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.

 

 

 

 

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

Almost all of us lament the criminalization of the mentally ill.  For more than a decade, prisons have become a more damaging place for 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.”

 

 

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.”

 

 

 

 

Look for the Tiny Rays of Sunshine in Walker’s Budget

Wisconsin Health News (9/22) offered comments by advocacy organizations about small steps forward in this year’s budget.  Here are excerpts.  WHN is a subscription service.

“The Survival Coalition of Disability Organizations said the budget would help eliminate long-term care wait lists for 2,200 children with physical, developmental or emotional disabilities. And they called a 2 percent increase in Medicaid personal care rates “an important first step in addressing the workforce crisis.”

“Wisconsin Health Care Association and Wisconsin Center for Assisted Living Executive Director John Vander Meer lauded the budget for including a 2 percent increase for skilled nursing facilities and a $60 million increase for Family Care over the biennium.”

“Linda Hall, executive director of the Wisconsin Association of Family and Children’s Agencies, said the budget makes a “significant investment” in student mental health by providing $3.25 million in new grants along with Medicaid-funded consultation services.”

On the other hand, WHN also reported that Walker vetoed a resolution passed by the Joint Finance Committee stipulating that the state’s requested Medicaid waiver could not be implemented without its approval.  The requested waiver is the most Draconian in the country.

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.

 

Cuts to Mental Health Block Grant Program Could Wipe out Progress in Wisconsin

Trump’s budget proposal for the Mental Health Block Grant program calls for a cut of about 25 percent.  Wisconsin’s Department of Health Services has been instructed to assume that it will receive $2.3 million less than it received the previous fiscal year.  DHS will submit its budget this week.

Wisconsin Health News interviewed advocates and providers of mental health services to gain an idea of the impact of the cuts.  Here are excerpts from those comments:

Barbara Beckert, Milwaukee Office director for Disability Rights Wisconsin, said that the grant had played a key role in increasing access to community services and decreasing reliance on crisis and inpatient care.  She mentioned employment opportunities for people with mental illness and early interventions for at-risk children.

Mental Health America would lose $125,000 from its suicide prevention program.  The National Alliance on Mental Illness Wisconsin could lose $52,000 or one staff member.  Family Ties of Wisconsin, which provides peer support to parents, could lose about $58,000.

Other cuts include:  access to mental health services for people who are homeless; training for providers and efforts to reduce inpatient readmissions;

The federal House of Representatives has approved the cuts.  Wisconsin’s Senator Tammy Baldwin sits on the Senate Appropriations Committee, which has yet to approve the cuts.