Voices from the Front Lines: Journey’s Dave Delap

Community Treatment Alternatives (CTA) was the first program in the country to offer Assertive Community Treatment in a jail diversion program.  Offered at the Journey Mental Health Center, CTA provides highly individualized and intensive mental health services to each client from a multi-disciplinary team.

CTA claims a stellar reputation among mental health advocates and professionals.  MOSES, the most persistent advocate for more jail diversion efforts, recommended an increase of 20 slots in the program.  The Diversions Task Force, appointed by the Dane County Board of Supervisors, concurred.  Funds for an additional 15 slots are included in the county’s 2017 budget.

Dave Delap, the program’s long-time director, has been paying close attention to recent discussions about jail diversion.  Like other advocates, he believes that portions of the jail are inhumane, unsafe, and in need of replacement.  But, along with those advocates, he thinks more could be done to promote jail diversion by expanding mental health services.

Delap said, “I was dumbfounded when Lynn Green, director of the Department of Health and Human Services, claimed, ‘No one is in jail because of lack of capacity for community mental health programs for jail diversion.'”

That remark was part of Green’s presentation to the June 6 joint meeting of two county board committees about jail diversion programs.  Delap also was disappointed that the statement went unquestioned by committee members.  (See Voices from the Front Line on this blog for more information about the meeting.)

Jail administrator Richelle Anhalt reported that 29 percent of the inmates were on psychotropic medication and 107 of them were termed as “special needs for mental health.”  In a later statement, using figures from the jail, Lindsay Wallace of NAMI-Dane estimated that 700 people could be diverted from the jail each year if appropriate mental health services were available.  (Producing an accurate count of the number of people in jails and prisons with mental illness is a contentious issue throughout the country.)

Delap has some common sense suggestions about how to increase jail diversion that result from his long experience at CTA.  Flexibility and a variety of approaches are important. People with mental illness who could benefit from jail diversion vary as much as other people with mental illness.

More flexibility in the criminal justice system itself could promote diversion.  Delap pointed out that Correct Care Solutions, which screens people for mental health problems when they enter the jail, is not funded to screen for the possibility of diversion.  He advocates screening at many points throughout the system: before arrest, after arrest but before sentencing; at sentencing, and as an alternative to revocation of parole or probation.

Instead of another increase in CTA’s slots, Delap recommends adding a short-term program for people who have been diverted from the jail.  Staff would work closely with them for six to eight months.  After the person is stabilized and their long-term treatment needs understood, he or she could be enrolled in a program offering appropriate help.

Delap’s suggestions about multiple points for screening are consistent with the views of MOSES and other organizations that have argued for a crisis restoration center to which police could take people for assessment and short-term treatment instead of a jail booking.  He noted that Journey operates a hospital diversion program that might be enhanced to meet the needs of jail diversion.  Opponents and county officials have pointed out the need for a secure facility.  That problem has been resolved in other communities.

Finding the money is an immediate and perpetual issue.  About funding, Delap also has the benefit of many years of experience.  He said that between 2003 and 2016, county funding directed to mental health services did not increase, despite the increase in inflation and population.  Inflation alone brought about a decrease of approximately 25 percent in real dollars for mental health services.

Delap said, “The annual transfer of approximately $6 million from the budget of the Department of Health and Humans Services to the General Fund is appalling in these circumstances.”

Check back to learn about progress in a campaign to address mental health funding in Dane County.




Stop Wisconsin’s Medicaid Waiver: Take Two

Governor Scott Walker submitted a request to the federal government for a waiver that would permit changes to the state’s Medicaid policies and requirements.   Because waivers can change eligibility for benefits, federal law requires that members of the public have 30 days to register their opinions.  The state must respond to concerns and may then forward the revised application to the federal government.  The federal government allows another 30-day period for comment.   That period ends on July 15.

More than 1,000 comments were received by the state.  Less than five supported the waiver.  State representatives had agreed to make all comments public as a part of its application.  Instead, they were released only after the state was forced to do so because of a reporter’s request through the Open Records Act.  The state had submitted only an 8-page summary of comments and its responses to them.   Likely the unabridged  comments depict more serious concerns and potential damage than the summary.

The state resisted notifying the public about the process for involvement or its own activities.   As a result, there appears to be much less protest directed to the federal government.  Nevertheless, Bobby Peterson, executive director of ABC for Health, submitted an extremely well-researched and comprehensive letter to the federal Department of Health and Human Services outlining the flaws with the waiver and the state’s process.  The letter includes research results from states that have implemented variations of Wisconsin’s proposals.  No state has implemented any version of drug testing as a condition for receipt of Medicaid benefits.

Click here to read the letter.   Click here to enter a comment.   Review the letter to develop your comments or check out  “Wisconsin’s Medicaid Waiver Can Be Stopped”  on this blog.

There are other ways of stopping the waiver.  The legislature’s Joint Finance Committee passed a resolution stipulating that the waiver could not be implemented without its approval.  We can review any version approved by the federal government, identify flaws using Peterson’s research and analysis, and begin a campaign to lobby members of the committee.

That lobbying effort could be helped by statements from Wisconsin’s own Legislative Fiscal Bureau.  It has questioned whether Medicaid programs can charge premiums for people who are under the poverty level or remove them from the rolls for non-payment.   It also questioned the imposition of a time limit on benefits for enrollees who have not found work.

Lobbying efforts could also remind the co-chair of the Joint Finance Committee, John Nygren, of his own more enlightened views about the best means of combatting drug abuse.  Rather than punitive measures, such as testing for drugs and denying benefits, he supported the expansion of treatment options.

He and Lt. Governor Rebeca Kleefisch, co-chairs of the Governor’s Task Force on Opioid Abuse, wrote, “We’re not talking about the ‘Just Say No’ campaign of the 80’s and 90’s…As the drugs on the street have changed, our policy and policing frameworks must catch up to shifting trends.”

Peterson identified legal grounds to challenge the waiver.  In particular, he pointed out court cases in which drug testing was ruled unconstitutional when used as a condition for receipt of benefits.

It appears that the entire application is a violation of the intent of the legislation. Waivers are to be “demonstrations of innovative ways to expand eligibility and Medicaid services to improve access to care and reduce costs.”  State officials claim their first objective is “ensuring that every Wisconsin resident has access to affordable health insurance to reduce the state’s uninsured rate.”  But, in its waiver proposal, it projects an enrollment decrease from 150,050 beneficiaries in CY 2016 to 146,407 in CY 2018.

Finally, we can always vote.   This struggle could be only a painful memory when we have a different governor.

UPDATE:  The League of Women Voters of Wisconsin issued an action alert with concise talking points about the hazards of the waiver and instructions about how to comment.  Click here to read it.

UPDATE:  Click here to read an article from USA Today, which reports comments from organizations that challenged Indiana’s request to include work requirements in its Medicaid waiver.  The federal government accepted the state’s request as complete even though time for public comments had not been allowed at the state level.

UPDATE:  United Health in Wisconsin submitted a letter opposing the waiver, citing continuity of care and other issues.  Click here for the letter.

UPDATE:  Click here for a letter from the Wisconsin Society for Addiction Medicine.

UPDATE:  Click here for a story from Politico that describes the increasing importance and popularity of Medicaid.  Wisconsin is out of step in its waiver request and refusal to accept Medicaid expansion funds.