Mental Health Takeover Bill Lacks Accountability
Appointed board members wouldn’t have to live in Milwaukee County or represent community
A bill fast-tracked through the Legislature would remove Milwaukee County supervisors’ responsibility for mental health services, putting an unelected Milwaukee County Mental Health Board selected by Gov. Scott Walker in charge of those services instead.
As drafted by state Rep. Joe Sanfelippo (R-West Allis) and state Rep. Leah Vukmir (R-Wauwatosa), and backed by Milwaukee County Executive Chris Abele, the 13-member board would report to the county executive. The county executive and the county board could each suggest three nominees, but the governor could ignore those suggestions and select all of the board members instead.
The board is heavily tilted toward medical professionals, based on the notion that they would be able to operate the county’s mental health services better than elected officials and county employees. They would meet four times a year. Eleven of the 13 members would have voting rights. The board would be formed 60 days after the bill’s signing.
There’s no residency requirement for board members, nor must the board be composed of racial or ethnic group members that reflect the county’s diversity and the communities the board would serve.
Milwaukee is different in many ways from the rest of the state, and the Legislature is planning to put together a board of individuals, all of whom could be outside Milwaukee County, to run a major Milwaukee institution. These individuals may be credentialed in their field and successful in a small rural community, but have little understanding of the mental health issues in a major urban area with tremendous cultural diversity. Again the Abele/Walker team is taking control away from the taxpayers of Milwaukee County.
The county is transitioning into providing more community services for mental health consumers; the state is undertaking a statewide study of mental health services as well.
Sanfelippo said his bill couldn’t wait and the transition to an appointed board was long overdue. He also cited the six deaths at the county’s Behavioral Health Complex in 2012, as well as previous assaults and deaths of patients in the county’s care, as reasons to move forward quickly.
“This gets us off the starting line,” Sanfelippo said.
Accountability Is Unclear
In last week’s hearing, state Rep. Sandy Pasch (D-Shorewood), a nurse who has specialized in psychiatric care, asked repeatedly about the oversight and accountability of the board.
“Where does the buck stop?” she asked Sanfelippo.
“The liability is still with the county,” Sanfelippo said.
Currently, the Milwaukee County board approves the annual county budget, which includes allocations for mental health. It also confirms the county executive’s appointee to run the Health and Human Services Department, currently Hector Colon. It recently overrode Abele’s veto of an audit of psychiatric care in private health facilities, a study it sought to help the county transition patients out of county facilities and into community settings.
But, as Milwaukee County Board Chair Marina Dimitrijevic and Supervisor Peggy Romo West pointed out to the committee via Skype from State Fair Park, the day-to-day oversight of Milwaukee County’s Behavioral Health Division lies with the county executive, who would become even more powerful under the bill.
So while the County Board would lose its oversight of mental health services under this bill, it would give more power to the two men who were charged with the day-to-day operations of the Behavioral Health Division—Walker and Abele—during the period Sanfelippo finds so concerning.
Milwaukee County Comptroller Scott Manske said that he was concerned about the bill’s budget. It caps the budget annually at $177 million, based on current expenditures. But if the state or federal government reduces its allocation, then the county must make up the difference with the property tax levy. And if the board finds new sources of revenue, it wouldn’t be able to increase its budget.
Advocates Want Details
A number of advocates who serve those with mental health issues asked for more details about the board’s finances and operations.
Barbara Beckert, head of Disability Rights Wisconsin, said she agreed with the authors that there was a need for bold change. But she said that they couldn’t look at the problems in the county “in a vacuum.”
Milwaukee County has the second-busiest psychiatric emergency room in the country and there are a limited number of beds in private hospitals.
Those needing an emergency detention are taken to Milwaukee County’s facility, but, in contrast, those needing emergency psychiatric care in Dane County are served in private hospitals, Beckert testified.
“Police don't take people to Mendota,” the state-run psychiatric hospital, Beckert said.
She also questioned the funding, transparency and accountability of the board as created by Sanfelippo and Vukmir.
“Who do people call for help?” she asked. “Would people on the board take calls from the community? Would supervisors continue to take those calls?"
Nichole Yunk Todd of Wisconsin Community Services (WCS) testified that at least 30% of the board’s members should be consumers of mental health services and it should ensure that current consumers would have continuity of care during a transition to board oversight. She also requested that the board’s meetings be open to the public and accessible via public transit.
A number of those who testified called for hearings on the bill in Milwaukee County so that residents could weigh in. Sanfelippo and Vukmir did not commit to those hearings.