In spring 2014, state Rep. Joe Sanfelippo (R-West Allis) and state Sen. Leah Vukmir (R-Wauwatosa) proposed to strip the Milwaukee County Board of Supervisors of its oversight of the county’s mental health and substance abuse programs.
Cheered on by the Milwaukee Journal Sentinel, Milwaukee County Executive Chris Abele and many mental health advocates, the proposal sought to put the county’s troubled Behavioral Health Division (BHD) in the hands of trusted professionals. Instead of getting caught up in political bickering, the new, all-appointee Milwaukee County Mental Health Board would be focused like a laser beam on the well-being of the county’s most vulnerable residents and transition BHD into becoming a more responsive, community-based health care system.
“We’re creating an independent board of professionals completely removed from the political and institutional pressures that have put the status quo ahead of consumers and family members for decades,” Sanfelippo said in a 2014 press release. (He didn’t respond to the Shepherd’s request to comment for this article.)
The proposal that became Act 203 flew through the state Legislature in two months. Gov. Scott Walker signed the bill in April 2014 and the board began taking shape last summer.
Now, a year later, the Milwaukee County Mental Health Board is in charge of the county’s mental health services, as legislators intended.
Or is it?
An investigation into the board’s operations shows that while it is comprised of knowledgeable mental health professionals who are volunteering their valuable time to serve on the board, members aren’t often consulted on major administrative initiatives, they have little to no input on the BHD budget and they have no staff support to help them research and develop policy proposals. Instead of being in the driver’s seat and setting policy, the board is struggling to assert itself with powerful county officials.
And the public—especially the county residents who are affected by the BHD’s operations—is rarely invited to speak to the board. Instead, the Mental Health Board hears almost exclusively from BHD administration, the very people the board is supposed to oversee.
Former Democratic state Rep. Sandy Pasch, a psychiatric nurse who worked to make Act 203 more reflective of and responsive to the community, said that the board was intended to be a check on the administration.
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“The purpose of the board was not to rubber stamp whatever came out of Abele’s office,” Pasch said. “It was supposed to be that people who understood mental health would be involved in making decisions. The mission of the board is to make sure that Milwaukee has a consumer-centered, recovery-oriented approach.”
These issues could be chalked up to growing pains as it creates a mental health governing structure that’s the first of its kind in Wisconsin. But Milwaukee County’s BHD offers vital and at times lifesaving services to county residents who are struggling with mental health or substance abuse issues, and the board’s operations have a great impact on their lives. In addition, BHD itself is undergoing massive change as the system is redesigned with an emphasis on services within the community. Acute care services currently performed at the county-run hospital were put out to bid in July by the BHD administration via a 20- to 35-year contract. Many mental health professionals think this is going to be an expensive recipe for disaster—higher costs and poorer quality services.
A Big Mission
Act 203 marked a massive shift in mental health service oversight in Milwaukee County, but the legislation itself is rather vague and primarily focuses on the makeup of the 11-member Mental Health Board. Appointees fill positions targeted to specific areas of professional expertise—for example, mental health nursing, substance abuse services, legal—and also reserves positions for consumers of mental health services. There is no requirement for members to live in the county. The original members were nominated by Abele and the Milwaukee County Board and approved by Walker, but Abele now is authorized to make all appointments to the board.
Act 203 requires the Mental Health Board to oversee all of the county’s mental health and substance abuse programs and services. That includes the $189 million BHD budget, to a point. It can set a property tax levy between $53 million and $65 million, but Abele can rewrite the board-approved budget at will, since Act 203 lacks a mechanism for the Mental Health Board to override an Abele veto and county supervisors have no authority to alter the BHD budget as part of their deliberations on the county-wide budget. The BHD buck stops with Abele.
Although Act 203 is pretty specific about the makeup of the board, it’s rather vague about members’ responsibilities. That lack of clarity is manifesting now in the board’s operations.
The all-volunteer board has no staff and relies on BHD administration for data. It must hold at least six meetings annually, “one of which must be a public hearing in Milwaukee County,” a pretty low bar. The board does hold regular meetings that are open to the public but they are barely noticed; are typically held at the Mental Health Complex on Watertown Plank Road and difficult to reach; only permit public testimony when invited; and meeting agendas, minutes and audio posted on its website are of poor quality.
Top county officials—including Department of Health and Human Services Director Hector Colon and BHD Administrator Patricia Schroeder—sit among board members during meetings and speak freely, typically participating more readily than some board members and reinforcing the notion that there’s little daylight between the board and the administration.
Even worse for an entity that is supposed to serve the public, the board’s website includes no contact information. The only phone number listed on board documents is for a BHD senior executive assistant. Individuals who want to bring an issue to the board’s attention have nowhere to turn.
But Abele’s spokesman indicated that the new Mental Health Board could be more responsive to community concerns than county supervisors. The statement is rather odd considering that as elected officials, Milwaukee County supervisors hold regular meetings, post videos and audio of their meetings, take testimony from anyone who wants to speak and stand for election every two years.
“The legislation that created the Mental Health Board was passed in the state Legislature by a vote of 122 to 1,” Abele’s spokesman, Nate Holton, emailed. “This was a resounding response to long-held community concerns related to the mental health care in Milwaukee that were never adequately addressed under previous governance. The Mental Health Board and its committees respond to community concerns by receiving written public comment, hosting opportunities for public comment, and being comprised of members who are personally responsive to the community.”
Many people who are concerned about the care of individuals with mental health issues supported the legislation; they are just disappointed that the intent of the legislation is being distorted. Kathleen Eilers, a former Milwaukee County mental health administrator who was appointed by Abele to serve as the transitional liaison between the board and the administration, said that while she helped board members get up to speed on the county’s programs and services, there wasn’t a similar emphasis on developing legislative processes that would result in a well-functioning board. Although her position could last for up to two years, she left after a few months.
“I think that the administration decided that there was no need for somebody in that role,” Eilers told the Shepherd. “And that any information or request or relationship issues they would deal with directly.”
Mary Neubauer, representing the Milwaukee County Mental Health Task Force on the board, said members are often left in the dark about big policy items until the administration decides to inform the board. For example, BHD administration plans to launch service centers in the community, one each on the North and South sides, with an administrative hub not located at the BHD offices. BHD Director Schroeder first pitched the idea to the board’s finance committee on May 21, and $1.2 million was budgeted for the North Side location in the 2016 budget, which the board approved. But the administration hasn’t had a robust conversation about the new centers with those who would actually use them, Neubauer said.
“I don’t think there’s transparency at this point in time,” Neubauer told the Shepherd. “Everyone from the community should have some input into what kind of services are needed out in the community.”
Asserting Its Independence
A year into the board’s tenure and members still seem unsure of their role and board processes, with members posing challenging questions about the board’s mission during a July debate over the 2016 budget proposed by DHHS Director Hector Colon this spring.
Last year, the Mental Health Board approved the 2015 BHD budget at its second meeting with little preparation. No amendments from board members or public comment were allowed.
This spring, with more experience under their belt, some board members seemingly weren’t so willing to accept a passive role.
At the July 9 meeting of the full board, two amendments were introduced, since there was no way to offer up the amendments earlier. One amendment asked for $346,000 to allow crisis resource centers to remain open during third shift so that law enforcement would have a safe place to take people in crisis at night other than the emergency room at the mental health complex or jail. The amendment passed over objections that there wasn’t enough data to support 24-7 staffing of the centers.
But Brenda Wesley, outreach coordinator at the National Alliance on Mental Illness Greater Milwaukee, said that she and other board members had asked BHD for data and got nothing.
A second amendment sought to hire a policy research analyst for the board so members could obtain independent data and get help drafting amendments and resolutions. A document provided with the amendment shows that similar mental health boards around the Midwest employ staffers, from three full-time employees in Champaign County, Illinois, to 44 board staffers in Cuyahoga County, Ohio.
Currently, the Milwaukee County Mental Health Board has no dedicated staff and gets all of its information from BHD, and some members complain that they aren’t getting information they request—for example, data to help them analyze the use of crisis resource centers.
It’s safe to say that DHHS Director Colon didn’t approve of allowing board members to consult their own analyst for independently researched data. He asked board members if the lone staff position would facilitate a “strong partnership” with the administration or if it would create an “adversarial or confrontational” relationship.
“This [amendment] is going in the exact opposite direction from what was intended in the specific legislation,” Colon told the board.
He said board members should continue requesting information from BHD Administrator Schroeder if they have a question.
“You have someone to go to,” Colon said.
(Colon didn’t respond to requests to comment for this article.)
Board Chair Kimberly Walker, a former county corporation counsel and current executive director of Legal Aid Society, also pushed back on the amendment.
“I feel like this creates a wedge between our access to and communication with the administration,” Walker said.
(The Shepherd reached out to Walker for comment, but she said she was unavailable.)
Psychiatrist Jon Lermann, a nonvoting board member representing the Medical College of Wisconsin, said he wondered if the amendment was symptomatic of the lack of trust between the board and the administration. For example, BHD administration didn’t allow the board to have much input on a recent request for proposals to privatize the county’s acute care services, despite board members having expertise that could improve the request, Lermann said.
“We don’t have a good working relationship right now and I wonder how much of this [amendment] is symptomatic of that,” Lermann said.
The amendment to hire an independent policy analyst failed by one vote.
Next week, in a new ongoing series about Milwaukee County’s mental health services, the Shepherd will explore the county’s effort to privatize its acute care services via a 20-year contract that could be won by an out-of-state, for-profit health care provider.
