With little fanfare, Milwaukee County’s mental health system was transferred to state control last week. Soon, the Milwaukee County executive and board of supervisors will send to Gov. Scott Walker their suggestions to fill the appointments on the newly established Milwaukee County Mental Health Board, which will oversee behavioral health services in the county.
Although the changes are already underway, many questions remain about the functioning and accountability of the mental health board—questions that even the county’s attorney couldn’t answer in a committee meeting with supervisors last Friday.
The situation is so confusing that Corporation Counsel Paul Bargren couldn’t state definitively that the county’s Behavioral Health Division employees were still employed by the county.
Supervisor Tony Staskunas requested that Jamie Kuhn, the board’s lobbyist, get more information from the bill’s authors and drafters about the status of these employees.
“Who do these people work for?” Staskunas asked.
Kuhn said there had been discussions about it at the state level, but implied that the question wasn’t fully resolved.
“It seems to be the understanding that these are county employees but that the Milwaukee County Mental Health Board has some purview over their salaries,” Kuhn said.
“I’d like to get something in writing,” Staskunas said.
Appointees Will Recommend Tax Levy
The new mental health board was launched via legislation authored by state Rep. Joe Sanfelippo (R-West Allis) and state Rep. Leah Vukmir (R-Wauwatosa), who testified that even though the county’s system is in the midst of downsizing and adding more community care, additional changes needed to be made immediately. Their solution was to remove the Milwaukee County board of supervisors’ oversight role and establish a mental health board with appointees who have experience in mental health services.
Until Jan. 1, 2015, the system will be run by the state Department of Health Services (DHS). Then, the new board will be transferred to Milwaukee County. Milwaukee County Executive Chris Abele supported this legislation, as well as Sanfelippo’s previous bill stripping supervisors of almost all of their duties and cutting their pay. Abele told the Journal Sentinel that he was “in charge,” but the mental health board is clearly in the state’s hands through 2014.
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Previously, the county executive and his administration had oversight of day-to-day operations of behavioral health services, while the supervisors set broad policy for it, held public hearings and approved its budget. As of last week, those responsibilities have been removed from the board.
The new mental health board will have 11 members and two nonvoting members suggested by the supervisors and county executive and appointed by the governor. They are not required to live in Milwaukee County. Elected officials, county employees and lobbyists are prohibited from serving. They must meet at least six times a year, but only one of those meetings is required to be within the county. Members won’t be paid for their services, but will be able to be reimbursed for the expenses they generate doing work for the board. A citizen’s advisory board will also be launched, again with no residency requirement.
The governor has 60 days to appoint the board, adding more uncertainty to who, exactly, is running Milwaukee County’s mental health services right now.
The board will be able to suggest a tax levy as long as it’s within the range of $53 million to $65 million; the current tax levy is $63 million. The mental health board will send its levy request to the county executive, who doesn’t have to abide by it, as long as his levy request is within the proscribed range. Abele’s levy will be sent to the board as part of his annual budget request. But unlike all other budget items from county departments, supervisors will not be able to alter it with amendments. It’s unclear what would happen if the tax levy isn’t enough to cover the costs to run the system, although the legislation does allow the tax levy to be increased if all three parties agree to it.
Nor does the bill require the board to use the county’s payroll and accounting services, County Comptroller Scott Manske told the supervisors.
In last week’s meeting of the Intergovernmental Relations Committee, supervisors questioned whether they would even get a detailed budget breakdown of the board’s revenues and expenses; the new law doesn’t require it and supervisors were unhappy with Abele’s budget narrative and transparency last year.
Peggy Romo West, chair of the Health and Human Needs Committee, said the board would merely be a “rubber stamp” for its budget request and was concerned that board members would run up costs that the county would be required to cover.
“Am I going to be approving cell phone bills, outfits, lunches?” Romo West said. “What exactly am I going to be approving? The way that the language is stated, it makes it sound as if it doesn’t matter what is included in that [budget request]. I just have to vote for it.”
The county would still be legally liable for its behavioral health services and employees and the board would likely not be part of any decisions about lawsuits and settlements.
“So I’ve been left out of the decisions, but now I have to foot the bill,” Romo West said.
She said the board was a way to set up a state takeover of mental health services in Milwaukee.
Milwaukee County Treated Uniquely
Supervisor Gerry Broderick questioned whether any other Wisconsin county ran its mental health services with this governance model.
Kuhn said other communities have mental health boards, but, unlike Milwaukee County’s, they play a more limited role and include elected officials.
“Obviously, they don’t set the budget,” Kuhn said. “The budget still goes through the county board process in all the other counties.”
Broderick wondered if this new board followed any best practices tested by other communities.
“I guess what I have difficulty understanding is that if these are worthy reforms, why they wouldn’t be applied statewide rather than in this select fashion?” Broderick said.
He said the new governance model’s lack of accountability to taxpayers would “open a can of worms that would be hard to put a cap on.”
“The people of this county did not elect us to act as a rubber stamp but rather to represent their interests in the expenditure of their tax dollars,” Broderick said. “This is a curious corruption of a system that I think is now really in need of reform.”
