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.  

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.”

Wisconsin Luminairies Focus Attention on Problems caused by Trauma

Important efforts by two dissimilar leaders in Wisconsin show emerging attention to the problems caused by childhood and other trauma.

In March, Marquette University President Mike Lovell issued an invitation to community groups to submit proposals to work with the university to address problems of trauma.  In November, he had hosted an “Epidemic of Trauma Conference.”   Here is an excerpt for the Milwaukee Journal Sentinel‘s article.

” Lovell predicts [the proposals are] almost certain to include treatment for neurological trauma — a condition that exists on an epidemic level in Milwaukee, where children in some districts routinely are exposed to homicide, neglect, abuse, violence, incarceration, alcohol and drugs as well as gunfire and police sirens, statistics show. Widespread trauma, in turn, worsens the ongoing social crisis in a city that for decades has defined the national extremes of poverty, unemployment, incarceration, infant mortality and broken homes…”

Click here to read details about his announcement and the problems in Milwaukee.

First Lady Tonette Walker aims to make Wisconsin the first “fully trauma-informed” state in the nation.  Her op ed describes progress at the Menominee Nation and her understanding of the harm caused by early trauma.  Here is an excerpt from her piece.

“We’ve made significant progress in other areas of our state as well, like in state government. Already, six Wisconsin agencies, including the Department of Health Services, Department of Veterans Affairs, Department of Workforce Development, Department of Children and Families, Department of Corrections, and Wisconsin Economic Development Corporation are implementing trauma-informed Care principles within their interactions with each other, as well as in the services they provide to the people of our state.

Click here to read Walker’s op ed.

UPDATE:  The MJS published an article describing an enthusiastic response by a broad spectrum of Milwaukee residents to Lovell’s proposals.  Click here to read the article.

Here is an excerpt.

“More than two dozen community organizations have expressed interest in the effort, along with 18 academics. And a wide range of community activists have been attending meetings to learn more and plant the seeds of collaboration.

“There’s tremendous interest in the community,” Mike Lovell said.

Lovell wants to organize a major conference in late September, bring together as many national trauma researchers and local activists as possible, maybe even rent the new Milwaukee Bucks arena as a venue.

“This has got to get really big,” said Franklin Cumberbatch, a member of Lovell’s steering committee and executive at Milwaukee-based Bader Philanthropies.”

 

Congress Shows Promising Increase of Bipartisan Support for Criminal Justice Reform: So Does Wisconsin

Democrats and Republicans in the Assembly’s Corrections Committee crafted an ambitious plan to close the notorious Lincoln Hills/Copper Lakes complex, negotiated successfully with county governments, ultimately got a unanimous vote for the bill in the Assembly and the governor’s signature.  It was a rare bipartisan success story.

At the federal level, representatives of both parties also are working together successfully, despite the punitive approach of the U.S. Attorney General.

Here are some examples from the Council of State Government’s Justice Center.

Congressional leaders in March took strong bipartisan action in support of three programs in FY 2019—the Second Chance Act, the Mentally Ill Offender Treatment and Crime Reduction Act (MIOTCRA), and the Justice Reinvestment Initiative (JRI)—aimed at increasing public safety and reducing recidivism at the local and state level.
U.S. Reps. Bill Johnson (R-OH), Danny Davis (D-IL), and Mark Walker (R-NC) gathered 74 signatures from members of the House in support of continued funding for the Second Chance Act, which will mark its 10th anniversary this year.
U.S. Reps. Doug Collins (R-GA), Bobby Scott (D-VA), Leonard Lance (R-NJ), and Norma Torres (D-CA) gathered 68 signatures from members of the House in support of continued funding for MIOTCRA.
U.S. Reps. Adam Schiff (D-CA) and Tom Marino (R-PA) gathered 68 signatures from members of the House in support of continued funding for JRI, a data-driven approach that helps states reduce corrections and related criminal justice spending and reinvest savings in strategies that improve public safety.

 

 

Problems Raised with SBH’s Proposal for a Psychiatric Hospital/Crisis Restoration Center

Middleton’s planning commission will host a public hearing on April 10 about the plans of Strategic Behavioral Health (SBH) to open a 72-bed psychiatric facility.  The city council has already endorsed the idea of providing $1.2 million in tax incremental financing to the for-profit company.

Through a review of public records, WSJ reporter David Wahlberg has uncovered a  number of violations by SBH in its operations in other states and nearby Green Bay.   Here are some of the most troublesome excerpts from his article.

“The Green Bay facility, called Willow Creek Behavioral Health, has had four medical directors, [since January 2017] and current and former employees say the facility is short-staffed. Aurora Health Care, which did medical exams at the hospital, terminated the contract this January.”

“After 10 youth escaped from Strategic Behavioral Center in Charlotte, North Carolina, on New Year’s Day, the state suspended admissions, issued a $20,000 fine and gave the psychiatric hospital an immediate jeopardy violation for failing to keep the facility secure.

The sanctions are among nine immediate jeopardy citations and other serious actions taken in recent years against psychiatric hospitals owned by Strategic Behavioral Health…”

“Immediate jeopardy “is the highest level of potential sanction, and it is not common,” said Mark Covall, CEO of the National Association of Behavioral Healthcare, which represents psychiatric hospitals and includes Strategic Behavioral Health as a member.

“But the real key is whether or not the hospital made the changes that were necessary to continue their license,” Covall said.”

Click here to read David Wahlberg’s article about the violations and responses of advocates, public officials, and health care experts.   Click here to read a description of the violations.

Click here to read an article in Isthmus about the problems with SBH.

More $ for Mental Health Services Shows Gains for Those who Need Them

Nearly 15 years ago, California voters passed Proposition 63, now known as the Mental Health Services Act.  The proposition imposed a 1 percent tax on people earning more than $1 million annually to pay for more mental health services.  The measure raises about $2 billion each year.

Los Angeles County, which receives the largest share of the money, commissioned a study by the Rand Corporation about the results of the new services.  The study was based on data from 2012 to 2016 and interviews with participants.  Here are excerpts about the findings, as reported by Kaiser Health News.

“The money is ‘critically important’ for the community mental health system and for people who need treatment but haven’t been served well in traditional ways, said Toby Ewing, executive director of the state’s Mental Health Services Oversight & Accountability Commission. “We can only imagine the challenges we would face if those funds weren’t available.”

The funds go beyond the more basic services that counties traditionally provide, helping to pay for workers to reach out to homeless people and triage patients with mental health issues in hospitals, he said.

The report covered two main programs — one for prevention and early intervention of mental illness in young people and another aimed at improving outcomes for people with serious mental illness.

Those who participate in the second program are in and out of jails and hospitals, and really need intensive services, according to Debbie Innes-Gomberg, the department’s deputy director. She said she was pleased Rand found that the services are making a difference. ‘It is a very good investment,’ she said, adding that the county plans to add more participants this year.”

Here is the key finding from the report itself.

“The evaluation found evidence that the Los Angeles County Department of Mental Health (LAC DMH) is reaching the highly vulnerable population it seeks to reach with its FSP and youth PEI programs. Furthermore, those reached by the programs experience improvements in their mental health and life circumstances.”

Click here to read “California’s Tax on Millionaires Yields Big Benefits for Those with Mental Illness.”  Click here to read the Rand study.

Passage of the referendum in California’s tax-weary state took determination, political shrewdness, and a sense of how to sell the need for more services.  Check the next blog post for information about how advocates made their case. 

 

 

 

Voters Will Support Mental Health Funding: California Offers Lessons

Proposition 13, passed in California in 1978, restricted increases in property taxes and required that all state tax increases be approved by a two-thirds vote of the state legislature. Because of the difficulty of securing that vote, advocates for various causes  turned to the use of propositions or “ballot-box budgeting” to raise revenue.  Most of those efforts were unsuccessful, but advocates succeeded in getting a measure passed that imposed a 1 percent tax for mental health services on people earning more than #1 million a year.  

Psychiatric News published a series of articles describing the campaign.  They contain lessons for advocacy in the future.

Click here to read “Complex Strategy Leads to Success of MH Initiative.”  Among the findings: Focus groups and polling revealed a strong positive response to the question: “Have you or someone you know suffered from a serious mental illness?”  The phrase “Everyone knows someone with mental illness” became a key theme of the campaign.

Click here to read “Lawmaker’s Crusade Boosts MH Funding.”  Darrel Steinberg traveled the state and found that residents could see the link between the emptying of mental hospitals and the rise of homelessness.

Click here to read “California Voters Say Rich Should Help Fund MH Care.”  Among the conclusions of a polling and analysis firm:

(1)[The] “severely mentally ill evoke the most sympathy and compassion from voters…. Even more cynical voters who doubted the measure’s means, merits, and objectives did not question the need to provide seriously emotionally disturbed children with [treatment]….”

(2) Voters want a proven model.   The new effort was modeled on California AB 34, a pilot program approved in 1999 that funds services to mentally ill adults who are homeless or at risk of becoming homeless or incarcerated.

Following are excerpts from the article.

The Campaign for Mental Health formed a broad coalition of organizations that together represent a number of different constituencies. In addition to state and national medical and mental health associations, the CMH includes six major California unions and organizations such as the California Teachers Association, AARP-California, and the California Police Chiefs Association (CPCA).

CPCA President Cam Sanchez wrote in a letter to the San Diego Union-Tribune, “Police chiefs like me face an awful reality: 20 percent of our officers’ time is spent dealing with untreated mental illness. Too often, we must take people with mental illness to jail, not because they have done anything wrong, but because there is nowhere else to go…. Proposition 63 will finally make mental health care a priority and free law enforcement to spend more of their time and resources on public safety rather than our failed mental health system.”

City councils in Los Angeles, Oakland, Santa Barbara, and Santa Monica supported the initiative, as did the San Francisco Board of Supervisors.

The CMH gathered more than 600,000 signatures, nearly double the number required to qualify the initiative for the ballot.  Sympathetic stories in major newspapers portrayed the impact of the failed mental health system and described lives that had been reclaimed by treatment.

Click here to read “Advocates Hope Tax on Wealthy Can Fund MH Services.”