More News on Crisis Restoration Centers and Jail Diversion: Join NAMI Meeting on 2/22

A two-part series by Wisconsin State Journal  reporter David Wahlberg delves into the need for jail diversion programs and treatment options in Dane County.  He also reports on assessments of the services provided by Strategic Behavioral Health in nearby Green Bay.   SHB announced that it will open a hospital with crisis restoration beds in Madison.

Click for “County Explores Crisis Restoration Center”

Click for Green Bay article.  Click for letter to the editor that describes a bill that would provide grants for crisis restoration centers throughout the state.

NAMI-Dane is offering a meeting with a SBH representative who will answer questions about plans for Madison.  Here is the information.

“Let’s Talk About It” Program Series
Please join us for our February Program Meeting to learn more about Strategic Behavioral Health (SBH) and the new psychiatric hospital planned in Dane County. This meeting has a Q&A format, where panelist Bret Morschauser – clinical liaison with Willowcreek Behavioral Health in Green Bay (a subsidiary of SBH) – will answer questions and comments from the audience.

February 22, 2018
5:30-6:30pm
United Way Building, Evjue A & B
2059 Atwood Ave.

Free event but registration is appreciated.
Call 608-249-7188 to let us know you’ll be there!

 

 

 

Two Veterans Travel a Rocky Road for Help with War Trauma

Military veterans Connie Walker and her son Michael Segich fought battles that neither had anticipated.

In 2003, Connie retired as a Navy Captain after 23 years of service.  At about the same time, her son returned from Army service in Iraq.  Back at home Michael would wake up screaming and was later diagnosed with post-traumatic stress disorder, schizophrenia, and depression.

Mother and son struggled together to find mental health treatment and services that would enable him to regain a sense of stability and independence.  Now, Michael lives in his own apartment and holds a job at Metcalfe’s in Hilldale as a grocery bagger.  But, his journey included hospitalizations, failed medications and treatment, and an unhappy spell at a group home.

Michael told reporter David Wahlberg, “If I didn’t have my mom or the other people advocating for me, I could very well be homeless.”

Daniel Zimmerman, secretary of the state Department of Veterans Affairs, named Connie the Woman Veteran of the Year for her “tireless advocacy for veterans.”  She developed and will lead Homefront, a series of six classes to be offered at NAMI-Dane.  In the series, Connie will use what she learned as Michael’s advocate to help veterans with mental illness, their families, and caregivers.

Click here for more information about Homefront and a registration form.

For more information about Connie and Michael, read David Wahlberg’s article “Retired Navy Captain Helps Son and other Veterans with Mental Illness.”

NAMI Gets Answers about the Crisis Restoration Center and Raises More Questions

Check out the blog post by Lindsay Wallace, NAMI’s executive director, for excellent reporting about the psychiatric hospital/crisis restoration center proposed by Strategic Behavioral Health (SBH).  Click here for a link.

Lindsay addressed the concern that SBH is a for–profit company.   Here is what she reported:

“There are distinct differences between not-for-profit and for-profit psychiatric facilities but SBH says their approach to care delivery is the same; they ensure all referring/community professionals, consumers, caregivers, and families are involved in the consumer’s treatment and recovery plan every step of the way.

I have reached out to other NAMI affiliates across the country who have SBH facilities in their community to see what their experiences have been in regards to care coordination and quality of care. In each instance, I received positive feedback. Our hope is SBH will deliver on this promise in Dane County as well. It is, of course, something we will monitor closely.

When it comes to service to patients who are unable to pay, SBH said they provide services regardless of ability to pay. They are able to do so because of the individual mandate through the Affordable Care Act. Those who have coverage are charged higher costs for services, making it possible for SBH to not turn away uninsured and underinsured patients – a practice we understand non-profit facilities utilize as well. Of course, there are concerns around the sustainability of such a practice with current tax reform efforts that include a repeal of the individual mandate.”  NOTE: As of 12/19, the individual mandate appears over.

Lindsay also raised these questions:

Will SBH have discretion over who they accept for inpatient treatment or must they accept referrals sent to them by the county?

Will SBH be required to serve people who are court ordered into treatment?

Will the contract with SBH establish requirements for discharge planning and linkages with community services?

Will SBH have the capacity to treat the physical health needs of people they serve, including preventive health services such as smoking cessation?

Will SBH’s performance be assessed on measures such as clinical outcomes, screening for metabolic disorders, coordination of mental and physical healthcare services, use of aversive measures such as restraints and seclusion, screening and treatment for alcohol or substance use, number of patients discharged on multiple antipsychotics and justification, and how quickly patients are seen in the community after discharge?

Click here for a link to NAMI-Dane County.  Lindsay is planning a forum with SBH in the spring.

UPDATE:  JUDGE EVERETT MITCHELL WILL BE THE KEYNOTE SPEAKER AT NAMI’S ANNUAL AWARD BANQUET.  He will speak about decriminalizing people with mental illness.  Date is April 5, 2018.  Check the website for NAMI-Dane County for details.

 

 

 

 

 

 

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.