CHAPTER 226
STATE MENTAL HEALTH INSTITUTES

Referred to in §21.5, 125.2, 225C.6, 229.1, 229.38, 229.42, 331.389, 476B.1

SUBCHAPTER I
GENERAL PROVISIONS

  
     
226.1  Official designation — definitions.
  1.  The state hospitals for persons with mental illness shall be designated as follows:
  a.  Mental Health Institute, Independence, Iowa.
  b.  Mental Health Institute, Cherokee, Iowa.
  2.  a.  The purpose of the mental health institutes is to operate as regional resource centers providing one or more of the following:
  (1)  Treatment, training, care, habilitation, and support of persons with mental illness or a substance abuse problem.
  (2)  Facilities, services, and other support to the communities located in the region being served by a mental health institute so as to maximize the usefulness of the mental health institutes while minimizing overall costs.
  (3)  A unit for the civil commitment of sexually violent predators committed to the custody of the director of human services pursuant to chapter 229A.
  b.  In addition, the mental health institutes are encouraged to act as a training resource for community-based program staff, medical students, and other participants in professional education programs.
  3.  A mental health institute may request the approval of the council on human services to change the name of the institution for use in communication with the public, in signage, and in other forms of communication.
  4.  For the purposes of this chapter, unless the context otherwise requires:
  a.  “Administrator” means the person assigned by the director of human services to control the state mental health institutes.
  b.  “Department” means the department of human services.
  c.  “Mental health and disability services region” means a mental health and disability services region formed in accordance with section 331.389.
  d.  “Regional administrator” means the regional administrator of a mental health and disability services region, as defined in section 331.388.
[R60, §1471; C73, §1383; C97, §2253; S13, §2253-a; C24, 27, 31, 35, 39, §3483; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.1]
96 Acts, ch 1129, §113; 98 Acts, ch 1155, §10
; 2001 Acts, 2nd Ex, ch 6, §33, 37
; 2009 Acts, ch 41, §263; 2015 Acts, ch 69, §44; 2019 Acts, ch 100, §2
Referred to in §230.20
Unit for civil commitment of sexually violent predators located at the mental health institute at Cherokee; 2002 Acts, 2nd Ex, ch 1003, §131

     
226.2  Qualifications of superintendent.
  The superintendent of each institute must be qualified by experience and training in the administration of human service programs. A physician shall not serve as both superintendent and business manager. A hospital administrator or other person qualified in business management appointed superintendent may also be designated to perform the duties of business manager without additional compensation. A physician appointed superintendent shall be designated clinical director and shall perform the duties imposed on the superintendent by section 226.6, subsection 1, and such other duties of the superintendent as must by their nature be performed by a physician.
[R60, §1430, 1474; C73, §1386, 1391; C97, §2255, 2258; C24, 27, 31, 35, 39, §3484; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.2; 81 Acts, ch 79, §1]

     
226.3  Assistant physicians.
  The assistant physicians shall be of such character and qualifications as to be able to perform the ordinary duties of the superintendent during the superintendent’s absence or inability to act.
[R60, §1432; C73, §1394; C97, §2260; C24, 27, 31, 35, 39, §3485; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.3]

     
226.4  Salary of superintendent.
  The salary of the superintendent of each hospital shall be determined by the administrator.
[R60, §1469, 1496; C97, §2258; C24, 27, 31, 35, 39, §3486; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.4]

     
226.5  Superintendent as witness.
  The superintendents and assistant physicians of said hospitals, when called as witnesses in any court, shall be paid the same mileage which other witnesses are paid and in addition thereto shall be paid a fee of twenty-five dollars per day, said fee to revert to the support fund of the hospital the superintendent or assistant physician serves.
[C73, §1429; C97, §2293; C24, 27, 31, 35, 39, §3487; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.5]
Mileage, §622.69 

     
226.6  Duties of superintendent.
  The superintendent shall:
  1.  Have the control of the medical, mental, moral, and dietetic treatment of the patients in the superintendent’s custody subject to the approval of the administrator.
  2.  Require all subordinate officers and employees to perform their respective duties.
  3.  Have an official seal with the name of the hospital and the word “Iowa” thereon and affix the same to all notices, orders of discharge, or other papers required to be given by the superintendent.
  4.  Keep proper books in which shall be entered all moneys and supplies received on account of any patient and a detailed account of the disposition of the same.
[R60, §1430, 1431; C73, §1391, 1393, 1430; C97, §2258, 2294; C24, 27, 31, 35, 39, §3488; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.6]
Referred to in §226.2

     
226.7  Order of receiving patients.
  1.  a.  Preference in the reception of patients into said hospitals shall be exercised in the following order:
  (1)  Cases of less duration than one year.
  (2)  Chronic cases, where the disease is of more than one-year duration, presenting the most favorable prospect for recovery.
  (3)  Those for whom application has been longest on file, other things being equal.
  b.  Where cases are equally meritorious in all other respects, the indigent shall have the preference.
  2.  If the district court commits a patient to a state mental health institute and a bed for the patient is not available, the institute shall assist the court in locating an alternative placement for the patient.
[R60, §1438; C73, §1422; C97, §2286; C24, 27, 31, 35, 39, §3489; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.7]
92 Acts, ch 1241, §69; 2009 Acts, ch 41, §263

     
226.8  Persons with an intellectual disability not receivable — exception.
  A person who has an intellectual disability, as defined in section 4.1, shall not be admitted, or transferred pursuant to section 222.7, to a state mental health institute unless a professional diagnostic evaluation indicates that such person will benefit from psychiatric treatment or from some other specific program available at the mental health institute to which it is proposed to admit or transfer the person. Charges for the care of any person with an intellectual disability admitted to a state mental health institute shall be made by the institute in the manner provided by chapter 230, but the liability of any other person to any county for the cost of care of such person with an intellectual disability shall be as prescribed by section 222.78.
[R60, §1468, 1491; C73, §1434; C97, §2298; C24, 27, 31, 35, 39, §3490; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.8]
96 Acts, ch 1129, §113; 2012 Acts, ch 1019, §75

     
226.9  Custody of patient.
  The superintendent, upon the receipt of a duly executed order of admission of a patient into the hospital for persons with mental illness, pursuant to section 229.13, shall take such patient into custody and restrain the patient as provided by law and the rules of the administrator, without liability on the part of such superintendent and all other officers of the hospital to prosecution of any kind on account thereof, but no person shall be detained in the hospital who is found by the superintendent to be in good mental health.
[C73, §1411; C97, §2278; C24, 27, 31, 35, 39, §3491; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.9]
96 Acts, ch 1129, §113

     
226.9A  Custody of juvenile patients.
  Effective January 1, 1991, a juvenile who is committed to a state mental health institute shall not be placed in a secure ward with adults.
89 Acts, ch 283, §21

     
226.9B  Net general fund appropriation — psychiatric medical institution for children.
  1.  The psychiatric medical institution for children beds operated by the state at the state mental health institute at Independence, as authorized in section 135H.6, shall operate on the basis of a net appropriation from the general fund of the state. The allocation made by the department from the annual appropriation to the state mental health institute at Independence for the purposes of the beds shall be the net amount of state moneys projected to be needed for the beds for the fiscal year of the appropriation.
  2.  Revenues received that are attributed to the psychiatric medical institution for children beds during a fiscal year shall be credited to the mental health institute’s account and shall be considered repayment receipts as defined in section 8.2, including but not limited to all of the following:
  a.  The federal share of medical assistance program revenue received under chapter 249A.
  b.  Moneys received through client financial participation.
  c.  Other revenues directly attributable to the psychiatric medical institution for children beds.
2005 Acts, ch 175, §95

  
     
226.9C  Net general fund appropriation — dual diagnosis program.  Repealed by 2018 Acts, ch 1165, §77.

  
     
226.10  Equal treatment.
  The patients of the state mental health institutes, according to their different conditions of mind and body, and their respective needs, shall be provided for and treated with equal care. If in addition to mental illness a patient has a co-occurring intellectual disability, brain injury, or substance abuse disorder, the care provided shall also address the co-occurring needs.
[C73, §1420; C97, §2284; C24, 27, 31, 35, 39, §3492; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.10]
2012 Acts, ch 1120, §64

     
226.11  Special care permitted.
  Patients may have such special care as may be agreed upon with the superintendent, if the friends or relatives of the patient will pay the expense thereof. Charges for such special care and attendance shall be paid quarterly in advance.
[C73, §1420, 1421; C97, §2284, 2285; C24, 27, 31, 35, 39, §3493; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.11]

     
226.12  Monthly reports.
  The administrator shall assure that the superintendent of each institute provides monthly reports concerning the programmatic, environmental, and fiscal condition of the institute. The administrator or the administrator’s designee shall periodically visit each institute to validate the information.
[C73, §1435, 1441; C97, §2299; SS15, §2727-a11; C24, 27, 31, 35, 39, §3494; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.12]
91 Acts, ch 38, §6

     
226.13  Patients allowed to write.
  The name and address of the administrator shall be kept posted in every ward in each hospital. Every patient shall be allowed to write once a week what the patient pleases to said administrator and to any other person. The superintendent may send letters addressed to other parties to the administrator for inspection before forwarding them to the individual addressed.
[C73, §1436; C97, §2300; C24, 27, 31, 35, 39, §3495; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.13]

     
226.14  Writing material.
  Every patient shall be furnished by the superintendent or party having charge of such person, at least once in each week, with suitable materials for writing, enclosing, sealing, and mailing letters, if the patient requests and uses the same.
[C73, §1437; C97, §2301; C24, 27, 31, 35, 39, §3496; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.14]

     
226.15  Letters to administrator.
  The superintendent or other officer in charge of a patient shall, without reading the same, receive all letters addressed to the administrator, if so requested, and shall properly mail the same, and deliver to such patient all letters or other writings addressed to the patient. Letters written to the person so confined may be examined by the superintendent, and if, in the superintendent’s opinion, the delivery of such letters would be injurious to the person so confined, the superintendent shall return the letters to the writer with the superintendent’s reasons for not delivering them.
[C73, §1438; C97, §2302; C24, 27, 31, 35, 39, §3497; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.15]

     
226.16  Unauthorized departure and retaking.
  It shall be the duty of the superintendent and of all other officers and employees of any of said hospitals, in case of the unauthorized departure of any involuntarily hospitalized patient, to exercise all due diligence to take into protective custody and return said patient to the hospital. A notification by the superintendent of such unauthorized departure to any peace officer of the state or to any private person shall be sufficient authority to such officer or person to take and return such patient to the hospital.
[R60, §1445; C73, §1423; C97, §2287; S13, §2287; C24, 27, 31, 35, 39, §3498; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.16]

  
     
226.17  Expense attending retaking.
  All actual and necessary expenses incurred in the taking into protective custody, restraint, and return to the hospital of the patient shall be paid on itemized vouchers, sworn to by the claimants and approved by the business manager and the administrator, from any moneys in the state treasury not otherwise appropriated.
[R60, §1445; C73, §1423; C97, §2287; S13, §2287; C24, 27, 31, 35, 39, §3499; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.17]
2019 Acts, ch 24, §104

     
226.18  Investigation as to mental health.
  The administrator may investigate the mental condition of any patient and shall discharge any person, if, in the administrator’s opinion, such person is not mentally ill, or can be cared for after such discharge without danger to others, and with benefit to the patient; but in determining whether such patient shall be discharged, the recommendation of the superintendent shall be secured. If the administrator orders the discharge of an involuntarily hospitalized patient, the discharge shall be by the procedure prescribed in section 229.16. The power to investigate the mental condition of a patient is merely permissive, and does not repeal or alter any statute respecting the discharge or commitment of patients of the state hospitals.
[S13, §2727-a25; C24, 27, 31, 35, 39, §3500; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.18]

     
226.19  Discharge — certificate.
  1.  Every patient shall be discharged in accordance with the procedure prescribed in section 229.3 or section 229.16, whichever is applicable, immediately on regaining the patient’s good mental health.
  2.  If a patient’s care is the financial responsibility of the state or a county, as part of the patient’s discharge planning the state mental health institute shall provide assistance to the patient in obtaining eligibility for the federal state supplemental security income program.
[R60, §1485; C73, §1424; C97, §2288; C24, 27, 31, 35, 39, §3501; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.19]
2005 Acts, ch 175, §97; 2006 Acts, ch 1010, §68
226.20 and 226.21Reserved. 

     
226.22  Clothing furnished.
  Upon such discharge the business manager shall furnish such person, unless otherwise supplied, with suitable clothing and a sum of money not exceeding twenty dollars, which shall be charged with the other expenses of such patient in the hospital.
[R60, §1485; C73, §1424; C97, §2288; C24, 27, 31, 35, 39, §3504; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.22]

     
226.23  Convalescent leave of patients.
  Upon the recommendation of the superintendent and in accordance with section 229.15, subsection 5, in the case of an involuntary patient, the administrator may place on convalescent leave said patient for a period not to exceed one year, under such conditions as are prescribed by said administrator.
[C73, §1424; C97, §2288; C24, 27, 31, 35, 39, §3505; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.23]
226.24 and 226.25Reserved. 

     
226.26  Dangerous patients.
  The administrator, on the recommendation of the superintendent, and on the application of the relatives or friends of a patient who is not cured and who cannot be safely allowed to go at liberty, may release the patient when fully satisfied that the relatives or friends will provide and maintain all necessary supervision, care, and restraint over the patient. If the patient being released was involuntarily hospitalized, the consent of the district court which ordered the patient’s hospitalization placement shall be obtained in advance in substantially the manner prescribed by section 229.14.
[R60, §1482; C73, §1408; C97, §2276; C24, 27, 31, 35, 39, §3508; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.26]
2001 Acts, ch 155, §42

     
226.27  Patient accused or acquitted of crime or awaiting judgment.
  If a patient was committed to a state hospital for evaluation or treatment under chapter 812 or the rules of criminal procedure, further proceedings shall be had under chapter 812 or the applicable rule when the evaluation has been completed or the patient has regained mental capacity, as the case may be.
[R60, §1460; C73, §1413; C97, §2280; C24, 27, 31, 35, 39, §3509; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.27]
84 Acts, ch 1323, §1
226.28 and 226.29Reserved. 

  
     
226.30  Transfer of dangerous patients.
  When a patient of any hospital for persons with mental illness becomes incorrigible and unmanageable to such an extent that the patient is dangerous to the safety of others in the hospital, the administrator, with the consent of the director of the Iowa department of corrections, may apply in writing to the district court or to any judge thereof, of the county in which the hospital is situated, for an order to transfer the patient to the Iowa medical and classification center and if the order is granted the patient shall be so transferred. The county attorney of the county shall appear in support of the application on behalf of the administrator.
[C24, 27, 31, 35, 39, §3512; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.30; 82 Acts, ch 1100, §6]
96 Acts, ch 1129, §113; 2019 Acts, ch 100, §3
Referred to in §226.31, 331.756(39)
See also §218.92 

  
     
226.31  Examination by court — notice.
  Before granting the order authorized in section 226.30, the court or judge shall investigate the allegations of the petition and before proceeding to a hearing on the allegations shall require notice to be served on the attorney who represented the patient in any prior proceedings under sections 229.6 through 229.15 or the advocate appointed under section 229.19, or in the case of a patient who entered the hospital voluntarily, on any relative, friend, or guardian of the person in question of the filing of the application. At the hearing the court or judge shall appoint a guardian ad litem for the person, if the court or judge deems such action necessary to protect the rights of the person. The guardian ad litem shall be a practicing attorney.
[C24, 27, 31, 35, 39, §3513; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.31]
90 Acts, ch 1271, §1503; 2020 Acts, ch 1063, §84

     
226.32  Overcrowded conditions.
  The administrator shall order the discharge or removal from the hospital of incurable and harmless patients whenever it is necessary to make room for recent cases. If a patient who is to be so discharged entered the hospital voluntarily, the administrator shall notify the regional administrator for the county interested at least ten days in advance of the day of actual discharge.
[R60, §1483; C73, §1425; C97, §2289; C24, 27, 31, 35, 39, §3514; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.32]
2015 Acts, ch 69, §46
Referred to in §226.33

     
226.33  Notice to court.
  When a patient who was hospitalized involuntarily and who has not fully recovered is discharged from the hospital by the administrator under section 226.32, notice of the order shall at once be sent to the court which ordered the patient’s hospitalization, in the manner prescribed by section 229.14.
[R60, §1484; C73, §1426; C97, §2290; C24, 27, 31, 35, 39, §3515; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.33]
2001 Acts, ch 155, §43

     
226.34  Investigation of death — notice.
  1.  Upon the death of a patient, the county medical examiner shall conduct a preliminary investigation as required by section 218.64, in accordance with section 331.802.
  2.  If a patient in a mental health institute dies from any cause, the superintendent of the institute shall within three days of the date of death, send by certified mail a written notice of death to all of the following:
  a.  The decedent’s nearest relative.
  b.  The clerk of the district court of the county from which the patient was committed.
  c.  The sheriff of the county from which the patient was committed.
  d.  The regional administrator for the county from which the patient was committed.
[C73, §1439; C97, §2303; C24, 27, 31, 35, 39, §3516; C46, 50, 54, 58, 62, 66, 71, 73, 75, 77, 79, 81, §226.34]
2008 Acts, ch 1187, §136; 2015 Acts, ch 69, §47
226.35 through 226.39Reserved. 

     
226.40  Emergency patients.
  In case of emergency disaster, with the infliction of numerous casualties among the civilian population, the mental health institutes are authorized to accept sick and wounded persons without commitment or any other formalities.
[C62, 66, 71, 73, 75, 77, 79, 81, §226.40]
Referred to in §226.41

  
     
226.41  Charge permitted.
  The hospital is authorized to make a charge for patients admitted under section 226.40, in the manner provided by law and subject to the changes provided in section 226.42.
[C62, 66, 71, 73, 75, 77, 79, 81, §226.41]
2019 Acts, ch 59, §65

     
226.42  Emergency powers of superintendents.
  In case the mental health institutes lose contact with the statehouse, due to enemy action or otherwise, the superintendents of the institutes are hereby delegated the following powers and duties:
  1.  May collect moneys due the state treasury from the counties and from responsible persons or other relatives, these funds to be collected monthly, instead of quarterly, and to be deposited for use in operating the institutes.
  2.  The superintendent shall have the power to requisition supplies, such as food, fuel, drugs and medical equipment, from any source available, in the name of the state, with the power to enter into contracts binding the state for payment at an indefinite future time.
  3.  The superintendent shall be authorized to employ personnel in all categories and for whatever remuneration the superintendent deems necessary, without regard to existing laws, rules or regulations, in order to permit the institute to continue its old functions, as well as meet its additional responsibilities.
[C62, 66, 71, 73, 75, 77, 79, 81, §226.42]
Referred to in §226.41

SUBCHAPTER II
PATIENTS’ PERSONAL FUNDS

  
     
226.43  Fund created.
  There is hereby established at each hospital a fund known as the “patients’ personal deposit fund”.
[C66, 71, 73, 75, 77, 79, 81, §226.43]
Referred to in §222.84

     
226.44  Deposits.
  Any funds, including social security benefits, coming into the possession of the superintendent or any employee of the hospital belonging to any patient in that hospital, shall be deposited in the name of that patient in the patients’ personal deposit fund, except that if a guardian of the property of that patient has been appointed, the guardian shall have the right to demand and receive such funds. Funds belonging to a patient deposited in the patients’ personal deposit fund may be used for the purchase of personal incidentals, desires and comforts for the patient.
[C66, 71, 73, 75, 77, 79, 81, §226.44]
Referred to in §222.84

  
     
226.45  Reimbursement to county or state.
  If a patient is not receiving medical assistance under chapter 249A and the amount in the account of any patient in the patients’ personal deposit fund exceeds two hundred dollars, the business manager of the hospital may apply any of the excess to reimburse the county of residence or the state when the patient is a resident in another state or in a foreign country, or when the patient’s residence is unknown, for liability incurred by the county or the state for the payment of care, support, and maintenance of the patient, when billed by the county of residence or by the administrator when the patient is a resident in another state or in a foreign country, or when the patient’s residence is unknown.
[C66, 71, 73, 75, 77, 79, 81, S81, §226.45; 81 Acts, ch 11, §16]
2012 Acts, ch 1120, §98, 130; 2018 Acts, ch 1165, §68
Referred to in §222.84

     
226.46  Deposit of fund.
  The business manager shall deposit the patients’ personal deposit fund in a commercial account of a bank of reputable standing. When deposits in the commercial account exceed average monthly withdrawals, the business manager may deposit the excess at interest. The savings account shall be in the name of the patients’ personal deposit fund and interest paid thereon may be used for recreational purposes at the hospital.
[C66, 71, 73, 75, 77, 79, 81, §226.46]
Referred to in §222.84

  
     
226.47  Administrator defined.  Repealed by 2015 Acts, ch 69, §79.