The Milwaukee County Mental Health Board had intended to decide this summer on outsourcing the operations of the county’s psychiatric hospital.
But that decision’s been delayed—and that’s a good thing, according to the board’s chair, Duncan Shrout.
“It was an aggressive deadline,” Shrout told the Shepherd. “But I think the way we are doing it is correct.”
The Milwaukee County Mental Health Board, an all-appointed board of behavioral health experts who took over the county supervisors’ authority over the county’s mental health and substance abuse programs in 2014, voted last year to privatize the hospital, which serves children, teens and adults and includes the county’s only psychiatric emergency room.
The hospital privatization plan is part of the county’s efforts to downsize its in-patient services and provide more services within the community. It closed down its remaining long-term care units in the hospital at the end of 2015, and has a capacity to care for up to 60 adult patients in the hospital, although staff shortages often lower capacity to around 50. Many of the patients have legal issues and very serious mental illnesses and require highly skilled, specialized care.
The Behavioral Health Division, which is overseen by the board, let out a request for proposals (RFP) in July 2015 for a 20- to 35-year contract for the management of in-patient services, emergency room and the observation unit. The vendor could be a local nonprofit or an out-of-state vendor—even a for-profit vendor.
In addition to providing services, the RFP also required prospective vendors to build a hospital for the county’s patients, since the current facility needs serious upgrades—regular maintenance on the building costs $10 million to $12 million annually. The Mental Health Board lacks the authority to bond for a new building.
Just two bidders responded to the county’s RFP last summer and BHD administrators suspended the process in October. Days later, Health and Human Services Director Héctor Colón announced he’d seek a single-source contract with a vendor and make the transition in 2018 instead of rethinking the county’s privatization plans and revising the RFP.
But the Mental Health Board disagreed with Colón’s plans, and created two task forces to look into privatizing the hospital—one to vet national vendors and the other to look into creating a partnership with one or more local hospital systems.
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Still at Work
The task forces haven’t finished their work and they likely won’t be finished for a while.
Two out-of-state vendors have expressed interest in operating the county’s hospital but no local provider has stepped forward.
Earlier this year, the members of the Milwaukee Health Care Partnership—which includes the local hospitals, the Medical College of Wisconsin, federally qualified health centers, and city, county and state health agencies—passed on the opportunity to take over the county’s hospital.
The Milwaukee Health Care Partnership’s Clare Reardon said the partners agree with the county’s decision to privatize the hospital but that none of them is able to take it on.
“None of the health systems currently have the capacity to take on these services or build a new facility on behalf of the county,” Reardon emailed. “They remain committed, however, to working collaboratively with BHD and the state’s Department of Health Services to ensure a coordinated system of behavioral health services for patients under emergency detention, and with other high acuity needs.”
Shrout said there are other options that might be worth pursuing.
For example, Shrout said that the board could look into identifying a foundation or entity to build the hospital, while the county would contract with service providers to care for the hospital’s patients.
“In case there would be some significant difficulty with a provider and we wish to end that relationship, we would not have to go through protracted conversations and negotiations regarding who owns the building,” Shrout said. “The building would be continued to be owned by the Behavioral Health Division. That’s one advantage. A second advantage is that it may turn out—this is not a prediction, just a possibility—that more than one entity may end up providing services within that hospital.”
Another potential solution would be to build a hospital that could serve patients from outside Milwaukee County that would otherwise be served at the state facilities in Mendota and Winnebago, Shrout said. This option would be picking up on measures in Act 203, which created the board in 2014. The law required the board to develop a plan for closing the county’s Mental Health Complex and for a state-run regional facility for behavioral health services. The Mental Health Board did commission studies and recommendations for policymakers, but the state-run facility option wasn’t taken up as a serious measure. Instead, the Mental Health Board pursued the privatization plan with more community placements.
Shrout said the addition of the state Department of Health Services’ Rosemary Kleman as an ad hoc member of the privatization task force is a sign that the state has “a strong interest in expanding its forensic and acute inpatient services around the state of Wisconsin.”
Although the board has missed its goal to offer a contract this summer, Shrout said the board is taking its time so that it can craft the right solution for the problems posed by the hospital.
“The deeper we go into this I really begin to appreciate the challenges that the Milwaukee Board of Supervisors faced over the many years of trying to determine the best approach to address the difficulties of the current facilities as well as the provision of services,” Shrout said.
