In 2017, the legislature requested a workgroup to look at persons with complex needs in Iowa. And, the legislature asked the workgroup to make recommendations related to the delivery and access of services needed for persons needing multiple types of care.

When the regional mental health system was designed, we did not have good data. We knew we had clients with complicated needs in Iowa. But, we had not been tracking them with unique identifiers. And, we could not confirm exactly how many people there were. Nor, did we know what needs they had.


As a result of the new regional legislation, regions started collecting data in 2013. Over a few years, data proved that some people were falling in the cracks. Iowa needed more robust services to wrap around and support people. And most importantly, people wanted services in the community where they lived.

What are Complex Needs?

The workgroup defined complex issues as a combination of mental health, substance use and disability needs. Often, these needs couple with housing or food security issues or behavioral challenges. Or, it could include a lack of support, or many other factors.

The Complex needs workgroup submitted a report to the legislature in December 2017. This report outlined their recommendations for meeting the needs of persons with complex issues. Most importantly, the workgroup identified several new services to add to the regional core base.

What services were added for complex needs?

Complex needs report suggested the following services:

  1. 6 Access Centers
  2. 22 Assertive Community Treatment (ACT) Teams
  3. A full array of mental health crisis response and sub-acute services
  4. Intensive residential service homes for 120 people
  5. Tertiary Care psychiatric hospitals

When the law passed, all but the tertiary care psychiatric hospitals made the core set of services within each region.

As a result, the regions implemented the full array of mental health crisis response services. Many regions had developed some of these before the legislation. As, the law previously listed these as “core plus” services. Many counties had already implemented some if not all of these services within each region.  Several regions created ACT teams, but not regions pushed into rural areas. Regions now must address issues like reimbursement rates and workforce limiting the development of the service.

Regions together with the state planned what an access center should look like and where in Iowa they should be developed. The State began writing rules for access centers and Intensive residential service homes. And an additional workgroup was formed to finalize the look and partnership of the tertiary hospital recommendation.

Our next post will look at the complex needs services in detail including the rule requirements for each.

Discussion Question:

After reviewing the complex needs legislation, what do you see as additional gaps in the system?