Drug Courts Save Taxpayer Dollars, but Show Bias Against Black Offenders

Wisconsin drug courts grow, but racial disparities persist,”  an excellent article by Taylor Chase of the Wisconsin Center for Investigative Journalism, can help inform the most recent efforts to bring  about criminal justice reform.

The good news: drug courts work and save money.  The article cites a study by Randall Brown, Ph.D., at UW-Madison, who found that offenders who participated in drug treatment courts were 50 percent less likely to commit new crimes.

A study by the UW Population Health Institute found that in seven alternative treatment programs funded by the state, 2,061 offenders over more than four years avoided more than 135,000 days of incarceration.  That study offered a cost-benefit analysis showing that the Treatment Alternatives and Diversion Benefits program resulted in financial benefits of nearly $1 for every $1 invested in the program by saving costs to the criminal justice system.

The bad news: black offenders are less likely to benefit from the opportunities offered by drug courts than white offenders.  According to the article, in 2012, about one-third of those arrested for drug crimes in Dane County were black, but they made up only 10 percent of those participating in the county’s drug program that year.  In May of 2014, 84 percent of defendants in Dane County’s drug court were white.

Chase also offers speculation by experts about why the disparities exist and a brief history of the establishment of drug treatment courts in Wisconsin.




Mental Health Gains under Affordable Health Care Act, but Miles to Go

Politico published a good summary of the effects of the Affordable Health Care Act on mental health services.  In short, inpatient services have benefitted, meaning fewer patients are languishing in ERs. Psychiatric hospitals and other institutions are being compensated for the care they provide, meaning they can provide more of it.

Outpatient care, however, remains difficult to access. Parity has been poorly enforced.   An insurance policy does not guarantee access to mental health treatment because of the limited number of psychiatrists and other mental health professionals included in company networks and other obstacles those companies create. Reimbursement rates for Medicaid patients remain low.  Dane County’s Journey, for example, recently announced it could no longer afford to accept Medicaid fee-for-service patients.

Read the full article here.


Good News on Mental Health Legislation, But Not Good Enough

The Helping Families in Mental Health Crisis Act passed the House of Representatives last week with a vote of 422-2.  In March the Mental Health Reform Act of 2016 was passed out of committee to the full Senate for a vote.

Good news, but as Linda Rosenberg, CEO of the National Council for Behavioral Health, points out, it could be better.  She has an excellent op-ed piece in the The Hill, that describes how the legislation could be improved.  Read it here.   Below are two paragraphs that are direct quotes from her piece.

“Provisions based on the Excellence in Mental Health Act, sponsored by Sens. Debbie Stabenow (D-Mich.) and Roy Blunt (R-Mo.), and Reps. Doris Matsui (D-Calif.) and Leonard Lance (R-N.J.), are key ingredients that need to be added to The Helping Families in Mental Health Crisis Act.

The Excellence Act offers what everyone – families, law enforcement, policy makers – wants: expanded access; evidence-based mental health and addictions services delivered by skilled staff; peer and family support; 24-hour crisis care; integration of physical and behavioral health care; a community continuum that prevents re-admissions, trauma, and disruptions to home, school and work. And through outcome monitoring, clinics held accountable for measuring patients’ progress and adjusting course when treatments aren’t working as hoped.”

The article is a must read for all those who believe our top priority should be to increase access to services.

Journey’s New Director Tackles Funding Problems

For nearly a decade, Journey’s staff have been told to do more with less.  Funding from Dane County has not kept up with inflation or increased demand.  And, “less” is taking  a toll on people in need of mental health services and the staff who provide them.  The agency stopped taking new Medicaid fee-for-service patients this month.  They are the neediest economically of those in search of help.

Journey’s new director Ron Lampert told Wisconsin State Journal reporter David Wahlberg his ideas about how to “grow” a way out of that dilemma.  He will try to persuade the state to increase rates for Medicaid reimbursement, an idea that was echoed by Mary Grabot, director of Adult Mental Health Community Services for Dane County, at a recent meeting about criminal justice reform. See here for full WSJ article.

Lampert should also look at ways to force better implementation of parity laws and regulations.  Although the Affordable Health Care Act requires that mental health services be reimbursed by insurance companies equitably with other health care services, those companies have found ways to evade the law.  See the mental health parity category on this blog.

In the 1980s, a famed psychiatric hospital came up with a method to survive a devastating decline in funds when insurance companies adopted managed care.  The CEO, Steven Sharfstein, embraced business principles that enabled Shepphard Pratt Hospital in Maryland to expand into a multi-service statewide health care system at a time when many psychiatric hospitals were closing.  Sharfstein added new kinds of services, such as special education, that were profitable.  He also persuaded the state to increase Medicaid reimbursement.  See here for more information.

Like Sharfstein, Lampert plans to expand horizontally and geographically by merging with organizations that provide services related to Journey’s core mission, such as job training, and by extending the agency’s reach beyond Dane County.  He also is looking into a more cost-effective and flexible payment system that reimburses at a single rate per person per month.