Parisi Responds to Pressure from Jail Diversion Advocates: Sheriff’s Department Benefits

MOSES and other organizations have fought persistently for the right of people with mental illness to be treated in the community instead of being incarcerated.

County Executive Parisi seems to have heard the words.  He includes a focus on jail alternatives and re-entry services in his most recent budget proposals concerning the Dane County Jail.   But, the meaning remains elusive.  Most of the new funding would go to the criminal justice system.

Here are some of the highlights from Parisi’s proposal, as reported in the Wisconsin State Journal (10/1).   Click here to read the article.

His budget proposal would reduce the total number of beds by 91 which, according to him, “illustrates our commitment to alternatives and services to avoid re-incarceration.”

The new jail would have 64 mental health beds.  It currently has none, resulting in solitary confinement for inmates with mental health problems.  According to Sheriff Mahoney, the proposed space “will allow us to virtually eliminate solitary confinement.”

The budget includes $110,000 for re-entry case management services that would provide peer support counselors to help inmates transition back into the community and offer  help finding housing, mental health or substance abuse treatment services.

The budget also contains $68,000 to hire someone to  coordinate the Dane County Re-Entry Team, which is made up of staff from the Sheriff’s Office and Dane County Human Services.

Sheriff Mahoney’s budget includes $1.1 million for re-entry and diversion staff and programming. That staff would work with the team in the community (budgeted at $110,000) to provide a “seamless handoff” as inmates leave jail.

The budget also provides: $100,000 for a comprehensive review of local mental health resources to identify gaps in services and barriers to access; $100,000 to keep  Safe Haven open, and $15,000 to NAMI-Dane to expand its crisis intervention training course for police, public safety and medical personnel.

The math does not compute for anyone who wants more community treatment and less jail time for people with mental illness.  Sheriff Mahoney gains more than $1 million for diversion and programming.  An unspecified community team is budgeted at about 1/10 that amount for re-entry case management services.  That team is responsible for assisting inmates find mental health services and other help.  Those services receive a zero increase.

ANOTHER LOOK AT THE BUDGET: Here is hopeful language from Parisi’s budget statement concerning the crisis restoration center.

” Recently, there’s been discussion about the feasibility of a Mental Health Crisis Restoration Facility to further our community’s response to mental illness. Done in the context of a more thorough examination of available mental health resources in our community, this concept is worth exploring. A comprehensive review of existing mental health services and potential gaps in services would identify how such a facility could be operated in partnership with health care providers and community organizations. It could also shed appropriate focus on the need for all entities – including our health care providers – to reexamine how current mental health services are accessed and administered. There is room to do better. My budget includes $100,000 for a comprehensive review of existing mental health services in our community. This work will both identify potential gaps while evaluating how a potential Crisis Restoration Center or similar community run facility could help improve care and outcomes.”

 

 

 

 

Voices from the Front Lines: NAMI’s Lindsay Wallace

Lindsay Wallace, executive director of NAMI-Dane County, published a blog post that offers a good explanation of how Medicaid reimbursement rates can limit access to care for many people.  She titled her article, “The Quiet Crisis in Dane County Mental Health Services.”   Here it is.

“Recently, we’ve received a high volume of calls on our support line from people on Medicaid who were finding it increasingly difficult to get care. It’s not hard to imagine the frustration and sense of helplessness these individuals felt when every provider they reached out to told them they were no longer accepting Medicaid patients.

As a result of the high volume of calls we were receiving, I’ve spent the last few months meeting with community mental health providers and private practitioners to get a better understanding of why people in need of treatment and on medical assistance (MA) were being turned away.

It became evident that the issue affected individuals on straight MA, or fee-for-service, and not those served through BadgerCare HMO contracts or SSI Managed Care contracts. Under fee-for-service, qualified Medicaid providers are paid for each covered service such as a psychiatric evaluation, outpatient therapy, or targeted case management according to rates set by the state. Currently, the fee-for-service rate paid by Medicaid is, on average, about 50 cents on the dollar.

Over the years, there has been little increase in the reimbursement rate even though the cost for delivering mental health care services continues to rise. With this in mind, providers like Journey Mental Health Center (JMHC), who offers services to many MA clients, have faced significant financial losses.

Lynn Brady, CEO of JMHC, said, “In the past, we used some of the general purpose revenue (GPR) we received from the county to supplement the fee-for-service rate. However, the county has to control their costs also, and no longer allows us to do this. They are focusing county dollars on the uninsured.”

Given the toll the financial losses were taking on JMHC’s budget, they made the decision to no longer admit straight MA (fee-for-service) clients into services from their Central Intake Unit. However, this does not mean that Journey is not seeing straight MA (fee-for-service) consumers. In fact, they are seeing high numbers of them.

Lynn explained, “The difference is that now, straight MA consumers get into service here because they had a crisis and were seen in our Emergency Services Unit.”

The result of the above change? Unfortunately, rates that are not reflective of the full costs to provide services mean straight MA clients must deteriorate to a point of crisis in order to get timely access to care. We know that early intervention leads to the best outcomes but stagnant fee-for-service rates guarantee poorer access to care and sicker adults and children. This is unacceptable.

Though the county and community providers like JMHC have advocated for change, as well as many other human service providers across Wisconsin, there has been no movement in bringing about the needed changes. It appears that this is largely due to the lack of awareness on the part of policymakers about the severity of the issue. This lack of awareness may, in part, be due to the fact that unlike a sudden crisis, poorer access to care has been progressive in nature, happening slowly over time. As a result, there is little to no media coverage of the “quiet crisis”, which often serves as the catalyst for change.

So, where do we go from here?

It’s no surprise the solution is adequate mental health funding to cover the costs of delivering care; however, accomplishing that goal rests with the state. NAMI Dane County and community mental health partners and providers, and other key stakeholders can educate policymakers about the negative consequences poor reimbursement rates have on the people they believe they are covering.

Our greatest asset and most powerful tool for accomplishing this goal is to use our voices by contacting legislators and leveraging relationships with various media outlets. Power in numbers exists when policymakers hear from a large number of their constituents advocating for the policies that ensure those affected by mental illness have access to quality mental health care support and services.”

To stay up to date on this issue, sign up for action alerts at : https://www.namidanecounty.org/policy-issues/.    The website for NAMI-Dane at http://www.namidanecounty.org has information about its advocacy committee and other events.

Check out the post “Low Reimbursement Rates for Medicaid Limit Access to Care” on this blog for more information.

 

Join Efforts to Provide Treatment instead of Jail Time for People with Mental Illness

At least 40 percent of the inmates at the Dane County jail have a mental illness, according to Sheriff Dave Mahoney.   Several years ago, he described the abysmal conditions under which many of them were housed and pressed for action on a new jail that would include better options for those inmates.

The Dane County Board of Supervisors appointed three task groups to consider problems of racial equity and the prevalence of mental illness among inmates.  The Board issued a report including  30 recommendations in September 2015 and appointed a task group to develop additional recommendations to divert people with mental illness from jail.

Click here to read the initial report.  Click here to read the report of the Diversions Task Force.

Recommendations in both reports include the idea of a crisis restoration center to which people with mental illness could be taken for assessment, short-term treatment, and referral to other community-based treatment.  Crisis restoration centers have been successful in other communities and ultimately have saved taxpayers dollars.

Some recommendations in the reports have been implemented.  However, there has been no movement towards establishing the center.  In fact, the share of county funds directed to mental health services continues to decline in relation to population growth and the share allocated to the criminal justice budget.

The League of Women Voters of Dane County and NAMI-Dane County want further conversation about how effective diversion, mental health, and addiction programs can be supported and established.   An excellent op ed from NAMI-Dane County appears earlier in this blog.

As a good step towards this dialogue, the LWVDC is urging people to contact their county board supervisors to request a joint meeting between the Public Protection and Judiciary (PP&J) and Health and Human Needs (HH&N) Committees before June 15 to discuss formulating a plan that would increase opportunities for diversion.   On June 15, the full board is scheduled to receive the latest version of the Mead & Hunt recommendations concerning the jail.

Members of PP&J include Carousel Bayrd, Dorothy Krause, Maureen McCarville, Michael Willett, and Chair Paul Rusk.   Members of H&HN include Hayley Young, Heidi Wegleitner, Chair Jeremy Levin, Matt Veldran, Nick Zweifel, Richard Kilmer, and Ronn Ferrell.   Click here to access the website for the Dane County Board of Supervisors.

UPDATE:  Advocacy works!   The Health and Human Needs Committee unanimously passed a resolution asking for a joint meeting with the Public Protection and Judiciary Committee to discuss jail diversion programs.

David Wahlberg has an excellent article in the Wisconsin State Journal that finds evidence for the oft-repeated claim that money is being transferred from the Health and Human Services budget to the General Fund, where it plugs holes in the budgets of over-spending departments.  Since 2011, the HH&S department has given up $25 million.

Here is an excerpt from the article:  ” [CEO] Lampert said in an interview that Journey could use additional money to expand treatment sites, boost substance abuse programs, add services for the homeless, serve more teenagers and help keep people out of the jail and Mendota Mental Health Institute.”

Click here to read the article.

 

Fewer Jail Inmates: More Mental Health Services

Lindsay Wallace, executive director of NAMI-Dane County, adds a cost-effective and humane approach to the debate about the Dane County Jail.  Here are the opening paragraphs from her opinion piece in the Wisconsin State Journal.

“Dane County doesn’t need a larger jail. It needs greater investment in community-based mental health treatment. It needs supported employment, affordable housing and preventive services to help keep people with mental illnesses from being incarcerated.

While the National Alliance on Mental Illness in Dane County agrees the current jail needs an upgrade to make it safer and more humane for inmates and staff, we strongly disagree on the need to plan for as many inmates with mental illnesses in the jail as our system now incarcerates.

The county would better serve nonviolent offenders with mental illnesses by reducing the jail population instead of expanding its capacity, as outlined in the Mead & Hunt jail update study.

We know that with a smaller jail population comes a smaller jail, which saves money in construction and staffing. This savings in other cities has paid for community-based alternatives to keep nonviolent offenders with mental illnesses from being jailed as our automatic response to infractions.

Further, approving expansion of jail capacity shows increased reliance on the jail to provide treatment to persons with mental illnesses. This is counter-productive because these settings often exacerbate psychiatric symptoms. It is fiscally irresponsible.

A more responsible and humane strategy is to invest more in crisis intervention training for law enforcement and corrections officers, mobile crisis response teams, community-based mental health treatment programs, and mental health jail courts. These measures are more cost-effective and have been shown to reduce arrests, jail days and hospital stays.”    Click here to read the full statement.

 

 

Join “Listening Session” on Jail Diversion Options

NAMI-Dane County and MOSES are sponsoring a listening session to discuss issues related to mental health and the Dane County Jail.  Paul Saeman of MOSES will present successful models for jail diversion in other jurisdictions.  Carousel Bayrd, who attended the Stepping Up Summit in Washington, D.C., will offer the perspective of a member of the Dane County Board of Supervisors.

The event will take place at Trinity Lutheran Church, 1901 W. Winnebago St., Madison from 6:00 to 8:00 on March 16th.

 

 

Gov. Walker Proposes Funds for Children’s Mental Health Services

Thanks to the Advocacy Committee of NAMI-Dane County for this information about Gov. Walker’s budget proposals for children’s mental health services.

Walker proposes  a categorical aid program of $3 million to pay for social work expenditures of school districts and independent charter schools, a grant program of $2.5 million to help connect youth to mental health services; and $1 million to provide training for school employees about how to provide mental health screening and intervention services.

A policy advisor to Wisconsin School Supt. Tony Evers will meet with the Advocacy Committee at 5:30 on February 13 at the NAMI office,  2059 Atwood Ave., Madison.

Check back here for more information about Walker’s budget proposals affecting mental health services.

NAMI-Dane County Moves Quickly to Meet New Challenges

Just when we need hope and energy they have appeared at NAMI-Dane County.  Lindsay Wallace, the new executive director, and the board of directors have launched several initiatives that will help members meet the obvious challenges ahead.

The board went through a strategic planning process designed to establish priorities and methods to measure success.  The three broad goals are: sustainability (fundraising-development), youth mental health, and advocacy.  Each goal has specific objectives to be met, often with target dates.

The redesigned website provides a staff blog.  A recent entry offers lessons learned from a MOSES-sponsored meeting on the mental health implications of crimeless revocation.  Such revocation occurs when a person is sent back to jail for a parole violation instead of committing a crime.  Executive Director Wallace was a speaker.

The strategic plan appears on the website, as do board minutes.  Recently, members heard an update on Housing Initiatives, a program that provides housing for people with mental illness.  Board members also are working on problems related to the criminal justice system.

NAMI-Dane County’s advocacy committee meets the 2nd Monday of every month from 5:30 to 7:00 at the United Way Building, 2059 Atwood Ave.  Currently, the committee is working on issues concerning youth mental health.

The website address is: http://www.namidanecounty.org.