Dane County Sheriff Dave Mahoney wishes that the community had somewhere nearby to take people who are having a mental health crisis.
The closest hospital is Winnebago Mental Health Institute in Oshkosh, at least a two-hour drive from Madison. That drive time adds to the already lengthy process of putting someone in protective custody. “It can take an entire shift or even 12 hours to get an individual care once law enforcement is summoned,” Mahoney says. “This is a real problem because it removes two officers from a jurisdiction for an entire shift and dramatically impacts the ability to answer calls for service in that community during the transportation.”
But, Mahoney laments, “It is our only option at this point.”
An alternative may be down the line if Strategic Behavioral Health gets the okay to build a 72-bed mental health facility at 3169 Deming Way in Middleton. It would cost $17 million to $20 million to build. The company proposes offering short- to long-term inpatient services for all ages and to accept people who are admitted voluntarily or involuntarily.
But that plan may be in jeopardy. The Wisconsin State Journal reported April 9 that Strategic Behavioral Health has faced sanctions at its facilities in five different states and that is giving some local officials pause. On Tuesday, Middleton’s Plan Commissioned recommended allowing the land to be used for a hospital. But it delayed approving this project until the commission can get an opinion from the city’s attorney about whether it can impose conditions, such as an approved security plan, on the facility.
Middleton City Administrator Mike Davis is hopeful that the company can address the concerns and the hospital will get built. “[City staff] are still supportive of the project, both from a land use perspective and due to the critical need for mental health services in the greater community,” Davis says.
Lynn Brady, president and CEO of Journey Mental Health Center, says there’s been a shortage of beds ever since the state closed Mendota Mental Health Institute to the public in 2014 in order to exclusively house men convicted of crimes.
That’s forced Madison to transport people in crisis to other communities when local hospitals’ smaller mental health units are full.
“Hospitals have a certain number of what they call acute beds and when those get full they don’t take anyone else and that leaves our emergency services unit with their hands tied,” Brady says. “If a person needs an admission, and there is no bed for them, then we have no recourse but to send them to Winnebago.”
According to Treatment Advocacy Center, a national nonprofit working to eliminate barriers to treatment of severe mental illness, the number of licensed psychiatric care beds in the state has dropped from 558 in 2010 to 458 in 2016.
The center considers 50 beds per 100,000 people necessary to provide minimally adequate treatment for individuals with severe mental illness. Wisconsin averages just 7.9 beds per 100,000 people. John Snook, the center’s executive director, says because of the shortage “people desperate for medical care are winding up on the streets or behind bars, caught in a criminal justice system incapable of meeting their needs.”
Mahoney says state law allows police to take people into protective custody, or “emergency detention,” for 72 hours for observation. But it’s a complicated, involved process. It starts by taking the person to a local hospital to ensure they can undergo mental evaluation, which can take several hours, Mahoney says. Then authorization must be obtained from Dane County’s mental health provider, Journey Mental Health, which evaluates the person to determine if detention is warranted.
“This occurs dozens of times a week with all of our law enforcement agencies including the sheriff’s office,” Mahoney says.
The Madison Police Department put 196 people into emergency detention last year, including 145 people who were taken to Winnebago, says Andrew Muir, the department’s mental health officer.
In an email, Madison Police Chief Mike Koval says the department is “desperate for any initiative that may mitigate the travel times, hours, and personnel that take constituents away from our community and keeps cops from being in their beats.”
The sheriff hopes that a new hospital would divert people from jail. “We run 24-hour mental healthcare in our jail and often find that there are individuals who need to be placed in a secure mental health facility other than the jail,” Mahoney says.
Strategic Behavioral Health proposes to alleviate this shortage of beds. It operates 10 psychiatric hospitals around the country, including one in Green Bay, and has two more under construction.
“We have determined that the Madison area is a place that has a great need for what we are offering and what we are trying to do,” says Jim Shaheen, the company’s founder and president.
If the Middleton Common Council approves the project, construction would begin later this year.
Apart from inpatient services the hospital would also offer partial hospitalization, a day treatment program and intensive outpatient services. Brady agrees a new hospital is badly needed.
“It’s really bad for patients to have the hardship of going to Winnebago if it’s not necessary,” Brady says. “It’s hard on them, hard on their families and it costs the taxpayers a lot of money because the police or sheriff have to transport them up there.”
Mike Garone, the company’s strategic director of development, agrees that people do better when they’re treated near their homes.
“We have a 68 percent greater chance of having a successful outcome when they are kept at home and we can involve the families, the treatment team, get them hooked up with wrap-around services once they discharge,” Garone says.
Strategic Behavioral Health would bring other benefits to the community, Garone says. The hospital would offer free mental health screenings and train local police agencies and school districts on how to deal with those in crisis.
Rob Elsner, director of corporate construction, says the facility would look like a library from the outside, but be secured with more than 100 cameras; points of egress would be carefully managed.
A major factor in design is preventing self harm. Windows and doors are made of lexan plastic and do not shatter. And there are no places where patients can hang themselves, Elsner says.
“Many of the people that are in our facilities may be intent on self harm, so we take every possible avenue to remove every possibility for self harm,” Elsner says. He adds that the design aims to be comforting, with high ceilings, wide corridors and a courtyard at the center of the building.
Strategic Behavioral Health is seeking a $1.2 million tax incremental financing grant for the project from Middleton.
As the State Journal reported, the company’s hospitals have been sanctioned nine times in recent years. At its Charlotte, North Carolina facility, 10 youths escaped on Jan. 1 and the company was fined $20,000. Other facilities were sanctioned for not having adequate staff, and having patients in their care who were injured, abused and sexually assaulted.
On Tuesday night, Shaheen told the Plan Commission the company takes the regulatory issues seriously and views them as guidance for improving.
“In a highly regulated healthcare [industry], regulators come in and decide where you need to improve and the speed at which you need to improve,” he said. “In the last 12 years we have never not improved and never not satisfied the regulatory agencies. We have never lost a license.”
He added that the business is complex and difficult, working with people who are troubled and often don’t want to be in its facilities. “No one is talking about the thousands and thousands of families that are better off today because of the care that we delivered.”
Middleton Police Chief Charles Foulke urged the Plan Commission to approve the project, noting that Green Bay officials have given the company’s hospital there positive reviews.
“Most of the people that we deal with in a mental health crisis get no help,” Foulke said. “They go to the emergency room, they are quickly turned back out onto the street or we arrest them and take them to jail. That’s why Dane County is spending millions of dollars to upgrade its jail, because it’s an inhumane uncivilized place to put people who are in a mental health crisis.”
