Fewer Jail Inmates: More Mental Health Services

Lindsay Wallace, executive director of NAMI-Dane County, adds a cost-effective and humane approach to the debate about the Dane County Jail.  Here are the opening paragraphs from her opinion piece in the Wisconsin State Journal.

“Dane County doesn’t need a larger jail. It needs greater investment in community-based mental health treatment. It needs supported employment, affordable housing and preventive services to help keep people with mental illnesses from being incarcerated.

While the National Alliance on Mental Illness in Dane County agrees the current jail needs an upgrade to make it safer and more humane for inmates and staff, we strongly disagree on the need to plan for as many inmates with mental illnesses in the jail as our system now incarcerates.

The county would better serve nonviolent offenders with mental illnesses by reducing the jail population instead of expanding its capacity, as outlined in the Mead & Hunt jail update study.

We know that with a smaller jail population comes a smaller jail, which saves money in construction and staffing. This savings in other cities has paid for community-based alternatives to keep nonviolent offenders with mental illnesses from being jailed as our automatic response to infractions.

Further, approving expansion of jail capacity shows increased reliance on the jail to provide treatment to persons with mental illnesses. This is counter-productive because these settings often exacerbate psychiatric symptoms. It is fiscally irresponsible.

A more responsible and humane strategy is to invest more in crisis intervention training for law enforcement and corrections officers, mobile crisis response teams, community-based mental health treatment programs, and mental health jail courts. These measures are more cost-effective and have been shown to reduce arrests, jail days and hospital stays.”    Click here to read the full statement.



County Executive Asks for yet another study of the Dane County Jail: Inmates Sue

There is much to stir outrage in Shut it Down, a recent story in Isthmus by Dylan Brogan.

Click on the link above and read it for yourself.   Here are some of the facts and quotes that got my attention.

The article came about because a former inmate, Lisa Mitchell, contacted Brogan to tell him about a lawsuit she had filed claiming that the environmental conditions in the jail amount to “cruel and unusual punishment.”

Mitchell and other inmates report dangerous levels of lead in their drinking water, a ventilation system that is recirculating asbestos fibers throughout the jail, and drain flies that come up through the showers.  Official reports substantiate their concerns.

Dane County Sheriff Dave Mahoney has called the facility “inhumane” and “dangerous,” despite the fact that he is named as a defendant in Mitchell’s lawsuit.  Brogan quotes Mahoney as saying, “It needed to be replaced yesterday…Now is the time to quit talking about it.  Quit studying it.  And come up with a plan to replace the City County jail.”

Calls to replace the jail began more than a decade ago.  Mahoney points out, “We have spent about $1.7 million in taxpayer dollars just on studies.  All we have to show for it are three-ring binders full of paper.”

The Mead and Hunt consulting firm, authors of the most recent study, told the County Board of Supervisors, “We believe Dane County should not consider extending the life of the jail, but should work towards getting out of the building with due haste.”  Last December, the firm proposed two options that both would require closing the jail.

County Executive Joe Parisi asked for more options in January because of the cost.  Consultant fees for this new plan will cost $82,200.  It is scheduled to be presented to the county’s Public Protection & Judiciary Committee on June 13.

Here is how Parisi describes the “true priorities” of the community and his reluctance to move ahead with the jail project.

“We can’t look at this jail project in a vacuum,” says Parisi. “Those capital dollars would be competing with what I believe are the true priorities of this community: Cleaning up our lakes. Providing affordable housing. Conservation of our natural resources. Road construction and rehabilitation.”

While we are constructing roads and conserving out natural resources, inmates of our county jail are drinking unsafe water and breathing air contaminated with asbestos.


State’s Low Reimbursement Rates for Medicaid Limit Access to Mental Health Services: Tell Legislature to Act

Medicaid, which is Badger Care in Wisconsin, is the most important source of funds for mental health services.  Private insurance companies are second.

State governments set reimbursement rates for the people and institutions that provide those services.  Rates in Wisconsin are among the lowest in the country, meaning that many mental health professionals and institutions can not afford to provide care or find it more profitable to work only with private insurance companies and Medicare.  The result can be limited or no access to mental health care for Badger Care recipients.

Click here to read an excellent story about the debate between a state senator and the WI Department of Health Secretary Linda Seemeyer about raising those rates.

Here are some excerpts from reporter Keegan Kyle’s article.

“Department of Health Services Secretary Linda Seemeyer repeatedly ducked requests to state a position on hiking Wisconsin’s rates, which are among the lowest in the nation.”

“A hike in Medicaid reimbursement rates for mental health providers wasn’t included in Walker’s proposed state budget this year, and legislative leaders haven’t been confident about boosting rates, citing competing budget priorities.”

“At the March 29 budget hearing, Seemeyer first told Sen. Jon Erpenbach, D-Middleton, that the state has been “trying to look at” rates for mental health services. Then she deferred rate hike decisions to state lawmakers. Then she said more study of rates was needed and suggested using a “pay-for-performance” system to reward providers who produce results. Asked if higher rates would help expand treatment services, she said, ‘Perhaps.'”

According to a video of the testimony accompanying the article, reimbursement rates for counseling in Wisconsin are $32/hr, as contrasted with $70/hr in Minnesota and $65/hr in Iowa.  The Department of Health returned $330 million to the General Fund .

UPDATE:  At an event sponsored by Wisconsin Health News in early June, Sen. Alberta Darling, co-chair of the Joint Finance Committee, said. “Would we like to give personal care workers more? Of course we would. But we cannot at this time. … I think provider rates in general for Medicaid are a huge issue. We’re, I think, at the bottom if not second from the last. Our provider rates are not good enough and it’s going to be a challenge significantly in the years coming up.”

UPDATE:  In July 2016, the Dane County Department of Human Services convened a meeting of contracted providers for behavioral health services to discuss issues and opportunities for collaboration.   Medicaid reimbursement rates was the top issue mentioned by DCHS.  Others were acceptance of new Medicaid patients by psychiatrists and some therapists and access to prescribers.

UPDATE:  Here is an excerpt from the Kids in Crisis/Legislative Action Tracker article that was part of a series by USA Today-Wisconsin  (June 2016)

There is evidence that Wisconsin’s Medicaid reimbursement rates – among the lowest in the country – are shutting children out of accessing outpatient behavioral health care and leading to higher costs associated with emergency psychiatric care.

A report by Milwaukee’s Public Policy Forum found that in Milwaukee County, low reimbursement rates were stopping mental health providers from accepting Medicaid patients. A 2014 survey by the Wisconsin Statewide Medical Home Initiative found that only 20 percent of Wisconsin pediatricians said they could find therapists when needed for their patients on Medicaid, and just 5 percent could find psychiatrists for patients on Medicaid.

UPDATE: (Aug 23,2017) New Richmond News reports that “In 2014-15, long-term care facilities in Wisconsin reported a $331.8 million “Medicaid deficit.”  The deficit is due to the low reimbursement rates for long-term care services.  Click here to read  “A Never Ending Death Spiral: SV Health and Rehab Faces Closure.”

UPDATE:  See “Walker Raised Medicaid Reimbursement Rates for Mental Health and Substance Abuse Providers” on this blog for recent information.



What Will Happen to Long-term Care as Wisconsin’s Population Ages?

Wisconsin Health News offers monthly luncheons with terrific speakers.  The May 2 event features the escalating problem of financing long-term care for an aging population.  Here is WHN’s description of the event.

“Wisconsin’s population is aging and healthcare care costs for the elderly and those needing long-term care are growing along with it. Gov. Walker’s budget increases Medicaid reimbursement for nursing homes and provides more money for direct care workers. Is it enough to address workforce shortages? And what’s next for Family Care? After pulling back its plans to overhaul the program, the administration is pushing forward with a statewide expansion. Will they incorporate other proposed program changes?”

Lynn Breedlove, Co-Chair, Wisconsin Long Term Care Coalition
Curtis Cunningham, Assistant Administrator of Long-Term Care Benefits and Programs, Department of Health Services,
Tim Garrity, Chief Innovation Officer, Community Link
John Vander Meer, Executive Director, Wisconsin Health Care Association

The luncheon will take place on May 2 from 11:30 to 1:00 at the Madison Club, 5 E Wilson St., Madison.  Wisconsin Health News is a subscription service providing daily updates on health news and exclusive interviews.  The lunch is $30 for subscribers and $40 for non-subscribers.  Click here to register and to learn about WHN.