By David Timmerman

newseditor@tds.net

& Adam Krebs

editor@themonroetimes.com

MONROE — For years, area law enforcement has had the burden of driving individuals in a mental health crisis hours away from southwest Wisconsin to the lone facility that deals with such issues.

For the last several years, different groups have tried to work toward creating regional places to go, to cut down the drive for both. Money was allocated, but facilities have yet to be set up.

It is hoped new proposed legislation will move things forward.

State Senator Howard Marklein — along with State Sen. Jesse James and representatives Clint Moses, and Rob Summerfield — circulated legislation to create the framework for so-called Crisis Urgent Care and Observation Centers for those experiencing a severe mental health crisis. 

The bill was crafted with input from stakeholders across the mental health care continuum, including the Department of Health Services (DHS).

The Crisis Urgent Care and Observation Centers bill will create a framework for DHS to issue certifications for new, 24/7 regional mental health facilities. The legislation will continue Wisconsin’s implementation of the “Crisis Now” model for mental health care, which is built on a nationwide best-practices model.

New Legislation

“SB 462 provides a significant and meaningful step in creating needed infrastructure to address these issues,” said DHS Secretary-designee Kirsten Johnson. “Under the bill, DHS would be required to establish a certification process for crisis urgent care and observation facilities. These centers would provide both voluntary and emergency detention crisis services to youth and adults in a calm, home-like environment on a 24/7 basis. Services would include assessments for physical health, substance use, mental health crisis including suicidality and would provide stabilization services to people who are appropriate for this care setting. These centers would offer a first responder drop-off area as well as accept people walking in to receive services.”

The facilities will be designed to be a “one-stop shop” for individuals experiencing a mental health crisis and will accept both voluntary and involuntary individuals for short-term stays (5 days or less). A friend, family member, EMS, or law enforcement can drop off individuals. There will not be a medical clearance requirement prior to admission, which will allow law enforcement to leave the facility upon drop-off.

“I have heard countless stories about individuals experiencing a severe mental health crisis who spend hours in the back of a squad car and driven many hours across the state to the Winnebago Mental Health Institute. This is a traumatic experience for the individual experiencing the mental health crisis and places a heavy burden on law enforcement,” Marklein said. “This legislation will allow these individuals a chance to receive appropriate treatment and recover in a space closer to home, while allowing law enforcement to return to serving their communities.”

Helping cops, help people

Reg Gill, Lafayette County Sheriff, said that this legislation would have “tremendous benefit” to area agencies and those suffering a mental health crisis.

“I understand it would be a huge hit financially to the state, but it would be very beneficial to all of counties around the state,” Gill said, adding that all the time wasted for “processing” adds up, and keeps law enforcement officers off the streets, trimming coverage in local jurisdictions. “It hits our budget, and, like most law enforcement agencies, we are short-handed already. When a person is in our custody, we need to always keep a deputy with them. Sometimes it takes another person as well, and that is two deputies away from their regular duties.”

Moses said the Crisis Now model is long overdue and will be a vital lifesaver.

“Long before I took office, I was aware of the major challenges individuals faced with a mental health crisis in my area,” Moses said. 

James said as a cop, he spent hours on mental health commitments.

“We need these new facilities to ease the burden on law enforcement and to help keep patients closer to home,” James said. “As a state, Wisconsin can do better. I think this is the first step of many to help address the mental health crisis we are experiencing. If these facilities help us navigate away from the hours it takes to transport individuals to Winnebago, it will be a win-win for law enforcement and patients across our state.”

The 2023-2025 state budget set aside $10 million for DHS to implement a grant program to support these facilities.

This bill was crafted with input from the Badger State Sheriffs’ Association, the National Alliance on Mental Illness (NAMI), the Wisconsin Counties Association, the Wisconsin Sheriffs and Deputy Sheriffs Association and DHS.

“Representatives from the Badger State Sheriffs’ and Wisconsin Sheriffs’ and Deputy Sheriffs’ Associations have been working with other stakeholders and policymakers for many years to establish a regulatory framework for regional crisis facilities,” said Grant County Sheriff Nate Dreckman, who served this past year as the Badger State Sheriff’s Association President. “This legislation represents many years of hard work and advancing this bill will put the state on the right path to large-scale reform to treat those individuals in crisis more quickly, closer to home and in a manner that is less dependent on law enforcement.” 

Earlier this year, Dreckman, along with Lancaster Police Chief Deb Reukauf and Platteville Police Chief Doug McKinley talked about dealing with people in crisis, which has continued to rise in the past decade.

“When I first started, and we’d be lucky if we had a mental health call type call, once or twice a week (in) the county as a whole,” Dreckman said in July. “And now it’s almost daily that one of our agencies is dealing with some type of mental health issue. So we’ve seen a ballooning of people, you know, struggling with mental health issues. And that’s led to my opinion, almost like a clogging of the system. And it blew up too fast that people don’t know how to handle it.”

When law enforcement gets to a scene to talk with a person in crisis, they assess the situation, and they see if the person is willing to participate in going into a place voluntarily. If that is the case, a friend or family member takes the person to a facility to check them in.

If that is not an option, or facts dictate that it is not, it will mean an emergency detention. And there is only really one detention facility for emergency detentions, the Winnebago Mental Health Institute outside of Oshkosh. 

“When I started out, we took a lot of patients to Boscobel to their mental health facility, and then that closed. For a while we could then take them to Mendota in Madison, cutting the distance in half, but that hasn’t been an option for several years,” Gill said. 

Limited state mental health facilities

In 2014, Mendota no longer was an available destination for emergency mental health crisis patients.

For residents who need to be taken to a state facility by law enforcement, it means 12-16 hours, first being with the people in an emergency room to be evaluated, then placed in a vehicle to be transported, many times with two officers.

“I took the last person in Lafayette County up to Winnebago, and the drive alone is 6 hours there and back,” Gill said. “It’s not unusual for the whole process to take 8-12 hours.”

A lot of that is sitting and waiting. Because Winnebago is a mental health facility, it needs a person cleared medically, which means law enforcement takes the person to their nearest hospital to be checked out and tested. That means lab tests.

Reukauf continued saying that after the testing, the doctor at the hospital and the doctor at Winnebago must then consult one another, and there can be a further wait if one or the other is not readily available.

Dreckman feels the situation just exacerbates the crisis the person is going through. “You know, they’re going through a crisis, and then you’re going to put them in another crisis, because you’re gonna put them in the backseat of a squad car to drive three hours, then drop them off.”

It is why Dreckman, as part of the Badger State Sheriff’s Association, has been part of an adhoc committee that has been trying to advocate for more facilities across the state, to cut down travel times, and provide more space to help people in crisis. He noted different doctors’ groups have been involved, the Wisconsin Psychiatric Association, hospitals, all have been trying to come up with solutions.

Dreckman said one idea has been to create psychiatric emergency rooms because the length of crisis is usually not that long. “Most people … their crisis can be averted within, like what they say less than 24 hours, they can be out of crisis and can go back to, you know, outpatient treatment, and so forth,” Dreckman said. “They need immediate help, but they don’t need to be all the way to Winnebago.”

For the current and past budget session, the State Legislature has worked on trying to deal with this issue, allocating funding, but there was not a mechanism set up for facilities and operations to allocate the money. DHS was asked for their input on how to utilize the funds, which is what the legislation is a direct result of.

“Addressing the lack of treatment options for Wisconsinites experiencing a mental health crisis has been one of our agency’s top priorities. Far too many people who are in crisis are brought to an emergency room with a long wait time and transferred to a mental health facility while in law enforcement custody, which can exacerbate a crisis. The mental health facilities are often far from their home and loved ones,” Johnson said. “This solution comes after years of dialogue and collaboration with our partners across the state and members of the legislature. We are eager to continue working with the legislature on this critical piece of legislation.”

Marklein noted the $10 million for Crisis Now, as well as $2 million to try a Telemedicine Crisis Response Pilot Program that has been very successful in South Dakota. 

“We also increased Hospital Behavioral Health reimbursements by $30,519,000, allocated another $30 million to mental health services in K-12 education and expanded the Opening Avenues to Reentry Success (OARS) program in the Department of Corrections (DOC), which provides acute case management and mental health services,” Marklein said.

Marklein addresses funding, profitability

Getting the funding is important, but Marklein noted that facilities have been reluctant to move forward because it hasn’t made fiscal sense up to this point. 

“One of the underlying issues is the reality that behavioral health is not profitable,” Marklein said in July when asked about the subject. “Hospitals and other mental health providers have not expanded their services, especially in rural areas, as these services are not self-sustaining. The Crisis Now model and changes to statute address some of these concerns and we know that the state must play a financial role.”

“One of the issues across the state and country is a shortage of crisis workers — you know; however, you term it, counselors, psychiatrists or whatever, there’s a shortage of that,” Dreckman said. “So obviously, we have to figure out a way to remedy that.”

Dreckman said if there was crisis staff, the region could do like many areas have, with a crisis response unit that will come in and deal with the situation.

“Very effective. Law enforcement might show up, make the scene safe. These people come in, they handle it from there, law enforcement leaves, and they’ve seen some success that way,” Dreckman continued. “But again, if you don’t have the people to be able to fill those roles out here in rural Wisconsin, we just don’t.”

“We’ve learned a shortage of cops,” McKinley said. “Yeah, the shortage of you-fill-in-the-blank. Yeah, and mental health professionals.”

Another option is Northwest Connections, a counseling firm that works with numerous local and state agencies to provide telephonic and mobile services for those in crisis. Based out of Menomonie, the firm, which also works with the Wisconsin Department of Veterans Affairs to deal with mental crisis for those who served, has limited resources to reach down with their own mobile units. 

Reukauf pointed out an example showing the dearth of counselors — for people utilizing Unified Services, the joint agency between Iowa and Grant counties, what used to be a month wait for an appointment now has doubled.

Many ideas are being looked at. For example, laws changed to allow for a private transport firm to handle these transports to get law enforcement out of it. Unfortunately, there is no firm covering southwest Wisconsin.

There has been talk about attempting to be able to utilize facilities across the border in Iowa and Illinois, but having law enforcement crossing into other jurisdictions, and who pays in another state appear to be roadblocks.

In short, while there are ideas, finding the manpower and the direction to make it happen holds any change back.

By Gary Mays

gmays@

themonroetimes.com

MONROE — Local law enforcement officials are lauding area lawmakers for trying to fix the state’s system of dealing with individuals in crisis, saying anything that could be done to lighten the load on police while improving outcomes for those suffering would be welcomed.

“It’s not just the trip, but it’s like you’re almost taking a whole shift off to take someone to Winnebago (in Oshkosh),” for a crisis evaluation, said Monroe Police Chief Fred Kelley. “Our officers have many hours of this (mental health) training, but it really is not a criminal justice problem, it’s a public health problem.”

When someone threatens suicide, say, in an emergency room or doctor’s office, Kelley said three entities — police, human services and medical — must all agree on whether they should be held at the state facility. And that is a process that can stretch for hours, stressing the person out even more, while heavily straining police resources.

What’s more, typically, at least two officers are required to do the transfer safely, taking those cops or deputies off the street.

The only other way to get a person “in custody” and sent to Winnebago, he said, is if the individual is “incapacitated by alcohol,” a high standard of impairment that few ever meet. Kelley estimates about 20 people a year are taken to the facility from the City of Monroe.

For Green County Sheriff Jeff Skatrud, not only does the issue involve resources — deputies transport those with court dates back and forth to Green County — but there also needs to be a focus on better outcomes for those in crisis. He estimates his department handles about 15 such cases each year.

“It’s an all-day thing for those involved,” Skatrud said. “You’re dealing with a person who, on maybe the worst day of their life, ends up riding in the back of a squad car for hours.”

With the recent mass shootings in Maine and elsewhere, reportedly involving people with known mental health issues, the stakes couldn’t be higher, police say. 

“We’re all concerned to death about these Maine type of incidents happening,” Kelley said.