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.


Virginia’s Mental Health Reform Legislative Progress

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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.


Community Support Like Gheel Belgium in Frederick Maryland

Since the 1400’s, the town of Gheel (also spelled Geel) Belguim has done an incredible “community project,” that as a psychiatrist I have read about periodically, and marveled at for decades. In short through an unbelievably improbable religious fluke of an event of historical Christianity, started a custom of taking in the mentally ill by families. In Gheel, families would care for the mentally disabled for as long as they could. If the parents of the caretaking family died, and the disabled ‘adopted’ member of the family was still alive, the grown children would take over their care. The system was unique in the world and still is. In fact, in some ways because of its historical longevity, it has in some ways become stronger. All this occurred centuries before any semblance of modern mental health care and it worked. Of course some of the mentally ill were so disturbed they could not be housed in families’ home but most could. The above link takes on to one of the best all around explanations of this social experiment, namely a Wikipedia article. In modern times, hundreds of social researchers and mental health professionals have made pilgrimages to Gheel to observe and study this centuries-old social ‘experiment.’

In an article entitled, “Unique programs offer people with mental illness a place in their communities, published recently in the New Haven Register, a somewhat similar social good work was profiled in the Frederick VA area, with photographs from the Washington Post. I have excerpted the following pictures and captions from that article, taken by the Post photographer and given due credit.

David Weiss, who is interested in Buddhism, seeks peace and calmness at the Tibetan Meditation Center in Frederick, Md. A favorite mantra is “Pull a weed, plant a flower.”

David Weiss, who is interested in Buddhism, seeks peace and calmness at the Tibetan Meditation Center in Frederick, Md. A favorite mantra is “Pull a weed, plant a flower.” Washington Post photo/Katherine Frey By Colby Itkowitz, The Washington Post
David Weiss, above, who is successfully dealing with several serious mental health conditions, plays a song he wrote about his sister Faith while his cat, Bab-Babes, rests close by in Weiss’s one-bedroom apartment in Frederick, Maryland. Way Station provided Weiss with the apartment as well as a case manager.David Weiss, above, who is successfully dealing with several serious mental health conditions, plays a song he wrote about his sister Faith while his cat, Bab-Babes, rests close by in Weiss’s one-bedroom apartment in Frederick, Maryland. Way Station provided Weiss with the apartment as well as a case manager. Washington Post photo/Katherine Frey
The profiled recipient of this comprehensive program, though lives on his own, attends community college classes, receives his care through clinical services of the renowned Shepherd Enoch Pratt Hospital system and lots of what we would call “ACT team wrap around” services in his apartment with visiting clinicians and by appointments in a clinic in the traditional manner. But he is overseen and in touch frequently and regularly by caring clinicians. And he still has active schizophrenic symptoms of hallucinations. He has had, it sounds like very good, cognitive therapy to help him manage his hallucinations and live with them with little or no disruption to his everyday social functioning.
Most of all he has his dignity, continues his education part time at age 64, has his dignity and his own “digs,” or place to live on his own.
His clinic program and home base for his outpatient care is a unique organization/clinic called Way Station which works very much in nontraditional ways, with its emphasis on integrating and maintaining clients in the community. It is an American derivation of sorts of the Gheel approach and seems to work well for at least some patients. The article cited above gives much more detail and background and is worth reading.
But programs like this are still too few are far between. What is usually happening now in this country is that such programs are not yet the norm, not funded and largely nonexistent. Patients who do have their own families to live with upon discharge are placed in “placements,” which range from nursing homes to entrepreneurial small to large group homes run by operators all over the country. And there are usually few to none of the social outlets, programs, educational or otherwise to further prepare and integrate clients into the ordinary fabric of our society.
We still have these new remnants of the “welfare hotels,” that were so prevalent most famously of all in New York City where out of business hotels or projects buildings, were renovated more or less well, and persons on disability income or the discharged mentally ill were housed in small hotel rooms as apartments. These places were rife with crime. They still exist typically in very large cities and are often little better managed or integrated into active treatment or rehabilitation programs and have turned into wellsprings of crime and drugs and all that goes with those scourges.
But now the funding nationally with the perhaps certain repeal of Obamacare may seriously in the future be threatened. One would hope not, and that instead these sorts of programs are replicated nationwide with links to education, employers and the levels of outreach outpatient care that is needed. But again it all boils down to money in this country. It costs money and a fair amount of funds to sustain these people-labor intensive community-based programs. We have made substantial progress in moving patients out of the state hospitals. But our high recidivism rates, readmission rates, at all state hospitals in this country demonstrate clearly that the above minimal “placement,” endpoints we now rely on, are neither working all that well nor sufficient. Let us hope that gradually our national commitment to those needed these levels of services becomes the norm in the future.

The New Grim Origin of Mental Illness Stigma

 In an article entitled: “Airport shooter shows challenges of nation’s mental health system,” published this week of January 15, 2017 in the San Diego Union-Tribune,  authored by Paul Sisson & Jeanette Steele, the very difficult shortcomings of our mental health care system which is based in a system of laws that provides for basic human rights as much as we possibly can, is full of holes and flaws. This article eloquently shares with us the very perceptive thoughts of two local figures of the San Diego area, one from the field of psychiatry and one from law enforcement. They discuss the incredible impossibilities facing us now as we see self-radicalized severely mentally ill turn into mass shooters with perhaps slowly increasing frequency.

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Progress at Western State Hospital in Washington State: A Good Example for Other Beleaguered Hospital Systems?

Western State (psychiatric) Hospital has been in operational distress for more than a year now and following the travails of this facility and its staff from the line ward workers and behavioral care technicians, nurses and professional staff has been quite sad and discouraging for anyone interested in mental health reform and service delivery policy.

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Washingston State Hospital System Fined

IN a very recent story of less than a week ago, entitled: “Washington accrues almost $7.5 million in contempt fines,” written by Martha Bellislea of the Associated Press published in many major newspapers across the country, the sad story of the travails of Washington’s Western State Hospital continues to showcase the plight of a number state public psychiatric hospitals.


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