Milwaukee County’s Mental Health Reform Successes

In a local publication, the Urban Milwaukee online newsletter reports on the beginnings of success in Milwaukee County’s difficult reform process addressing their overstressed mental health services delivery system. Milwaukee County had made the national news more than a few occasions in the last three years or so, as its deficiencies came to light. The reader is encouraged to use any search engine to see such accounts as this, to get a feel for what the advocates, patients, public mental health agencies and the local county government, were facing. It sounded even to this reader and observer, like another example of failure, governmental funding neglect, inadequate services, etc., that would take its place alongside numerous other instances of local and regional failure in mental health services delivery. It was also very much in doubt that adequate solutions would or could be organized, funded and put into place.

However, the local groups involved in Milwaukee County from county officials to agencies, advocacy groups, patients, and mental health providers, pledged to address the issues jointly, and they did so for over two years. Their efforts, I am sure, were extremely difficult and daunting to everyone involved. But they persevered under very stressful circumstances, and as the television commentators would say, ‘they pulled it off.’

In an article entitled “Milwaukee County’s Approach in Mental Health Reform is a National Success Story,” this unusual effort is detailed anyone interested in this national and local issue to read, take heart from, and to learn from.

One of the signal features of their effort was truly bringing all the “stakeholders” together to work in a very unified manner, encouraging novel ideas. Very different worlds, from police to clinicians and local governmental officials of all stripes formed working groups in a “multidisciplinary” way[another current buzzword that I often detest, but seems to apply in this effort]. One example is that early on in their work process, the reformers for lack of a better term overcame the usual city-county splits of governmental entities, clinical entities, and police law enforcement groups. Too often I have seen all kinds of efforts ranging from budgetary matters to who pays for the pro football team’s new stadium to where the next trash landfill will be located. In greater Milwaukee, the city-county entities worked together [gee, I wish Congress could do that…]

So, if you are interested in mental health reform and need an example of success to strengthen your own resolve, please read about Milwaukee’s efforts.

 

Advertisements

Virginia’s Mental Health Reform Legislative Progress

Continue reading “Virginia’s Mental Health Reform Legislative Progress”

Larned State Hospital Turns to Law Enforcement Figure for Hospital Superintendent

I am calling attention once again to the long-standing troubles at one of the two Kansas state psychiatric hospitals, Larned State Hospital, which has had over the last few years a host of staffing, management, clinical and accreditation problems. I am reaching back a bit, now six months to refer to an article, published June 29 of last year, 2016, by the online arm of KHI News Service of Topeka, “Longtime Kansas State Attorney Name Larned State Hospital Superintendent by Bryan Thompson.” The new hospital superintendent is Mr. Bill Rein, long experienced in state mental health affairs. Mr. Rein brings a vast amount of experience with him, including his former positions as the former chief counsel for the Kansas Department for Aging and Disability Services, which oversees the state’s mental health hospitals in Larned and Osawatomie. He also had been the former chief counsel for the Kansas Department for Aging and Disability Services, which oversees the state’s mental health hospitals in Larned and Osawatomie. He also had supervised attorneys representing the state hospitals from 1984 to 1987. So this man has had an unusual career of experience in mental health policy planning, drafting mental health-related legislation and direct experience in a vital sector of legal representation of the state’s mental hospitals.

 

Bill Rein the new superintendent of Larned State Hospital since June 2016
CREDIT FILE PHOTO, KHI News Service, Topeka KS

 

When Mr. Rein was appointed he spoke of the tasks facing him and showed an unusual and encouraging grasp of the magnitude of the problems that face this hospital in particular which mirror those of other state hospitals around the country, including long-term inadequate funding, overworked staff forced into overtime work shifts much too frequently causing high staff turnover, difficulties recruiting care and professional staff at all levels because of the very rural location of the hospital with a small’ish surrounding population base, and particular difficulties attracting professional mental health staff because of low salaries that are noncompetitive.

This man is shouldering a very large task and this writer hopes he can turn this hospital and vitally needed system around in time. I hope to watch and monitor developments and bring them to the reader in the future. Kansas hopefully can become an example to other states of what it will take to put in place quality based reforms at the state psychiatric hospital system level for other states facing almost exactly the same problems, of which there are more than a few in this country.

 

New State Hospital Already Destined to be Closed

In an article, “New state hospital may close,” published in the Bulletin of the Salem’s Central Oregon region,  the Associated Press reported December 3, 2016, that Oregon’s Governor Kate Brown had suggested she had decided or was in the process of deciding to close a new state psychiatric hospital, in the Eugene, OR area, near Junction City. which is the new site of the original Oregon State Hospital.This hospital has a total capacity of 100 beds.

The hospital which has been open only 18 months and cost $130M to build, is slated for possible/probable closure in mid-2018. Its closure was heralded as necessary to save the economically beleaguered state much-needed monies. No real details are given by the state personnel’s’ announcement concerning this drastic move except there is a large budgetary “hole” in the state’s health care departments’ budgets and closing the hospital, which has 422 employees will save the state $34.5M a year.

Continue reading “New State Hospital Already Destined to be Closed”

The Simplest Mental Health Reform Blueprint

In an unassuming online article published by WDKI television of Kansas, “Mental health reform proposed in Kansas,”there is laid out a summary of the initiative(s) now stirring in Kansas that show the simplest and some of the most needed mental health reform measures needed in this country. The irony is that they are incredibly simple, intuitive and long known as needed by policy wonks in the field and providers of all types in the mental health professions.

They boil down to basically simply and (stupidly enough) restoring some of the most basic lynch pins of our system of mental health care delivery.

Those essential foundations or struts of the superstructures of local or regional mental health care delivery systems of ANY size, consists of two basic things, money (“funding” in the ever dominant bureaucratic talk) and providers. Such a non-complex concept that we are starting to circle around to and rediscover. [Read angry irony in that last sentence please].

The last 20 years have seen state legislatures  cut funding for state and local mental  health services, fight Medicaid expansion to help provide mental health insurance and thereafter access to the ‘new’ privatized’ models of MH services agencies {they used to be called “mental health centers” in each country]. In most states, the new mental health reforms were SUPPOSED to cover the uninsured but somehow they often did not because of limited funding {read “block funding”]. Block funding as a concept originated mostly under the Nixon administration and since then has been largely used by a political party of a certain flavor tp punish frowned upon governmental services, such as Planned Parenthood, National Public Radio, and other entities, you get the idea. The concept was that funding was not cut off to avoid too much blowback, but given in limited and sometimes ever shrinking amounts with the admonition to choose upon what to spend it, leaving the do-gooders in the agencies to make the cuts and make the less than kind decisions and “be the bad guys.” That way legislators could crow to their constituents that they had not increased spending and had not cut funding [the latter often untrue but who’s quibbling here, this is politics…).

The other major pillar of deconstruction of the old county-based mental health system has been the ever shrinking pool of psychiatrists, counsellors, substance abuse counsellors, psychologists, child therapists of all disciplines and especially outreach workers in the old public health system sense, the “outriders,” who visited homes and if nothing else dropped the essential daily antipsychotic doses into patients’ mouths and made sure they swallowed them. It’s called “compliance.” Training programs until the last 10 years have done nothing but stay static in numbers of graduates or shrink dramatically as my one training program did for years. Some few departments of psychiatry closed or merged such as the famous occurrence at Tufts University Dept. of Psychiatry in Boston decades ago which was essentially saved and bought out by Harvard.

Reading the article makes me realize it has taken 30 years to pummel into the heads of the so-called reformers that three simple needed measures: outpatient services including residential systems of living centers for displaced mentally ill out of destroyed or as they would say in the Peron dictatorship years in Argentina, “disappeared,” hospital beds, and increase the funding and programs for providers, in this case, psychiatric residents. Sen. Chris Murphy’s bill and Former Rep. Patrick Kennedy’s now in effect merged national mental health reform bill does the same things largely except on a national basis

Dr Harold Carmel MD of Duke Psychiatry said now over a decade ago, “it will take us 10 years to get back to where we were 10 years ago.” At least we have real starts now.

 

History of Osawatomie State Hospital in Kansas as National Metaphor

Ms. Megan Hart of the Kansas Public Radio Station KCUR and the group Heartland Health Monitor partner KHI News Service has been following and chronicling the long sad story of the Osawatomie State Hospital in Kansas for quite some time now, nearly two years or perhaps longer, that this writer has been aware. Ms. Hart’s latest article, “Osawatomie State Hospital: A Leading Light for Mental Health Care Slowly Dims.” published  July 25, 2016 documents very ably both the issues of this state hospital, its parent state, and the social vise that all too many such state hospitals more or less find themselves facing in this time of hoped for reform.This piece of American state hospital history is in many ways not unique to the fascinating and very checkered social history of the American state psychiatric hospital for public inpatient care of the seriously and chronically mentally ill.

Continue reading “History of Osawatomie State Hospital in Kansas as National Metaphor”

Helping Families in Mental Health Crisis Act Passed the House of Representatives

I have long awaited this juncture, the partial passage of the most significant, and hopefully helpful federal mental health reform legislation in this country since President Kennedy’s 1963 Community Mental Health Center Act, the Helping Families in Mental Health Crisis Act,” or HR 2646. [I would encourage readers to actually follow the link to the text of the bill and give it a studied read]. Politics is ordinarily as an area I steer away from in my public blog writings as for the last 30 years it has been nothing more than a hopeless, dirty, pointless and non-productive quagmire that until recently has held no real relationship to the issues dear to this effort’s mental health professional’s heart.

But the time has come to start commenting upon, openly following in [I hope] responsible medical journalistic fashion, the life, future and fruits and/or unintended consequences of the slow legislative efforts and developments of years of failed political/legislative efforts to repair our long broken mental health care delivery system, both public and private. The Helping Families Crisis Act now appears to be the first piece of legislation with at least a reasonable potential to effect a vast amount of good effort in the right directions and quarters. One of the many recent news articles, printed over the last year or so to keep this bill alive in the public’s mind, prompted my entering into the national discussion regarding this legislation and its significance. I had held off doing so as for months it has appeared that it would be lost in the polarization of the political parties of the last four Presidential terms or buried/ignored because of lack of support since it concerned “mental health issues,” and all their complexities that at time legislators seems to avoid like the plague. But now it has recently “made it over the top,” as it were and appears destined for passage by the Senate in the near fall. In fact, it has seemed to gain a sort of hallowed status as one of those bills that the pols finally realize they had better jump on to the bandwagon rather than ignore any longer. And politically speaking, it has greatly helped that two brave Republican Congressman have fought hard for this legislation and made it politically acceptable to even most extremists to support.”

Continue reading “Helping Families in Mental Health Crisis Act Passed the House of Representatives”