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.

 

 

 

 

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.

 

Voices from the Front Lines: MUM’s Linda Ketcham

Nothing to worry about here.

That might be the conclusion of attendees at the June 6 meeting about the county’s jail diversion programs. Lynn Green, director of Dane County’s Department of Health and Human Services, and her staff offered a slide presentation that seemed to depict a seamless mental health system with many opportunities for services.

Yet, the providers of those services know the reality for people who need help is often quite different. The phrase “falling through the cracks” is commonly heard. This post is the first of a series of efforts to identify gaps in the system by talking with people who deal with them every day.

Linda Ketcham of Madison Urban Ministry (MUM) has been on the front lines for many years.  She directs an agency that aims to reduce the recidivism rates of those leaving prison and jail. MUM’s offerings might seem like simple common sense: case management, job readiness, housing assistance, and peer support programs.  Their success, however, is highly unusual.  The agency’s clients have a recidivism rate of less than 10 %, compared with a statewide rate of 67%.

“We need ‘real’ pre-release programs in the jail,” said Ketcham. By “real” she means they must be funded adequately and carefully designed. Simply opening up jail space to volunteer efforts can give the illusion of help, although it might not exist. MUM has already demonstrated the effectiveness of the kind of programs that could give jail inmates a chance at a successful life in the community.

Approximately one-third of the inmates in Dane County jail are on psychotropic medications. Continued access to that medication can be the determining factor in terms of a person’s ability to maintain emotional stability and take further steps towards recovery. Upon release, however, each of them receives medication that will last only five days.

Journey Mental Health Center offers appointments on a first-come basis twice a week. Ketcham said that the “window of availability” is short and people are turned away.  She wonders if Journey collects data on the number of those who arrive and are not seen.  In addition, a recently released inmate might not be stable enough to plan a trip to the center and wait for an appointment.

Badger Care offers other obstacles. There are reports of waits of up to five weeks for an appointment with a psychiatrist through one of its HMOs. Director Green told the county board supervisors that complaints about waits for appointments are not the responsibility of her department. No agency does accept responsibility, although the wait times would appear to violate state and federal parity requirements.

Lack of affordable housing worsens many community problems said Ketcham. “The idea was that people would move from a shelter to transitional housing to permanent housing. But there is a log jam, so they get stuck in place.” If they are stuck in a shelter or on the street, people with mental illness face particularly acute challenges. They need predictability and a sense of safety in order to develop the strengths that will lead to any version of recovery.

The opioid epidemic likely will aggravate the existing problems with the mental health and substance abuse treatment system. “We have been treading water for a number of years,” said Ketcham, “but unless capacity for treatment is expanded more people will cycle in and out of jail and prison.”

What’s the solution? More money would help. But, so would some honest discussion about the budget for the Dane County Department of Health and Human Services (HHS) .

Ketcham was one of the advocates who pressured County Executive Parisi for more transparency about the annual transfer of money from HHS to the General Fund. In 2015, the county board of supervisors approved the transfer of $6.2 million. Since 2011, the cumulative figure is $25 million. Click here to read an article about the transfer.

Other budgeting practices can also be misleading to the general public, she said.  For example, many of the program allocations/expenditures in the HHS budget are not funded with taxpayer dollars.  Therefore, a total HHS budget figure gives an inaccurate picture of the contributions of county funds to health and human services programs.   Actually, on a percentage basis, those funds have declined.

Advocates are developing a campaign to educate the public about the Health and Human Services budget and to increase the contribution of county funds.  Check back for updates.

 

 

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.

 

Funding Mental Health Services Can Pay off for the Taxpayers, as well as the Beneficiaries

Dane County took a big step forward when it received a grant from the MacArthur Foundation to support expansion of its restorative justice activities.  We have been less successful in mobilizing support for expansion of the mental health services that would help keep people out of jail.

But, investments in those services can pay off.   Bexar County in Texas is the site of a national model that has inspired county governments throughout the country to improve their treatment of people with mental illness and save taxpayer dollars

At the heart of the model are the Crisis Care and Restoration Centers.  Together, they offer 24/7 screening for mental illness, an inpatient psychiatric unit, outpatient psychiatric services, and a variety of substance abuse treatment options.  A police officer can drop off an individual with a mental health crisis and be back on the street within 15 minutes.  Referrals also come from mobile crisis teams, the courts, sobriety unit, mental health professionals, and families.

The two centers serve about 2,200 people per month who otherwise would have gone to jail or emergency rooms or back to the streets.  Before the centers were available, law enforcement officers spent an average of 12 to 14 hours in emergency rooms waiting for psychiatric evaluations.  They now wait about 15 minutes.  The county saves more than $10 million per year on averted jail costs and emergency room costs.

How did they do it?  It took sustained commitment by a wide variety of dedicated people in the criminal justice, county government, and health care communities.  The effort began more than a decade ago.

Identifying and securing funding was key.  Among the sources are Medicaid, Medicare, and the University Health System.  The county secured state funds that allow it to earn Medicaid Administrative Claims, which can cover from 25 to 30 percent of the cost of diverting an individual from jail.

County administrators encouraged state hospitals and other institutional practitioners to seek funds from private insurance, Medicaid managed care payers, and the Veterans Administration.  They received grants from the federal Substance Abuse and Mental Health Administration and foundations.

Click here for a link to a case study about the Bexar County model.

What Happened after “No New Jail” in Dane County?

In February 2015, the Dane County Board of Supervisors got “sticker shock” at the price of a new jail.  Members were also faced with opposition to the idea of spending money on a new jail, particularly since African-Americans make up a considerably larger share of the inmate population than their numbers in the general population.

“When we build them, we tend to fill them,” said Linda Ketchum, executive director of the Madison Area Urban Ministry, in an article by Joe Tarr in Isthmus.

Sheriff David Mahoney also pointed out the long-standing problem of housing people with mental illness in the jail.  He told reporter Tarr, “We’ve always housed those individuals in disciplinary housing units–units that are meant to change behavior, not treat mental illness.”

Funding for programs that would provide mental health treatment instead of jail time has not kept up with population growth and need, according to David Delap, head of a diversion program run by the Journey Mental Health Center.

Mahoney concurs.  “I haven’t heard of anyone stepping up to [provide services].  Since the ’70s, it’s been just the opposite.”

As a response to these problems, the Board appointed three task groups to come up with recommendations concerning problems with the criminal justice system in Dane County, with special attention to racial inequities and mental health.  The groups moved quickly and the Board issued a final report in September 2015.  Click here for the report.

Each group was to come up with 10 recommendations, five of which would require no new cost. Here are the recommendations concerning  “mental health, solitary confinement, and incarceration.”

  1. Remodel the current jail to reflect a more humane and modern facility.
  2. Develop culturally relevant community-based crisis, assessment and resource center.
  3. Increase the number and reach of mobile crisis response staff/teams.
  4. Develop more culturally relevant and family centered outreach and engagement.
  5. Add culturally relevant staff to work in collaboration with current mental health, substance abuse, or developmental disability services and community resources.
  6. Create and sustain a culturally diverse workforce.
  7. Reduce the length of time in solitary confinement and administrative segregation.
  8. Convene a leadership team of mental health providers, advocates and others to explore financing issues. (County Executive should lead.)
  9. Support the development of a plan to deliver additional training and resources for judicial officials, attorneys, and others involved in the court process, and
  10. Convene a workgroup under the auspices of the Criminal Justice Council to identify and sustain to improve processes and expedite cases for inmates with significant mental health, substance abuse, and developmental issues as may be appropriate.

In April, the League of Women Voters of Dane County will host a forum to consider progress on these recommendations and other issues concerning mental health services in Dane County.   Please feel free to comment on progress as you have seen it.

UPDATE: Click here for February 25 update on plans for jail.

UPDATE:  Click here for recent news about plans to update the jail.

UPDATE:  Click here for a statement from Board Chair Sharon Corrigan about the jail.  She writes that the Board added money for a “jail diversion program to emphasize community services.”

The System Can Work

Peter Rossmeissl, formerly a graduate student at UW-Madison, told WSJ reporter David Wahlberg about his journey toward recovery from a serious mental illness.

Rossmeissl spent time in jail and at Mendota Mental Health Institute before he was able to get a slot in transitional housing.  Yahara House, a clubhouse for those with mental illness, helped him move ahead with his life into a job as a peer support specialist at a program sponsored by Journey Mental Health Center.  His psychiatrist and medication help him maintain his recovery.   Read an interview with him here.