Mental health care in the state of Iowa is no longer just a state issue or a county issue. The state reorganized the financial handling and care for mental health patients into 14 individual regions. The funding mechanism has changed frequently over the last 3 years. What was once a capped, per capita county levy is now funded by the state to the regions with some counties still requiring a levy.
Member counties of Sioux Rivers Mental Health Region are Dickinson, Emmet, O’Brien, Lyon, Plymouth and Sioux. O’Brien moved from Care Connections to Sioux Rivers in 2021. Soux Rivers is based on Sioux Center.
Some cases of mental health cross into the court system. When that happens, the court can appoint an advocate. Iowa law prohibits mental health regions to hire advocates. The duties of an advocate often conflict with the interests of a mental health region, potentially creating a conflict of interest. When a patient gets entangled with the court system, an advocate’s duties are first to the best interest of the patient.
O’Brien County employs Abbie Wallin as a mental health advocate. Her services are provided to the Sioux Rivers Mental Health Region and also to part of the Care Connections Region based in Spencer.
At the March 7, 2023 O’Brien County Supervisors meeting a discussion was held over some activity of Sioux Rivers’ staff leadership. Wallin came to the supervisors seeking clarification of her employment and duties which were reinforced by the board. Efforts by Sioux Rivers leadership were in part attempting to establish compensation for the advocate position which is the responsibility of the employer. Oftentimes, the treatment recommendation of the advocate for any particular patient embroiled in the courts is costly. The recommendation might be hospitalization which is costly and can be the responsibility of the region. In not plain language it seemed as if the Sioux Rivers Region was attempting to influence treatment decisions.
During the meeting the Sioux Rivers agreement was examined. The advocate’s scope of services was discussed thoroughly. Item 1 identifies the advocate as an O’Brien County employee and directs the performance of advocate duties to the counties of the region. The manner in which the advocate performs their services is set by state code. According to the agreement the Sioux Rivers CEO and its Governance Board can give direction to the advocate. No action was taken.

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