More Bipartisan Support for Regional Mental Health Crisis Centers

An editorial in the Racine Journal  supports legislation that would provide a grant program for mental health crisis restoration centers.  The bills would also allow law officers to take people with acute psychiatric needs to the closest mental health institute in the state.

The authors point out that although access to psychiatric care would be more quickly available in some parts of the state with passage of the bills, residents in the Racine area still would have to travel at least two hours for help.  Therefore, they support the funding of regional crisis centers that would be situated at hospitals.  Click here to read the editorial.  Here is an excerpt.

“So the aspect that has us enthusiastic is the proposed grants for developing regional mental health crisis centers. Given all of the facilities operated by Ascension, Aurora and United Hospital System in the Racine-Kenosha area, we see no reason why one of the area facilities couldn’t obtain a grant and establish itself as a regional center.

We want our law officers on duty within Racine County, not taking 4-plus hours out of a shift to transport someone in need of mental health care to a state-mandated facility. Especially when a facility within 40 miles of the station could be established as a regional destination for such patients.”

The bills (SB 681/AB 815) were introduced by Republican and Democratic legislators and by members from Dane County and the center of the state.  Among its supporters are: the Wisconsin Chiefs of Police Association; the League of Wisconsin Municipalities; the Dane County government; the Dane County Cities and Villages Association, and the League of Women Voters of Wisconsin.

See “Bipartisan Support for Better Access to Mental Health Institutes” on this blog for background on the legislation.

UPDATE:  Local criminal justice and other officials in St. Croix also reported problems because of the lack of crisis restoration centers.  Here is what they told Attorney General Schimel.

“Yehlik and others made clear to Schimel that it does agencies in western Wisconsin no good to open more beds on the other side of the state.

North Hudson Police Chief Mark Richert said funding issues make local hospitals hesitant to establish such facilities in western Wisconsin. That, Schimel said, is because of reimbursement issues.

But, he noted, law enforcement also isn’t getting reimbursed for the cost of transports to the state’s Winnebago Mental Health Institute, which he said can exceed $1,000. St. Croix County Sheriff Scott Knudson said his office performed 47 such transports to Winnebago last year.”

Schimel later called the issue “a gigantic drain on county and local budgets.”

The above comments come from the River Falls Journal.  Click here to read the full article.

Bipartisan Support for Better Access to Mental Health Institutes

A bipartisan group of legislators is proposing a solution to problems posed by the state’s decision in 2014 to limit access to Mendota Mental Health Institute in Madison to criminal cases.  As a result of that decision, two police officers must transport a person in a psychotic or seriously disturbed state to the Winnebago Mental Health Institute near Oshkosh.

The trip from Madison takes two hours each way.  It is a frightening and damaging trip for the person locked in a police car and a costly one for city and county governments.

From 2014 to 2016, transports to Winnebago from Dane County cost more than $330,000, including nearly $151,000 for the Dane County Sheriff’s Office and nearly $61,000 for the Madison Police Department, according to the Dane County Chiefs of Police Association.

The bill would allow law enforcement to take individuals to be detained for “emergency detention or involuntary commitment” to the most convenient mental health institute.  It has bipartisan support because counties and individuals throughout the state have suffered as a result of the state’s 2014 ruling.

The bill also proposes a program that would provide grants for hospitals for regional mental health crisis centers.   The grants would be funded in the 2019-21 legislative session.

Click here to read the proposed legislation.

David Wahlberg reports on the history of the problem and reaction by local officials in “Bill would restore mental health crisis detentions at Mendota.”

In “Crisis Cops,” Abigail Becker offers insights from the police about the Mendota restrictions.

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.

 

 

 

 

 

 

A Crisis Restoration Center for Madison: Who will Pay?

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.

 

 

 

 

Shortage of Mental Health Care Providers has Lasting Consequences for Wisconsin Youth

Almost all of us lament the criminalization of the mentally ill.  For several decades, prisons have been a more damaging place for many adults with mental illness than the coercive psychiatric hospitals they replaced.

A recent article in the Milwaukee State Journal  shows that the link between mental illness and the criminal justice system can start at a young age.  Reporter Rory Linnane  quotes Peg Rauschenberger, a registered nurse at Milwaukee County’s youth detention center.

“It’s almost like they have to get into some sort of trouble before they get into [mental health] services,” she said.  “They end up being incarcerated for really what is a health issue and it shouldn’t have gotten that far.”

A stay at the youth detention center might begin the journey to the Lincoln Hills School for Boys or Copper Lake School for Girls.  About 75 % of male inmates and 85% of female inmates at the complex meet the criteria for at least one mental health disorder, according to Wisconsin state figures.

The facilities are under judicial order because of inhumane and ineffective treatment of the young inmates.  More to the point, the American Psychological Association has threatened to remove its accreditation as an intern site because of excessive mental health caseloads, inconsistent intern supervision, ethical lapses by staff, transparency failures and other issues.

Read Linnane’s article Shortage of Mental Health Providers Hits Crisis Point for a good analysis of some underlying reasons why many young people end up at the detention center and ultimately the failed juvenile complex.  Largely because of inadequate funding and low reimbursement rates,  Wisconsin does a worse job than most states in providing access to all types of mental health professionals.

UPDATE: The APA has placed the mental health program on probation.  Click here to read a story with more details about the failures of mental health services at Lincoln Hills.

Walker Raises Medicaid Reimbursement Rates for Mental Health and Substance Abuse Services

Wisconsin’s rates have long been among the lowest in the country.  The result is that mental health services are curtailed because of lack of availability of those who can afford to provide the services.  See “Voices from the Front Lines: NAMI’s Lindsay Wallace” for a discussion of how the low rates affect people with mental illness in Dane County.

Gov. Walker has just announced that rates will be raised next year.  According to him, they will be competitive with those in neighboring states.  Click here to read the press release.  Here are excerpts.

“This morning, at the 13th Annual Mental Health and Substance Use Recovery Training Conference in Wisconsin Dells, Department of Health Services Secretary Linda Seemeyer announced an investment of about $17 million, including $7 million in state funding, to raise rates for professionals providing outpatient mental health and substance use disorder services.”

“Effective January 1, 2018, Wisconsin Medicaid will increase reimbursement for outpatient mental health and substance use disorder treatment. This policy change will increase the maximum allowable fee for each covered outpatient service, and simplify the current rate structure, moving from five different fees per service to two fees per service. The new rates are competitive with border-state Medicaid programs and Medicare reimbursement, supporting growth of the Wisconsin provider workforce.”

Click here to read a story in the Milwaukee Journal Sentinel that describes reactions by advocates to the increase.

UPDATE:  Wisconsin Health News provided this report about the state’s AG’s reaction to the opioid crisis.

“Attorney General Brad Schimel called for increased attention to prevention and higher reimbursement rates for addiction treatment at a Medical College of Wisconsin forum on the opioid epidemic.

‘We’re making great progress but I kind of liken this to a sinking rowboat,’ he said. ‘Law enforcement is bailing it out by arresting drug dealers. Treatment providers are bailing it out by helping people get treatment. But there’s a big hole in the bottom of the boat. And I think this is the most important piece of our efforts, it has to be the prevention side. We’ve got to get this message out to the public and to the medical community.’

Schimel also said that ‘we’re going to commit to dramatically raising the rates at which we reimburse people to provide mental health services’ and addiction treatment services to attract more workers to the field.

He and other attorneys general are putting pressure on insurers to make those changes, he said.”

UPDATE:  Wisconsin Health News (11/29) reported on problems identified by the Wisconsin Hospital Association.  Here is an excerpt from WHN‘s report.

“In comments submitted to DHS in mid-November, the association praised the increase. But they urged the department to add codes for psychiatrists, advanced practice psychiatric nurses and psychiatric physician assistants.

WHA general counsel Matthew Stanford wrote that the lack of codes for those professions is a “significant omission if the goal is to provide a comprehensive outpatient behavioral health reimbursement increase to address access difficulties – particularly Wisconsin’s acute shortage of psychiatrists.”