How are You Going to Pay for It?

Push for better mental health services long enough and you will hear that question.

This blog will help explain ways in which the money we have for mental health services could bring about greater returns and explore how to increase those resources.  I will focus on the impact on Dane County residents of decisions made at all levels of government and will include reports of on-the-ground efforts by local advocates to help bring about reform in mental health services.

I know the mental health system at personal and professional levels.  My sister was first hospitalized with a diagnosis of schizophrenia when she was 14.  She is 74, so I have first-hand knowledge of improvements in care and the continuing failures of the system.  I was a reporter for Psychiatric News, the bi-weekly publication of the American Psychiatric Association, specializing in health care economics and community psychiatry. Katie L Mulligan

NOTE:   A disproportionate number of people in the criminal justice system have a mental illness.   People advocating for family members and others with a mental illness are seeing that intersection and urging criminal justice reform.  It is also clear that taxpayer dollars are being wasted because of the current jail and prison systems.  I will be adding news about criminal justice reform to this blog.  

Winnebago Mental Health Institute a Threat to Patients

More problems have surfaced with the use of the Winnebago Mental Health Institute for Dane County residents and others suffering from acute psychotic episodes.   Two Madison police officers drive two hours each way to escort a person in great stress to Oshkosh.  The person likely deteriorates and the officers spend time that could be better used in policing.

Mental health advocates, family members, and criminal justice professionals have all urged a better approach to the problem of getting care for a person who could be a danger to himself or others.

A recent article suggests that the trip might be the least of the problems with the use of Winnebago.  Read “Feds Sanction Winnebago Mental Health Institute” by WSJ reporter David Wahlberg to learn about a series of horrific incidents that threatened the lives of patients and put Medicare funds in jeopardy.

In December and February, federal inspectors issued 48 citations for violations of important Medicare rules including  improper patient care, inadequate nursing staff, poor oversight of medical staff, and an unsafe physical environment.

Even more shocking are some of the incidents Wahlberg reports.

“After a patient fell and hit his head, it took more than 14 hours before he was sent to an emergency room, where he needed surgery for a brain bleed.”

“Before another patient was discharged, he told a nurse he would jump out of his father’s vehicle on the way home. After his father picked him up, the patient ran onto a highway. He was readmitted.”   The patient had initially been admitted for a suicide attempt and had tested positive in a suicide screening the month he was released.

At 10 a.m. Oct. 15, [a] patient was seen hitting his head on the floor. Afterward, he lay unresponsive in a day room for about 12 hours, including at least two hours after urinating on himself and not being cleaned up, before nurses returned him to his room, inspectors said.   A doctor working at Winnebago temporarily assessed the patient twice that day and said there were no concerns, including no brain bleed. Nurses said they didn’t move or change him earlier because of short staffing, though a nursing supervisor told inspectors other nurses were available to help. After “neurochecks” were done on the patient at 11:10 p.m., and another doctor on call said he should go to the ER, he was taken there at 12:30 a.m. the next day.”

Poor management and callousness at Winnebago are obvious.  However, the difficulties of getting help for people with severe mental illness go beyond that institution.  Wahlberg also reported on violations by Strategic Behavioral Health, the company approved to open a psychiatric facility in Middleton.  Click here to read his article.

The solution is both simple and complicated.  We need more public money for mental health services.  Rallying support for that money and figuring out how to spend it are the complicated aspects.

A first step is passage of a bill that would have provided funds for the establishment  of mental health crisis centers throughout the state.   The bill was supported by county governments, criminal justice organizations, and the League of Women Voters.

Click here to read a letter to the editor describing that bill and the diverse support for it.    This legislative session has ended, but we have an opportunity in November to elect representatives who will support the use of public money to help those who need it most.

UPDATE:  The man who fell and was left on the floor for 14 hours later died.  Click here to read an article about the investigation.

 

 

Federal grants to decrease the number of people with serious mental illness in jail: Deadline May 29

Here is an announcement from Stepping Up about a grant program to reduce the number of people with serious mental illness in jail.  The Dane County government and Journey Mental Health appear to be eligible for funding. 
The U.S. Department of Justice, Office of Justice Programs-Bureau of Justice Assistance seeks applications for funding for The Justice and Mental Health Collaboration Program (JMHCP). The JMHCP supports cross-system collaboration to improve responses and outcomes for people who have mental illnesses or co-occurring substance use disorders who come into contact with the criminal justice system. This grant program provides awards ranging between $100,000 and $750,000 for a 12- to 36-month project period to states, units of local governments, federally recognized Indian tribal governments, and state-county authorized mental health authorities.

There are three grant categories:
Category 1: Collaborative County Approaches to Reducing the Prevalence of Individuals with Serious Mental Illnesses in Jails
Category 2: Strategic Planning for Law Enforcement and Mental Health Collaboration
Category 3: Implementation and Expansion

The deadline to apply is May 29.

Register for Webinar about This Funding Opportunity
The Council of State Governments Justice Center, with funding support from the U.S. Department of Justice’s Bureau of Justice Assistance, will be hosting a webinar to provide guidance on how to respond to this solicitation on Tuesday, May 8 from 2-3:30 p.m.

Click here for the announcement, including links for more information and registration.

Advocate for Youth Mental Health: Join “Kids in Crisis” Event on May 10 in Madison

USA-Today in Wisconsin has been running an excellent series on youth mental health.  Click here for a link to some of the articles in the Kids in Crisis series.

Young people will share their stories at a Madison event on May 10, to be followed by opportunities for state advocacy.  Here is the information:

Our “Kids in Crisis Day of Action”  event will be from 10 a.m. to 11:30 a.m. May 10 at the Overture Center for the Arts, 201 State St. in Madison.

 

 

 

 

 

Older Prisoners Languish and Cost Taxpayers Millions Each Year

Here are some key take-aways from an excellent article in the Milwaukee Journal Sentinel.

“More than 1,200 people age 60 and older were serving time in Wisconsin prisons as of Dec. 31, 2016, the most recent count available. By one estimate, the average cost to incarcerate each of them is $70,000 a year — for an annual total of $84 million.”

“Last year, just six inmates were freed under [Wisconsin’s compassionate release program].   Among those who didn’t qualify were a blind quadriplegic and a 65-year-old breast cancer survivor who uses a breathing machine and needs a wheelchair to make it from her cell to the prison visiting room.”

“From August 2, 2011, through the end of June 2017, 25 people were released under the program, according to the corrections department. Only one was approved due to advanced age alone; the others had health conditions.

“A key reason is this: The law governing compassionate release says only people whose crimes were committed on or after Dec. 31, 1999, making them subject to truth in sentencing, are eligible.

“More than 25% of the state’s elderly prisoners serving long sentences — as well as some younger people with serious health problems — were locked up before that. That means some of the oldest and sickest prisoners can’t apply.

The article contains compelling examples of prisoners whose release would cause no threat to public safety and would save taxpayer dollars.  Click here to read “Compassionate Release Could Save Millions.”

Wisconsin Luminairies Focus Attention on Problems caused by Trauma

Important efforts by two dissimilar leaders in Wisconsin show emerging attention to the problems caused by childhood and other trauma.

In March, Marquette University President Mike Lovell issued an invitation to community groups to submit proposals to work with the university to address problems of trauma.  In November, he had hosted an “Epidemic of Trauma Conference.”   Here is an excerpt for the Milwaukee Journal Sentinel‘s article.

” Lovell predicts [the proposals are] almost certain to include treatment for neurological trauma — a condition that exists on an epidemic level in Milwaukee, where children in some districts routinely are exposed to homicide, neglect, abuse, violence, incarceration, alcohol and drugs as well as gunfire and police sirens, statistics show. Widespread trauma, in turn, worsens the ongoing social crisis in a city that for decades has defined the national extremes of poverty, unemployment, incarceration, infant mortality and broken homes…”

Click here to read details about his announcement and the problems in Milwaukee.

First Lady Tonette Walker aims to make Wisconsin the first “fully trauma-informed” state in the nation.  Her op ed describes progress at the Menominee Nation and her understanding of the harm caused by early trauma.  Here is an excerpt from her piece.

“We’ve made significant progress in other areas of our state as well, like in state government. Already, six Wisconsin agencies, including the Department of Health Services, Department of Veterans Affairs, Department of Workforce Development, Department of Children and Families, Department of Corrections, and Wisconsin Economic Development Corporation are implementing trauma-informed Care principles within their interactions with each other, as well as in the services they provide to the people of our state.

Click here to read Walker’s op ed.

UPDATE:  The MJS published an article describing an enthusiastic response by a broad spectrum of Milwaukee residents to Lovell’s proposals.  Click here to read the article.

Here is an excerpt.

“More than two dozen community organizations have expressed interest in the effort, along with 18 academics. And a wide range of community activists have been attending meetings to learn more and plant the seeds of collaboration.

“There’s tremendous interest in the community,” Mike Lovell said.

Lovell wants to organize a major conference in late September, bring together as many national trauma researchers and local activists as possible, maybe even rent the new Milwaukee Bucks arena as a venue.

“This has got to get really big,” said Franklin Cumberbatch, a member of Lovell’s steering committee and executive at Milwaukee-based Bader Philanthropies.”

 

Congress Shows Promising Increase of Bipartisan Support for Criminal Justice Reform: So Does Wisconsin

Democrats and Republicans in the Assembly’s Corrections Committee crafted an ambitious plan to close the notorious Lincoln Hills/Copper Lakes complex, negotiated successfully with county governments, ultimately got a unanimous vote for the bill in the Assembly and the governor’s signature.  It was a rare bipartisan success story.

At the federal level, representatives of both parties also are working together successfully, despite the punitive approach of the U.S. Attorney General.

Here are some examples from the Council of State Government’s Justice Center.

Congressional leaders in March took strong bipartisan action in support of three programs in FY 2019—the Second Chance Act, the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA), and the Justice Reinvestment Initiative (JRI)—aimed at increasing public safety and reducing recidivism at the local and state level.
U.S. Reps. Bill Johnson (R-OH), Danny Davis (D-IL), and Mark Walker (R-NC) gathered 74 signatures from members of the House in support of continued funding for the Second Chance Act, which will mark its 10th anniversary this year.
U.S. Reps. Doug Collins (R-GA), Bobby Scott (D-VA), Leonard Lance (R-NJ), and Norma Torres (D-CA) gathered 68 signatures from members of the House in support of continued funding for MIOTCRA.
U.S. Reps. Adam Schiff (D-CA) and Tom Marino (R-PA) gathered 68 signatures from members of the House in support of continued funding for JRI, a data-driven approach that helps states reduce corrections and related criminal justice spending and reinvest savings in strategies that improve public safety.

 

 

Problems Raised with SBH’s Proposal for a Psychiatric Hospital/Crisis Restoration Center

Middleton’s planning commission will host a public hearing on April 10 about the plans of Strategic Behavioral Health (SBH) to open a 72-bed psychiatric facility.  The city council has already endorsed the idea of providing $1.2 million in tax incremental financing to the for-profit company.

Through a review of public records, WSJ reporter David Wahlberg has uncovered a  number of violations by SBH in its operations in other states and nearby Green Bay.   Here are some of the most troublesome excerpts from his article.

“The Green Bay facility, called Willow Creek Behavioral Health, has had four medical directors, [since January 2017] and current and former employees say the facility is short-staffed. Aurora Health Care, which did medical exams at the hospital, terminated the contract this January.”

“After 10 youth escaped from Strategic Behavioral Center in Charlotte, North Carolina, on New Year’s Day, the state suspended admissions, issued a $20,000 fine and gave the psychiatric hospital an immediate jeopardy violation for failing to keep the facility secure.

The sanctions are among nine immediate jeopardy citations and other serious actions taken in recent years against psychiatric hospitals owned by Strategic Behavioral Health…”

“Immediate jeopardy “is the highest level of potential sanction, and it is not common,” said Mark Covall, CEO of the National Association of Behavioral Healthcare, which represents psychiatric hospitals and includes Strategic Behavioral Health as a member.

“But the real key is whether or not the hospital made the changes that were necessary to continue their license,” Covall said.”

Click here to read David Wahlberg’s article about the violations and responses of advocates, public officials, and health care experts.   Click here to read a description of the violations.

Click here to read an article in Isthmus about the problems with SBH.