions, he said, are working financially and they’ve elevated services for residents.

“There’s no question that citizens across Iowa have more mental health services now than they did when it was county-based,” Foxhoven said.

"I think it's relatively healthy for counties to say, 'Did we make the right pick to begin with?'..."

Each region is required to provide core mental health services to residents. These include crisis evaluation, home health aides and peer support services.  

But the regions have changed over time. Greene County in central Iowa moved from a four to an 11-county region called Central Iowa Community Services. The Sioux Rivers Mental Health and Disability Services region in northwest Iowa on Tuesday officially accepted Lyon County in and accepted Woodbury County’s resignation as they it move to a region to the east called Rolling Hills Community Services. Both are effective July 2019.

"The state is not trying to prescribe to regions how they run their region."

Foxhoven says DHS didn’t form the regions.  Counties split off into groups themselves. He doesn’t see a problem if counties want change.

“We kind of assumed, I think, that regions would try to get together and find out is this a good mix or not and I think it’s relatively healthy for counties to say ‘did we make the right pick to begin with or should we be with some different counties? Would it be a better mix somewhere else?’,” Foxhoven said.

Foxhoven says the most important thing is that counties continue to provide core mental health services to residents. He compared it to how schools are required to teach certain subjects to kids, like English and math.

“The state says to schools ‘these are the subjects you have to teach. We don’t really care how many people are on your school board. You decide on that.’ That’s kind of how it works with the regions as well. The state is not trying to prescribe to regions how they run their region,” Foxhoven said.

Fifteen regions formed when the state moved to regional systems in 2014. The smallest region that included Marion and Mahaska counties in southeast Iowa no longer exists because those two counties have since joined bigger regions.

DHS spokesman Matt Highland said in an email that at the time the regions formed, both counties’ plans to join one failed and they were out of time to apply for an exemption. Legislation allowed the two counties to form their own region.

“This allowed the two counties and the Department time to determine if they were able to meet all requirements and outcomes to function as region,” Highland said. “Following that period the counties joined the regions in which they are currently members.”

The state requires at least three counties per region, but Polk County is large enough to stand on its own. Woodbury County tried to become its own region earlier this year due to a poor working relationship with Plymouth and Sioux counties, but Foxhoven told the Sioux City Journal in April that the county cannot be on its own and a region with just Plymouth and Sioux wouldn't fit the three-county requirement. Woodbury County then applied to Rolling Hills and was accepted.

Foxhoven said the change in Sioux Rivers with the region losing Woodbury County and gaining Lyon County is “a little bit like a divorce.”

“You have property that’s owned by the region and you’re arguing about who gets it and how do you pay for it,” Foxhoven said. “What I’ve seen is that in spite of the disputes, ultimately all the affected counties have stepped back and said ‘what’s best in terms of services for our citizens’.”

Woodbury, Plymouth and Sioux counties share an assessment and stabilization center that belongs to Sioux Rivers. The property is located in Woodbury County. Don Kass, a Plymouth County supervisor who is on the Sioux Rivers Governing Board, said Sioux Rivers will continue to own the center when Woodbury County leaves the region. The board will discuss in the future how Rolling Hills and its counties could be involved and how the center could benefit both regions.

Katie Peikes is IPR's agriculture reporter