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.

 

 

 

 

 

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.

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.”