Wisconsin's mental health treatment picture remains hazy

Jul. 4—EAU CLAIRE — Few dispute the need for better mental health services and access for Wisconsin residents. Solutions have proven elusive, though, and a state senator says it's not clear what resources are even available across Wisconsin.

There are an estimated 859,000 Wisconsin adults with a mental health condition, according to the Wisconsin chapter of the National Alliance on Mental Illness (NAMI). The range of needs varies widely. For some, mental illness is a chronic but manageable issue that requires therapy or medication. For others, what most people consider a normal lifestyle is all but impossible.

And there are also people for whom it's a matter of life and death.

The percentage of people in Wisconsin who face a mental health issue is undoubtedly higher than the 14 percent implied by NAMI's count. For one, the estimate doesn't include children. Awareness of pediatric mental health needs has grown in recent decades, but the image for many remains that of mental health as a challenge adults face.

For another, people with mental health issues can be remarkably good at hiding their needs. Decades of stigma and misunderstanding still make wearing a mask of normalcy seem like a better option to many than admitting they need help.

Wisconsin officials know there's a need for mental health services in the state. There are resources available but, troublingly, no one seems to know just what they really are.

The lack of information isn't just a frustration for family and friends of people who need help. It's a community health and safety issue. People with acute mental health crises can be the subject of emergency calls to 911, and police have come under scrutiny for their interactions with people who were in crisis. Even in cases when people are taken to a hospital, the resources at that point vary depending on what's available in the region.

Delays, gaps found

The gaps in knowledge are enough that officials from a range of backgrounds have taken notice. There are hopes that the state may soon have better information from which to work. But, in the meantime, delays and gaps are far too often the reality.

Sen. Kathy Bernier (D-Chippewa Falls) said clearing up the picture will require cooperation from multiple state and local agencies.

"DHS doesn't even know what all is currently available. As a matter of fact, there was a committee voluntarily put together with the police, or sheriff's association, along with the Wisconsin Counties Association, the hospital association, and I'm probably missing a couple. There was a pretty large group of people that have been meeting routinely to talk about what is available in what areas of the state, what do we need where do we need to go," she said. "And the fact of the matter is, is there is not a clear map of Wisconsin with an understanding of here are the crisis stabilization facilities, here are the crisis diversion facilities."

Bernier said the conclusions from earlier efforts to look at the state as a whole concluded Wisconsin has enough beds to care for those who need in-patient treatment for mental health issues. But no one has ever clarified what is where.

When the availability of local resources is in question, it means a lot of work for everyone who is trying to get a person help during a crisis. Bernier used a hypothetical police call as an example. The officer who responds finds a person in crisis and is able to defuse the situation for the moment. That's only the start of the work.

"Law enforcement has made their concerns loud and clear that they can have an officer go to a home where someone is having, you know, a huge mental health crisis situation, and then they stay on the phone for long periods of time trying to figure out where to take this individual," she said. "So when law enforcement is in that predicament, they do a triage-type thing where they determine 'well this individual probably could just go to the hospital,' you know, and then they have to make calls to find out where there's a hospital bed."

The result is that people who need treatment may have to get it a considerable distance from their homes. That puts stress on both the patients and their families. It reduces the number of contacts they can have, since driving a couple hours one-way for a visit isn't always an option.

Distance difficulties

Mary Kay Battaglia, executive director of NAMI Wisconsin, said distance creates problems of its own.

"Most treatment plans for people with mental illness include their family members or their support system, or their support unit. It is not a stabilized system to send somebody to a hospital and then some back to the system where there's no support," she said. "Closer to home and in your community is much better for everyone involved. It's more economical. The odds of being successful are much greater."

The United States has a long, often controversial history when it comes to how people who have mental health issues are treated. Involuntary commitment to an institution was once a widely-accepted approach. It was dramatized in the 1948 film "The Snake Pit," starring Olivia de Havilland. In that film, the institution's staff members aren't demonized, but the experience is still shown as terrifying and disorienting.

A bit more than a quarter-century later, "One Flew Over the Cuckoo's Nest" had a major effect on how people thought about mental health treatment. The 1975 film, anchored by Jack Nicholson's iconic performance, was based on Ken Kesey's 1962 novel. It showed a very different view of institutional treatment, with Nurse Ratched overseeing a ward that used shock treatment and lobotomies to keep patients in line.

Battaglia said the portrayal was regrettably accurate in many cases.

"Back in the early 80s, many of the psychiatric hospitals were run horribly and funded horribly and the care was, in many cases horrific. Many were closed because of those reasons," she said. "People wanted better care and better facilities. And so they closed a lot of those mental health hospitals with the intention of following funds for community based services."

Unfortunately, the funding didn't follow.

"What we essentially did is we replace mental health hospitals that were run poorly with more people in jails and prisons with mental illnesses because we don't know how to service them," she said.

Awareness raised

In recent weeks the issue of rights for mental health patients exploded into view again with the public hearing on singer Britney Spears' longtime conservatorship. Spears' testimony in opposition to the continuation of the conservatorship raised serious questions about how far the right of self-determination for someone in her position can — or should — be curtailed.

Then there are the less high-profile instances, like the death of Marilyn Roeber in Eau Claire. Roeber was reasonably well known to those who worked near the downtown business where she often slept. People had tried to help over the years. She was known as being reasonably friendly, chatting happily with those who would take the time. But efforts to get her the help she needed were ultimately unsuccessful.

Bernier said the state has a delicate balance to strike in deciding when a person can be compelled to undergo treatment.

"I don't think we have more mentally ill than we've had in the past by percentage of population. I haven't done research on it but I highly doubt that," she said. "What we do have is we have more seriously mentally ill, on the streets, living on the streets with nowhere to go, and some, you know, refuse to go to live anywhere else. ... We had long term care for them in the past. We don't anymore."

Battaglia said the reality is that Wisconsin is not treating mental health as a health concern. It's treated as something else, something separate from the idea of physical health. She compared a person having a mental health crisis to a person having a heart attack. Emergency aid for the latter is widely available, but not for the former.

"Why do we treat this differently than a health condition? It is a health illness. It is something that needs to be viewed as a part of your health, and we're not treating it that way," she said.

Figuring out where resources are needed is one thing. Creating solutions is another. That requires funding and, in all likelihood, the political will to provide money. Given the sometimes dysfunctional relationship between the branches of Wisconsin's government, it might surprise people that Bernier is optimistic about the odds of that happening.

One proposal Bernier said she has seen calls for funding a state-level study about what resources Wisconsin has for mental health, and then setting aside $10 million for responses once the report is complete. She said there are concerns about the ability to sell that to legislators, but that it indicated at least an interest in trying to address Wisconsin's needs.

Regionally, Bernier's long-term goal is to find the funding for 22 additional mental health beds in the Chippewa Valley, and use those resources to serve a 13-county region in northwestern Wisconsin. But even that won't be a complete solution.

"We do have to talk, have a serious conversation every state and the federal government has to have a serious conversation about long term care for the seriously mentally ill. And you, we cannot medicate them into perfection. It's just not possible," Bernier said. "Until we use our resources to concentrate on severe mental illness. We're always going to be in this cycle of having to talk about this over and over again."

Battaglia hopes state officials will look outside Wisconsin's borders for ideas.

"What we should be doing is looking at some of our neighbors and some of the other states who have a much better setup system," she said. "And, you know, I would highly recommend we look at Minnesota's system because they have advocated and received a lot of funding to set up a system that's community based, and not so much that you discard everybody to Winnebago."

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