Nothing to worry about here.
That might be the conclusion of attendees at the June 6 meeting about the county’s jail diversion programs. Lynn Green, director of Dane County’s Department of Health and Human Services, and her staff offered a slide presentation that seemed to depict a seamless mental health system with many opportunities for services.
Yet, the providers of those services know the reality for people who need help is often quite different. The phrase “falling through the cracks” is commonly heard. This post is the first of a series of efforts to identify gaps in the system by talking with people who deal with them every day.
Linda Ketcham of Madison Urban Ministry (MUM) has been on the front lines for many years. She directs an agency that aims to reduce the recidivism rates of those leaving prison and jail. MUM’s offerings might seem like simple common sense: case management, job readiness, housing assistance, and peer support programs. Their success, however, is highly unusual. The agency’s clients have a recidivism rate of less than 10 %, compared with a statewide rate of 67%.
“We need ‘real’ pre-release programs in the jail,” said Ketcham. By “real” she means they must be funded adequately and carefully designed. Simply opening up jail space to volunteer efforts can give the illusion of help, although it might not exist. MUM has already demonstrated the effectiveness of the kind of programs that could give jail inmates a chance at a successful life in the community.
Approximately one-third of the inmates in Dane County jail are on psychotropic medications. Continued access to that medication can be the determining factor in terms of a person’s ability to maintain emotional stability and take further steps towards recovery. Upon release, however, each of them receives medication that will last only five days.
Journey Mental Health Center offers appointments on a first-come basis twice a week. Ketcham said that the “window of availability” is short and people are turned away. She wonders if Journey collects data on the number of those who arrive and are not seen. In addition, a recently released inmate might not be stable enough to plan a trip to the center and wait for an appointment.
Badger Care offers other obstacles. There are reports of waits of up to five weeks for an appointment with a psychiatrist through one of its HMOs. Director Green told the county board supervisors that complaints about waits for appointments are not the responsibility of her department. No agency does accept responsibility, although the wait times would appear to violate state and federal parity requirements.
Lack of affordable housing worsens many community problems said Ketcham. “The idea was that people would move from a shelter to transitional housing to permanent housing. But there is a log jam, so they get stuck in place.” If they are stuck in a shelter or on the street, people with mental illness face particularly acute challenges. They need predictability and a sense of safety in order to develop the strengths that will lead to any version of recovery.
The opioid epidemic likely will aggravate the existing problems with the mental health and substance abuse treatment system. “We have been treading water for a number of years,” said Ketcham, “but unless capacity for treatment is expanded more people will cycle in and out of jail and prison.”
What’s the solution? More money would help. But, so would some honest discussion about the budget for the Dane County Department of Health and Human Services (HHS) .
Ketcham was one of the advocates who pressured County Executive Parisi for more transparency about the annual transfer of money from HHS to the General Fund. In 2015, the county board of supervisors approved the transfer of $6.2 million. Since 2011, the cumulative figure is $25 million. Click here to read an article about the transfer.
Other budgeting practices can also be misleading to the general public, she said. For example, many of the program allocations/expenditures in the HHS budget are not funded with taxpayer dollars. Therefore, a total HHS budget figure gives an inaccurate picture of the contributions of county funds to health and human services programs. Actually, on a percentage basis, those funds have declined.
Advocates are developing a campaign to educate the public about the Health and Human Services budget and to increase the contribution of county funds. Check back for updates.