County eyes health care money to solve mental health crisis
Private hospitals blamed

Also on this page: Mental health "crisis" in Milwaukee County

June 23 -- Decisions by private hospitals to close their acute care psychiatric units have left the Milwaukee County Health Complex with an overwhelming caseload, according to County Supervisor Lynne DeBruin.

The psychiatric crisis service unit of the Milwaukee County Mental Health Complex was so inundated with patients earlier this year that some people needing immediate psychiatric evaluations were kept waiting for hours in squad cars parked at the complex, DeBruin said.

One patient sat in a squad with an officer for six hours, she said.

“That is the most expensive and inappropriate way to” handle the backlog of urgent cases, she said. The image of such a scenario “is outrageous to people,” DeBruin said, both because urgent patient care is delayed and officers are taken off the streets.

Staggering caseloads are not a problem just with the crisis service unit. Patient count in the complex’s five adult acute care units are so high that supervisors are considering raiding the $14.4 million in tax levy that supports health care for the uninsured and use at least some of it to build and staff an additional acute care mental health unit, DeBruin said.

Moving the tax levy could, in turn, put at risk up to $34 million in state and federal health care assistance for the uninsured, DeBruin said. The county must put its own money into the program – called the General Assistance Medical Program – to leverage the state and federal money.

“This is a real crisis,” she said.

DeBruin

She said responsibility for the situation lies with private hospitals that that over the past few years closed their inpatient acute care psychiatric units, leaving patients who need services with nowhere to go but to the county.

The Medical Society of Milwaukee County last week said inadequate county funding for inpatient mental health treatment was contributing to the crisis.

“You folks – your hospitals caused it,” she said, referring to some Medical Society members. “The hypocrisy of that is what is so frustrating,” she added.

Using General Assistance Medical Program tax levy to pay for mental health services will cause some financial pain to those same private hospitals, because most GAMP money goes to hospitals to pay them for treating uninsured county residents, she said. The hospitals will have to write off more costs as charity care or bad debt if the GAMP funding dries up, she said.

“This is the carrot and stick thing,” she said.

The county never was meant to be the only provider of in-patient mental health care, she said.

“We were set up as both the payer and provider of last choice,” she said. “We are supposed to be the last resort. We are the safety net.”

DeBruin said supervisors were disturbed that County Executive Scott Walker knew about the problems for months, but did not tell members of the County Board. When she told other supervisors about the situation Tuesday, she said, “The universal reaction was, ‘how could we not know?’ There’s a major concern that this has been going on since February and the board wasn’t told.”

Walker previously has been criticized for not providing important information to the board, most notably regarding Family Care problems that led the county to go into deficit by millions of dollars.

Mental health "crisis" in Milwaukee County

June 22 -- Shortfalls in county funding for in-patient psychiatric care is contributing to "a crisis" situation, according to the Medical Society of Milwaukee County.

"Private hospitals lose too much money treating uninsured and underinsured patients, and the Milwaukee County Mental Health Center does not get enough money from the County budget to provide adequate services for that population," the society said in a prepared statement.

The inadequacy of county funding levels is not a new issue. County Supervisor Lynne DeBruin warned of shortfalls as early as November, well before the budget year even began.

The Medical Society said the county should reconsider funding for in-patient services.

Medical Society Board Member Mary Alice Houghton, a psychiatrist, said the county Mental Health Center's Psychiatric Crisis Service (has been consistently running at 30% over capacity for the last several months.

“The staff of the PCS has been doing a phenomenal job trying to keep up with the patient overload,” she said.

DeBruin said in November that the county would likely have to open a new acute care mental health unit this year new acute care mental health unit in 2004 to provide services that St. Michael Hospital and Aurora Sinai dropped because they are unprofitable.

The county's mental health in-patient load could increase by 400 per year, she said.

"It will be pure tax levy and that's not budgeted for," she said.

Adding another in-patient unit would could cost well over $1 million per year, according to county budget figures. The county's mental health budget is about $19 million.

DeBruin could not be reached for comment Sunday.

In its statement, the Medical Society requested that "other community organizations also look at short-term interventions that can assist in alleviating this dilemma.

MSMC requests that other Milwaukee County organizations work collaboratively to influence the Milwaukee County Board and, if necessary, state legislation that will address solving these issues."