A well-connected county health system director from southeastern Wisconsin has been selected by Milwaukee County Executive Chris Abele to lead the Milwaukee County Behavioral Health Division.
Mike Lappen, director of Ozaukee County Human Services, is expected to start as Administrator of BHD on May 27 pending the approval of the Milwaukee County Mental Health Board.
The board will vote April 28 on whether to approve Lappen’s appointment.
The position was previously held by Patricia Schroeder, who resigned in January after 18 months. Schroeder oversaw the closure of the county’s last long-term psychiatric care units. For the past few months, Alicia Modjeska has served as interim administrator while the county searched for a permanent replacement.
Lappen has led the Ozaukee County Department of Human Services since September 2013. In the 11 years prior, he ran Ozaukee County’s Behavioral Health Division, where he expanded outpatient services and increased collaboration with nonprofits.
He also established partnerships with the Ozaukee County Sheriff’s Department, implemented accountability measures to track the performance of health care providers working under contract with the Department of Human Services, and modernized Ozaukee County’s record-keeping system.
“I’m walking away from a fantastic job in a place that I love,” Lappen said. “But the only thing I would leave for is something like this, where I feel like I can make a big difference. I believe I’m a perfect candidate at a perfect time for this job with the direction Milwaukee County is moving in. It’s not going to be easy. I know it’s going to be hard. There’s going to be frustrations. I’m going to count on a lot of people and advocates. I feel like I have really positive relationships with some of those folks. With me it starts over and it’s a different time.”
Lappen is familiar with Milwaukee and its mental health system. From 1998 to 2002, he was a case manager for a small intensive community support program run through Wisconsin Correctional Service, now called Wisconsin Community Services. The program worked with a cohort of patients who spent decades in a long-term care unit at the Milwaukee County Mental Health Complex.
He received his bachelor’s degree in psychology from the University of Wisconsin-Milwaukee in 1995, and a master of science in educational rehabilitation counseling from UWM in 1998. Lappen is also a graduate of Marquette University High School.
Mental health advocate Barbara Beckert, director of Disability Rights Wisconsin’s Milwaukee office, said Lappen’s hiring is a signal that the county plans to follow through with its promise to expand community-based programs. Disability Rights Wisconsin is the state’s federally mandated protection and advocacy agency for people with disabilities and has advocated for changes to the Milwaukee County mental health system for years. In 2013, the group hired a psychiatrist to investigate the deaths of six patients that occurred at the Milwaukee County Mental Health Complex in 2012. The psychiatrist concluded inadequate psychiatric and medical care contributed to the patients’ deaths and said the complex should be closed.
“This is exactly the type of candidate that I have suggested to the administration is needed — someone who has been successful in implementing a community-based system in another county,” Beckert said of Lappen’s nomination. “It’s a very specialized area. I think he’s really well respected and I think he has a lot of respect for people that we serve. Mike (Lappen) is certainly an individual who I have a lot of respect for. I think it was a good choice. It reflects the direction we’ve been hearing the county wants to move in — to implement a community-based system.”
Beckert said that while she feels the county has made good initial steps in overhauling its mental health system — particularly in downsizing long-term care — its expansion of community services has been “very modest and limited.”
“There needs to be an urgency about expanding community services, because the amount of beds at the county hospital has been reduced significantly,” Beckert said. “In terms of community mental health services, to date there hasn’t been very much expansion of the services offered by the county.”
In particular, Beckert said the county has an immediate need for the expansion of community support programs, comprehensive community services and community recovery services.
“These psycho-social programs have a whole range of supports that assist people in living independently in the community,” she said. “Right now it’s difficult to get access to them.”
A BizTimes cover story published in March outlined Milwaukee County’s plan to dramatically overhaul the way it delivers mental health care by 2020. Expanding community-based services and reducing reliance on long-term and emergency care is a major component of those plans.
Lappen said if the board approves his nomination, he would immediately begin repairing the county’s relationship with certain mental health care providers in the area and build a strong comprehensive community services (CCS) program through an expanded network of partners.
CCS programs are state and federally funded. Mental health systems that implement CCS programs build a team of case workers and service providers around patients who require ongoing treatment for mental illness and substance abuse problems to develop a specific treatment and recovery plan.
“The better that network is, the more options we have and really the bigger menu we have of services,” Lappen said. “That’s really where the success will be. I believe we need to improve care, shorten waiting times, make services more accessible to people and develop good providers in Milwaukee.”
As the county shifts toward a model that would outsource most care to private providers, which he refers to as vendors, Lappen said using data to identify top performing and under-performing providers is essential.
“The idea is to take the lead with the vendors and help them get comfortable with the key concepts of recovery and what a recovery-oriented system looks like,” Lappen said. “I’m sure some of that is in place already, but that’s an area of emphasis for me. Data is hugely important to me. I think we need to show how things are successful and how things are going, and identify what the trends are. Are emergency room visits declining? Are we getting outcomes from vendors that we expect? Whatever the metrics we decide to use are, we always have to go back and see how they’re doing. If they slip, we need to deal with that and get staff trained. If we find they can’t really can’t do it and they fail, we need to hold them accountable and move to someone who can.”
In addition to deciding whether to approve Lappen as the new BHD administrator, the Mental Health Board is also reviewing proposals submitted by private providers to build and operate a 60-bed mental health center on behalf of the county in exchange for reimbursement for uninsured patients. So far, three have submitted proposals: Bala Cynwyd, Pa.-based Liberty Healthcare Corp.; Nashville, Tenn.-based Correct Care Solutions; and King of Prussia, Pa.-based Universal Health Services Inc. A decision is expected to be made in June.
