Future direction

Statement on the Future of Acute Services Provided by Milwaukee County

by Hctor Coln, MS, OT, Director Department of Health & Human Services

The Milwaukee County Behavioral Health Division has been a presence in the Milwaukee community for over a hundred years. It has resided on the Milwaukee Regional Medical Campus grounds on Watertown Plank Road since the 1960s. The facility itself is over 900,000 square feet, and was originally intended to provide health care and living circumstances to thousands of individuals with mental illness.

From almost the moment it opened, there were changing national perspectives on best practices for care of those with mental illness — focusing on recovery and community living rather than institutionalization and long term living within the site.

Under County Executive Abele, the Mental Health Redesign Initiative of Milwaukee County began in 2011, embracing the perspective of increasing community based services and a strong focus on prevention of the needs for acute services. Since that time, and based on significant work of many across the community including BHD leaders, we have made great strides in transitioning to a much more community focused model of mental health and substance use services. This has included:

  • Transitioning all long term care for residents into community living arrangements. As of January 2015, Hilltop Center for those with mental illness and developmental disabilities has been closed, with all residents carefully placed in community settings. Residents of Rehab Central are in the process of transitioning to the community, with only 20 people still residing and awaiting new homes.

  • Emergency Department admissions have reduced by 20% based on strategic efforts to intervene in the community.

  • Emergency detentions of people have been reduced by 30% based on strategic efforts to intervene in the community and to help those in crisis before they need to be detained.

  • Acute care admissions have reduced significantly by 48%, again based on strategic efforts.

The inpatient facility on Watertown Plank Road now provides services to fewer than 100 individuals per day, as well as those cared for in the psychiatric emergency department, and several clinic services. Much of the remaining space is used as staff offices. Less than half of the building is occupied at this time. Further, the aging structure is expensive to operate and maintain, and is nearing the end of its useful life. The high expenses of the facility takes money away from services that can be of great value to the community.

Work has been done over the past 10 years to evaluate space and identify a different location for BHD acute services. Attempts to lease and renovate other locations have not succeeded for various reasons. A facility planning group, including national consultants, has been meeting weekly to create a new plan for physical space for BHD acute and community based mental health services.

Three studies have been completed analyzing MCBHD, and published within the past year. They include:

  • Inpatient Demand Capacity Analysis, Public Policy Forum and HSRI, September 2014
  • Audit of BHD, State of Wisconsin, December 2014
  • Fiscal Analysis of MCBHD Expenses, Public Policy Forum, January 2015

All of these studies reflect the need for continued acute services to be supported by Milwaukee County and to be delivered in a way that reduces cost to make it sustainable. In its current structure within Milwaukee County, uncontrollable expenses significantly influence the cost of doing business as a county entity. All studies recommended considering alternative models for acute care delivery such as outsourcing acute services to a public-private partnership, to a private entity, or to the state. Note: At this time, the state does not anticipate moving forward in assuming acute services as an additional state entity.

This raises the possibility of exploring outsourced models for acute services for the future. As with every other decision, the goal is always ensuring the best care we can provide. To that end, we are committed to aggressively exploring any opportunity to do better by those we serve. At the April meeting of the Mental Health Board, there was an endorsement to proceed with a Request for Proposals for acute services that would identify alternatives that would remain high quality as well as high value/efficient services.

The executive leaders at Milwaukee County Behavioral Health Division have started to draft an RFP to explore if there are potential partners willing to participate in the delivery of future acute services and provide a physical facility in which to do it. The plan has been guided by experts internal to Milwaukee County as well as external experts. Specific performance measures will be defined in the document. Proposals will be evaluated by an expert panel, again, some from within Milwaukee County and some from other (non-competitive) settings. To be clear, a proposal will only be recommended if there is evidence that a partner could provide the best care and outcomes to the people we serve. Given the need to maintain confidentiality and process integrity, more detailed descriptions of the RFP are not possible until it is released.

We anticipate being in the current facility for several more years until such time as a potential transition and the building of a new facility is completed.

The analysis of future acute services sets the stage to reconsider the future Behavioral Health Division and its mission and directions. Given its commitment to the community and enhancing services available beyond acute care, a plan is being proposed to the Mental Health Board to transition parts of the organization back into the community. Two centers are being recommended — one on the north side and one on the south side.

Design of services to be provided is still under development, and will consider the site as an actual and virtual “front door” to behavioral health services, including registration, assessment and triage into the most appropriate settings and levels of care for the person involved. Dollars are being proposed in BHDs 2016 budget to take an initial step into the northside center by Fall 2016, and into the southside center within 2017. That will coincide with the timing of closing the BHD facility and transitioning acute services to an alternative facility location. These centers will have a primary role in making sure everyone in the community tht needs mental health services has access to them.

Strategic planning is underway with the Mental Health Board, with leaders from Milwaukee County, and with leaders and staff across the Behavioral Health Division. We believe this is continuing the vision that was set four years ago in fostering excellent, acute, and community-based behavioral health services in Milwaukee.

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Last edited by Tyler Schuster.   Page last modified on June 19, 2015

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