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.

Mental Health Gains under Affordable Health Care Act, but Miles to Go

Politico published a good summary of the effects of the Affordable Health Care Act on mental health services.  In short, inpatient services have benefitted, meaning fewer patients are languishing in ERs. Psychiatric hospitals and other institutions are being compensated for the care they provide, meaning they can provide more of it.

Outpatient care, however, remains difficult to access. Parity has been poorly enforced.   An insurance policy does not guarantee access to mental health treatment because of the limited number of psychiatrists and other mental health professionals included in company networks and other obstacles those companies create. Reimbursement rates for Medicaid patients remain low.  Dane County’s Journey, for example, recently announced it could no longer afford to accept Medicaid fee-for-service patients.

Read the full article here.


Journey’s New Director Tackles Funding Problems

For nearly a decade, Journey’s staff have been told to do more with less.  Funding from Dane County has not kept up with inflation or increased demand.  And, “less” is taking  a toll on people in need of mental health services and the staff who provide them.  The agency stopped taking new Medicaid fee-for-service patients this month.  They are the neediest economically of those in search of help.

Journey’s new director Ron Lampert told Wisconsin State Journal reporter David Wahlberg his ideas about how to “grow” a way out of that dilemma.  He will try to persuade the state to increase rates for Medicaid reimbursement, an idea that was echoed by Mary Grabot, director of Adult Mental Health Community Services for Dane County, at a recent meeting about criminal justice reform. See here for full WSJ article.

Lampert should also look at ways to force better implementation of parity laws and regulations.  Although the Affordable Health Care Act requires that mental health services be reimbursed by insurance companies equitably with other health care services, those companies have found ways to evade the law.  See the mental health parity category on this blog.

In the 1980s, a famed psychiatric hospital came up with a method to survive a devastating decline in funds when insurance companies adopted managed care.  The CEO, Steven Sharfstein, embraced business principles that enabled Shepphard Pratt Hospital in Maryland to expand into a multi-service statewide health care system at a time when many psychiatric hospitals were closing.  Sharfstein added new kinds of services, such as special education, that were profitable.  He also persuaded the state to increase Medicaid reimbursement.  See here for more information.

Like Sharfstein, Lampert plans to expand horizontally and geographically by merging with organizations that provide services related to Journey’s core mission, such as job training, and by extending the agency’s reach beyond Dane County.  He also is looking into a more cost-effective and flexible payment system that reimburses at a single rate per person per month.