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 Continues to Jeopardize Patient Health

Serious problems remain at Winnebago Mental Health Institute, according to two recent news reports.

Action News 2 at WBAY.com reported on July 30 that the Center for Medicare and Medicaid Services (CMS) told the facility that it was not in compliance with federal standards in terms of physical environment, special staff requirements, and medical records.  The facility’s proposed “correction plan” includes such key areas as improving treatment plans and providing sufficient nursing staff and psychiatric care technicians.

CMS extended its deadline for compliance yet again.  The new date is October 1.  If the facility does not comply, it can no longer receive Medicare and Medicaid funds.

Click here to read “Winnebago Mental Health Gets Another Chance to Meet Medicare Standards.”

A July 25 report in Oshkosh Northwestern offers supporting and frightening details.

“As of July 3, the facility had at least 41 vacancies — that’s about 6.5 percent of the full staff. Openings include six full-time psychiatrists and nine full-time psychiatric care technicians.”

“An April report by a consultant for the state found Winnebago was “heavily relying” on overtime, increasing risk of harm to patients, causing staff to quit, and incurring substantial cost. Winnebago employees made nearly $1.9 million in overtime between July 2016 and July 2017.

Click here to read “Inspectors: Problems at Winnebago Institute Linger 8 Months After Patient’s Death

Police and Firefighters are Teaming up with Mental Health Professionals to Address Trauma in Milwaukee

Everyday,  police and firefighters are involved in events that can cause lifelong trauma in others.  They see what a fire, a shooting, a robbery, and domestic violence can do to the immediate victims and those around them.

Experts are also beginning to understand the ways that traumatic experiences can be passed from generation to generation.  In simple terms: a violent environment for a child can led to stress, inhibit healthy growth, and ultimately perpetuate the cycle of violence.

Until recently, police and firefighters had no tools to help the survivors of exposure to violence.   But, under the auspices of a new county-city team, they have referred 700 families and individuals to mental health professionals for help with trauma.

Click here to read “How a City-County Partnership with Mental Health, Police, and Firefighters is Treating Trauma in Milwaukee” in the Milwaukee Journal Sentinel.

Click here to read “In High-Trauma Milwaukee Journey House Sees Mental Health Therapy as Missing Link,” another effort to address trauma in Milwaukee

Wisconsin should emulate Rhode Island’s success by offering methadone treatment in jails and prisons

Pew Charitable Trusts, which spent a year studying the state’s opioid treatment system, offered recommendations to a state task force.  Among them was the suggestion for a pilot program that would offer medication-assisted treatment in at least one prison or one jail.

Rhode Island has such a program that led to a 61 percent decrease in overdose deaths among recently incarcerated people and a 12 percent decrease in overdose deaths statewide.

Pew consultants also recommended that the state:

—-Expand opioid treatment programs.  The state has too few providers offering methadone treatment.

—–Develop a legal definition for recovery housing that would bar discrimination against those using methadone treatment, and

——Fund an expansion of buprenorphine training for providers during training programs for doctors and other medical professionals.

UPDATE:  Click here to read an article from the Milwaukee Journal Sentinel about a pioneering program in the Dane County Jail to treat substance abuse.

 

 

 

 

 

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.”