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In 2010, a report commissioned by Milwaukee County’s Behavioral Health Division charted a path forward for the department, which was deemed overly reliant on crisis intervention and institutionalized care.
Among the 10 recommendations issued by the Human Services Research Institute, the Wauwatosa-based mental health provider was to downsize its inpatient capacity, work more closely with private providers and increase access through community-based services.
This fall, a new, privately-operated mental health hospital will open in West Allis, where BHD will outsource acute inpatient services that are currently housed in a portion of its sprawling 900,000-square-foot campus at the Milwaukee Regional Medical Center.
Meanwhile, a planned new mental health emergency center on Milwaukee’s near north side is advancing through city approvals, which would allow BHD and four health care partners – Advocate Aurora Health, Froedtert Health, Ascension Wisconsin and Children’s Wisconsin – to move forward with their public-private joint venture that will serve patients in crisis.
And increasingly, BHD staff are becoming embedded in community health centers throughout the county to provide care to patients before more intensive and costly interventions are needed.
When the in-progress Granite Hills Hospital – at 1706 S. 68th St. in West Allis – and future emergency center – planned for a site at 12th and Walnut streets in Milwaukee – eventually open, BHD’s campus will be vacant, marking a milestone in a department redesign more than a decade in the making.
Michael Lappen, administrator of the BHD, cites many statistics to illustrate his department’s transformation since that initial report was released, but one of the more notable is the 50% decrease in psychiatric care services visits over the past decade. From 2010 to last year, those visits dropped from 13,443 to 6,471 – a figure that reflects in part a COVID-related decline, but still is consistent with the decade-long trajectory.
“The downward trend is pretty amazing,” Lappen said.
While BHD aims to see those numbers decline even further as it builds out a mental health infrastructure that has more robust services “upstream” – before challenges escalate to a crisis point – there will always be a need for emergency services within that ecosystem.
“We always use the analogy that you can do all the healthy eating in the world and all the exercise in the world, but people still have heart attacks and strokes. So, you still need to have that facility that is in place for those emergencies,” Lappen said.
The emergency center will be developed and operated as a joint venture, with the county taking on half of the estimated $12 million in construction and upstart costs; the four health systems will be responsible for the remainder. Advocate Aurora has agreed to manage the facility, though many of the details related to the complex project – which Lappen described as “starting a hospital from scratch” – are still being hammered out.
If all approvals go through on schedule, construction would begin this month, with completion expected for spring 2022.
One key advantage of the planned new center is its location. Currently, 93% of patient visits to the BHD’s Psychiatric Crisis Services Center originate from the city of Milwaukee, with the 53218, 53209, 53206, and 53208 zip codes accounting for 33% of total visits, according to a HSRI report.
The new center’s proximity to patients is expected to result in a spike in demand for those seeking emergency care – at least initially.
“Because it’s so much easier to access in its (new) neighborhood, and so many of the people we serve are literally 5 minutes away from the new center … we’re anticipating somewhere between 8,000 and 10,000 visits,” Lappen said. “And our hope is to get the numbers down eventually and serve fewer people because we have so many things in place that we want people to access sooner and more upstream.”
The array of mental health services available in the county now reflects the recommendations put forth in the HSRI report from 10 years ago.
BHD has established a presence in clinics operated by Sixteenth Street, Outreach and Progressive Community Health Centers, and is working to solidify a partnership with Milwaukee Health Services’ clinic located near 82nd Street and Silver Spring Drive.
Being in those outpatient settings is beneficial on a few levels. For many residents, they are familiar settings, where providers have well-established, trusted relationships already in place. And having BHD services there helps breaks down the perceived barrier between mental health care or substance abuse treatment and the battery of other health services patients seek regularly.
“It’s another attempt to reduce the stigma of getting help,” Lappen said. “You might come in for your flu shot, but then say to someone ‘Hey, I’m kind of having a hard time with anxiety’ and you can get help right under that same roof, without having to go to some place special.”
In recent years, the county has also opened three crisis resource centers, which provide an alternative to involuntary emergency room admissions and criminal justice facilities for people experiencing psychiatric crises.
BHD has also developed a non-police mobile service that dispatches clinicians who provide assessment and stabilization for adults and children in crises. The department responded to about 4,000 of those calls last year. Another program, called Crisis Assessment Response Teams, pairs a trained clinician and law enforcement officer who has received crisis intervention training when responding to high-stress situations. Those teams, which currently operate in Milwaukee and West Allis, responded to more than 2,000 calls last year.
“Every one of those mobile (responses) very well would have been an emergency department visit at some point in the past,” Lappen said.
Those are the kinds of interventions – along with a significant increase in supportive housing units in the community – that have also helped drive down inpatient admissions in recent years from 2,254 in 2010 to 648 in 2020.
With construction nearing completion on Granite Hills, inpatients are expected to begin receiving care at the new 120-bed hospital, operated by Pennsylvania-based Universal Health Services, within the calendar year. The hospital has a target opening date of Sept. 8.
“We hope to have a significant amount of the transition completed by the end of this year,” Lappen said, adding BHD will continue serving inpatients at its mental health complex as long as it’s needed.
UHS is expected to retain BHD staff in the transition to the new facility.
“They’re banking on being able to recruit and retain our staff,” Lappen said, adding that an ideal scenario would be to strike an agreement with Granite Hills that allows existing staff members to end their shift at the BHD campus and start their shift the next day at the new hospital.
While BHD has been making progress toward a more integrated and effective system, community perceptions don’t shift quickly.
A 2018 report from HRSI based on interviews with community members and BHD employees found many perceive the system to still be fragmented, with the inaccessibility of the current campus cited as another persistent challenge.
“The system was said to be an overwhelming maze to navigate even for professionals embedded within it; consumers and advocates noted that it is even more challenging for individuals and families,” the report said.
Lappen acknowledged that coordinating – and making sure the system’s many providers are on the same page – will be key as BHD gets out of the inpatient care business and increasingly delivers care through partnerships in the community.
Current estimates expect BHD to move off its Wauwatosa campus in the first half of 2022.
In 2020, a consortium that included Froedtert, the Medical College of Wisconsin and Children’s purchased the 41 acres encompassing BHD’s campus. The groups have not disclosed plans for the site, but will demolish the currently vacant buildings, said Bob Simi, executive director of the MRMC. The Milwaukee County Transit System has plans to install a stop on the site as part of its bus rapid-transit line, and MCW has floated the idea of developing a forensic science center on the property.
Simi said future uses of the site will “support health care, health education and associated purposes.”
Whatever takes its place, it will be the first time there hasn’t been an operating psychiatric hospital at the site since 1880, Lappen said.
“From a historical perspective, it’s a big shift,” he said.