New Energy for Mental Health Services in Madison

Yesterday, Strategic Behavioral Health (SBH) announced plans for a psychiatric hospital in the Madison area to open by late summer 2019.  It would provide 72 beds, cost $15 to 20 million, and offer inpatient and outpatient services.

According to county officials, the hospital would meet the long-established need for an alternative to a trip to Winnebago State Hospital for persons suffering from a psychotic episode and the police who accompany them.  It would also provide many of the services offered by a crisis restoration center.  Click here to read David Wahlberg’s article in the Wisconsin State Journal.

SBH has an entrepreneurial and ambitious approach to mental health services.  Its website offers this invitation:

“We are currently seeking opportunities to bring services to areas where there is an identified need. We are looking for places where Strategic Behavioral Health can be a good provider and also a good community citizen. Please email our home office to discuss opportunities.”

Since 2006, Strategic Behavioral Health has opened centers in 11 cities, primarily in the south and west.  Willow Creek Behavioral Health Center in Green Bay, which opened in January 2017, was the first site in the mid-west.  According to SBH’s website, the company offers a full range of mental health and substance abuse services to just about any kind of client in need.

Funding mechanisms–the perpetual issue for mental health service providers–are less clear.  SBH offers this guidance on its website.

“With payments often times being the last item patients and their families want to address, we make it a point to keep all involved parties informed while keeping the focus on treatment and recovery. Strategic Behavioral Health works with most major insurance companies and is able to work with each individual to determine the best approach for covering the cost of treatment.”

Private insurance will not cover costs for many of the people who might need a crisis restoration center or other mental health services.  It is likely SBH will be competing with existing service providers for state and county funds.   Let’s hope it is a “good provider and good community citizen” and that competition turns out to be a good thing.

 

 

 

 

Shortage of Mental Health Care Providers has Lasting Consequences for Wisconsin Youth

Almost all of us lament the criminalization of the mentally ill.  For more than a decade, prisons have become a more damaging place for adults with mental illness than the coercive psychiatric hospitals they replaced.

A recent article in the Milwaukee State Journal  shows that the link between mental illness and the criminal justice system can start at a young age.  Reporter Rory Linnane  quotes Peg Rauschenberger, a registered nurse at Milwaukee County’s youth detention center.

“It’s almost like they have to get into some sort of trouble before they get into [mental health] services,” she said.  “They end up being incarcerated for really what is a health issue and it shouldn’t have gotten that far.”

A stay at the youth detention center might begin the journey to the Lincoln Hills School for Boys or Copper Lake School for Girls.  About 75 % of male inmates and 85% of female inmates at the complex meet the criteria for at least one mental health disorder, according to Wisconsin state figures.

The facilities are under judicial order because of inhumane and ineffective treatment of the young inmates.  More to the point, the American Psychological Association has threatened to remove its accreditation as an intern site because of excessive mental health caseloads, inconsistent intern supervision, ethical lapses by staff, transparency failures and other issues.

Read Linnane’s article Shortage of Mental Health Providers Hits Crisis Point for a good analysis of some underlying reasons why many young people end up at the detention center and ultimately the failed juvenile complex.  Largely because of inadequate funding and low reimbursement rates,  Wisconsin does a worse job than most states in providing access to all types of mental health professionals.

UPDATE: The APA has placed the mental health program on probation.  Click here to read a story with more details about the failures of mental health services at Lincoln Hills.

New Energy for Medicaid Expansion: Some Good News

Maine and Virginia are getting lots of attention for their resounding support for Medicaid expansion.

By a large margin, Maine voters approved a referendum in support of expansion.  Maine’s governor had vetoed legislation for the expansion five times.  An estimated 70,000 to 90,000 people could gain insurance.

In Virginia, a Democratic governor had been unable to get Medicaid expansion approved by the state legislature.  On Tuesday, voters elected a Democrat as governor and the party won 15 out of the 17 seats they need to take control of the state legislature.  Several races were too close to call on Wednesday or require a recount.

Other news might be even more promising.  In exit polls, two out of five voters in Virginia identified health as their top concern.  That number was double that of any other concern mentioned.

In Utah, a political committee completed required public hearings around the state and will start gathering the signatures needed to get a Medicaid expansion question on next year’s ballot.  The state’s governor and state senate had already tried to pass expansion, but failed because of the Republican controlled legislature.

Maine’s success is also encouraging efforts in Idaho for a ballot initiative on expansion.  Reclaim Idaho has submitted a proposal to add the issue to the ballot for the 2018 election.  The group must gather signatures from six percent of registered voters in order for the ballot initiative to move forward.

Click here to read “Health Care Galvanizes Voters.”

Read “What Red States Pass Up as Blue States Get Billions”

Read Medicaid Expansion Reduces Medical Debt

Here is a step backwards for Wisconsin.  Drug testing for some Medicaid recipients is more likely through the state’s waiver request.  Click here to read the article in the MJS.

Finally, check out this story from the Washington Post.  “Fresh Democratic Faces Emerge from the Anti-Trump Backlash’

 

 

Derail the Jail: What’s the Argument?

Advocates are campaigning to defeat the budget proposal for jail renovation.  They argue that the money could be better spent on affordable housing, mental health services, and other programs that would help keep people out of jail.

Click here  for their website.  You will find information on the remaining opportunities to register your opinion about budget proposals.  Organizers polled country board supervisors about how they will vote on the jail renovation proposal and report their findings.

Click here for an article in Cap Times about a short-term training for employees of the correctional system and others in how to keep people with mental illness out of jail..

Click here for an article in Isthmus in which county and correctional officials respond to arguments from derail the jail advocates.

Proposed Budget Amendments Would Benefit Mental Health Services

On October 25 at 5:30 in room 354 of the City/County Building, Supervisor Heidi Wegleitner will present budget amendments to benefit human services at the Health and Human Needs Committee.  Here are the items.

HHN-O-09 (Wegleitner)
Increase operating expenditures by $780,000 to fund supportive services for affordable housing admissions and continued occupancy for persons on the Homeless Services Consortium of Dane County’s Priority List, including homeless veterans (42), chronically homeless (268), and homeless youth (71).

Other related amendments
HHN-O-01 (Levin)
Increase expenditures by $30,000 to expand HUD coordinated entry to areas outside the City of Madison.

HHN-O-07 (Wegleitner)
Increase operating expenditures by $300,000 to provide one buss passes for some of the 22,227 SNAP case units.

HHN-O-08 (Wegleitner)
At the end of fiscal year 2018, any surplus of deficit of general purpose revenue in the Human Services Fund, net of any deficit or surplus in the Badger Prairie Fund, shall be retained in the Human Services Fund. Any surplus will be applied in fiscal year 2019 to support programs of the Human Services Department. Only by a 2/3 vote of the County Board may surplus funds from the Human Services Reserve Fund be appropriated for other purposes.

HHN-C-01 (Wegleitner)
Increase expenditures and borrowing proceeds by $8,000,000 for planning and development of one or more 24/7 community-based crisis, assessment, and resource centers focused on supporting persons in the community, and diverting persons with mental health, substance abuse, or developmental disability issues who have contact with law enforcement from being arrested and/or admitted to
the County jail.

NOTE: Annually, approximately $6 million is transferred from the Human Services Fund to other areas of the Dane County budget.  The sheriff’s department often is the recipient.  The proposed budget amendment would keep any surplus in the Human Services Reserve Fund unless 2/3 of the county board approve a transfer.

UPDATE:  The amendment for planning and development of community-based crisis, assessment and resource centers failed.   An amendment for $40,000 for bus passes passed.

 

Walker Raises Medicaid Reimbursement Rates for Mental Health and Substance Abuse Services

Wisconsin’s rates have long been among the lowest in the country.  The result is that mental health services are curtailed because of lack of availability of those who can afford to provide the services.  See “Voices from the Front Lines: NAMI’s Lindsay Wallace” for a discussion of how the low rates affect people with mental illness in Dane County.

Gov. Walker has just announced that rates will be raised next year.  According to him, they will be competitive with those in neighboring states.  Click here to read the press release.  Here are excerpts.

“This morning, at the 13th Annual Mental Health and Substance Use Recovery Training Conference in Wisconsin Dells, Department of Health Services Secretary Linda Seemeyer announced an investment of about $17 million, including $7 million in state funding, to raise rates for professionals providing outpatient mental health and substance use disorder services.”

“Effective January 1, 2018, Wisconsin Medicaid will increase reimbursement for outpatient mental health and substance use disorder treatment. This policy change will increase the maximum allowable fee for each covered outpatient service, and simplify the current rate structure, moving from five different fees per service to two fees per service. The new rates are competitive with border-state Medicaid programs and Medicare reimbursement, supporting growth of the Wisconsin provider workforce.”

Click here to read a story in the Milwaukee Journal Sentinel that describes reactions by advocates to the increase.

UPDATE:  Wisconsin Health News provided this report about the state’s AG’s reaction to the opioid crisis.

“Attorney General Brad Schimel called for increased attention to prevention and higher reimbursement rates for addiction treatment at a Medical College of Wisconsin forum on the opioid epidemic.

‘We’re making great progress but I kind of liken this to a sinking rowboat,’ he said. ‘Law enforcement is bailing it out by arresting drug dealers. Treatment providers are bailing it out by helping people get treatment. But there’s a big hole in the bottom of the boat. And I think this is the most important piece of our efforts, it has to be the prevention side. We’ve got to get this message out to the public and to the medical community.’

Schimel also said that ‘we’re going to commit to dramatically raising the rates at which we reimburse people to provide mental health services’ and addiction treatment services to attract more workers to the field.

He and other attorneys general are putting pressure on insurers to make those changes, he said.”

UPDATE:  Wisconsin Health News (11/29) reported on problems identified by the Wisconsin Hospital Association.  Here is an excerpt from WHN‘s report.

“In comments submitted to DHS in mid-November, the association praised the increase. But they urged the department to add codes for psychiatrists, advanced practice psychiatric nurses and psychiatric physician assistants.

WHA general counsel Matthew Stanford wrote that the lack of codes for those professions is a “significant omission if the goal is to provide a comprehensive outpatient behavioral health reimbursement increase to address access difficulties – particularly Wisconsin’s acute shortage of psychiatrists.”

 

 

New Funding for Jail Diversion and Violence Reduction Stimulates Creative Responses

Nearly a year ago, Madison’s City Council approved $400,000 to fund the first steps of a violence reduction plan developed by the Focused Interruption Coalition.   Three agencies responded to the RFPs issued by the city with proposals that offer both new and  time-tested approaches to reducing recidivism, violence, and the trauma associated with it.

Below are the highlights of the proposals as reported by Abigail Becker in Cap Times. Click here to read “Three Agencies in the Running for Madison’s Long-term Peer Support Program.”

According to the proposal from Nehemiah Community Development Corporation , “Participants would receive peer counseling and case management in addition to help with housing, transportation, access to AODA and mental health services and priority entry into job skills training and placement programs.”

“The program would operate a 24/7 hotline with two dispatchers on call to respond to situations. Each peer support specialist would maintain a caseload of 10 to 15 participants, and services would be provided for no less than six months.”

Madison Urban Ministry (MUM)  would provide participants ” access to community engagement opportunities, peer support and mentoring, employment and housing opportunities and mental health and AODA support.”

MUM’s proposal is particularly strong in terms of job training and opportunities.  An  “innovative element to MUM’s proposal is the urban agriculture employment and vocational training program through the FAIR Initiative. The program would train up to five program participants in literacy and cultural competency skills and local food systems in addition to urban agriculture and entrepreneurial training. Participants would earn $13.01 per hour for the training.

Other employment learning opportunities could be available through FoodShare Employment Training, the Employment and Training Association and MUM’s Just Bakery vocational training program.”   In addition, MUM has a long and successful history offering programs that reduce recidivism.

“Zion City International Church Ministries proposed a program called Renewal After Prison, which is meant to teach skills to make the transition from incarceration successful and to stabilize an individual’s life through support services.”

“Under the program, participants would meet in one of four groups, three time per week for one year and will meet with a case manager until stable. The four groups serve as phases and include the initial transition, integration, family reunification and implementation. After a year, participants who are interested can become a peer support specialist.Under the program, participants would meet in one of four groups, three time per week for one year and will meet with a case manager until stable. The four groups serve as phases and include the initial transition, integration, family reunification and implementation. After a year, participants who are interested can become a peer support specialist.”

UPDATE:  Four city council members are proposing a cut of $250,000 in the $400,000 allocated for this effort.  Click here to read the story.

UPDATE: Nehemiah Community Development Corporation and Madison Urban Ministry were recommended by Madison’s Finance Committee to receive funding.  Click here to read the article.  (The cut of $250,000 was not approved.)

UPDATE:  Dane County DA’s office shows a poor response to the opportunities for diversion through restorative justice.  Click here to read an article in Cap Times.