Representatives from the health care, government and nonprofit sectors gathered in late summer to celebrate construction progress on a new mental health emergency center being built on Milwaukee’s near north side.
The emergency center – a partnership among Milwaukee County and the area’s four largest health systems that’s backed by public and private dollars – was widely celebrated at the beam-signing ceremony. Throughout the program, speakers lauded the new facility as the most important thing the region has done related to mental health in decades, a significant investment in dismantling racial inequities in health care, and a needed intervention in the broader police reform effort.
The 12,000-square-foot facility, expected to open next year, will receive people experiencing psychological crises and help transition them to longer-term care. The emergency center is one of two new facilities in the county designed to serve those in crisis, along with Granite Hills Hospital, a 120-bed West Allis facility that will provide inpatient behavioral health services when it opens later this fall.
Following decades of calls for reform to the way mental health care is delivered in Milwaukee County, the new buildings for many represent signs of progress. But long-standing staffing challenges – exacerbated by the COVID-19 pandemic – have created an uphill battle for those leading the new facilities, who will have hundreds of positions to fill when they open in the coming months.
Some of the new positions will be filled by current employees of the county Behavioral Health Division’s hospital campus at the Milwaukee Regional Medical Center in Wauwatosa, which will eventually outsource all of its emergency services to the new emergency center being built at the intersection of North 13th and Cherry streets in Milwaukee and its inpatient services to the privately-run West Allis hospital.
Even if all current BHD employees transfer, however, it wouldn’t be enough to fully staff the new facilities. The BHD has 197 full-time employees currently working in inpatient services. When open and fully operational, the new facilities will together have roughly 320 employees, including 250 at the hospital and 70 at the emergency center.
Granite Hills, owned by Pennsylvania-based Universal Health Services, has been actively recruiting staff and holding town halls at BHD in recent months.
Granite Hills chief executive officer Jennifer Bergersen assumed that position this summer after 22 years with the county’s BHD, most recently as chief operations officer under administrator Mike Lappen. The two organizations have taken a collaborative approach to the staffing transition, Lappen said.
“We recognize that in order for us both to be successful, we have to have some sort of coordination around staff, so it’s been a really thoughtful process,” he said, noting Bergersen has already hired a handful of leaders and staff from BHD.
Once Granite Hills ramps up its inpatient services, BHD will incrementally wind down until it’s able to close its oversized and aging campus. Granite Hills plans to open to 10 to 12 patients this fall and scale up from there.
Granite Hills’ inaugural group of employees likely will come from outside of the BHD, Lappen said, noting the hospital doesn’t have “the staff to spare” at the moment.
The Mental Health Emergency Center also plans to hire employees currently working in the BHD’s Psychiatric Crisis Services facility.
“We hope to attract as many of them as possible,” said Pete Carlson, vice president and chief administrator at Aurora Behavioral Health Services.
As operations manager of the new center, Milwaukee- and Downers Grove, Illinois-based Advocate Aurora Health is responsible for hiring the new employees, but it will be able to draw on the HR departments of its partner health systems – Froedtert Health, Ascension Wisconsin and Children’s Wisconsin – to fill open positions, Carlson said.
“We hope that the workers are there. …We’ve got provider shortages pretty much all the time anyway, so that, frankly, is nothing new,” Carlson said. “… We are going to leverage every pipeline, every possibility that we have to fill positions. … It’s a little bit of a crapshoot, though, because there are others looking for the same folks.”
BHD has felt those workforce pressures for a while. Its current focus is on keeping its hospital and PSC employees until they can transfer elsewhere.
When BHD announced that it planned to outsource its inpatient behavioral health services, the department began offering retention bonuses amounting to 20-30% of an employee’s salary to direct-line staff who stayed on through that transition.
Inpatient behavioral health facilities are particularly hard-pressed to find qualified workers. Nurses are in short supply across the health care industry, and that pool narrows even further for nurses who have a thorough understanding of mental illness and are prepared to care for patients in psychiatric crises.
“These are really specialized folks. I don’t think most people understand that running a high-acuity psychiatric unit, it requires a very specialized knowledge and skill,” especially related to patient safety and de-escalation strategies, Lappen said.
“That can be an art form,” he added. “How you approach people, how you speak with them, establishing a treatment alliance and trust in people – those soft skills are really hard to teach. We can teach people how to do these things, but some people are good at it, and some people aren’t.”
BHD leaders expected they would face a challenge in retaining employees amid the looming hospital closure, but they couldn’t have anticipated it would be compounded by a global pandemic, which has caused burnout among workers and increased the demand for mental health services.
Despite aggressive recruitment efforts – including $7,500 sign-on bonuses for full-time RNs and emergency service clinicians and $1,000 referral bonuses – Lappen estimates BHD has not hired a permanent hospital employee in three months. It’s left the hospital to rely on traveling and temp nurses.
Earlier this month, BHD increased its hourly hospital staff pay by $5 to $10, depending on the shift. It’s also offering a “critical fill bonus” of $250 per eight-hour shift for employees who pick up work outside their assigned hours.
“We figure instead of paying temps and travelers, we’d rather reward people who have stuck with us and who are mission-aligned and want to be here through the close,” Lappen said.
Lappen noted that a hospital of Granite Hills’ eventual size will benefit from economies of scale that BHD no longer has. As of early October, BHD had a census of 26 adult and five child inpatients on its sprawling campus, which was built in the late 1970s with a capacity of 1,300 patients. In recent years, the department has shifted its strategy toward providing more upstream services in outpatient clinics, community settings and through crisis mobile response teams, rather than in inpatient facilities.
“One of the advantages that Granite Hills has is that they are going to run a 120-bed hospital, so your fixed costs, like pharmacy and dietary and all those things that are spread out across the larger census, you can make it work,” he said. “That is the biggest difference between us and Granite Hills. We have always been basically a bare bones facility.”
The difference in reimbursement structures between the two facilities is another key difference. BHD operates as a critical access hospital for under- or uninsured patients, while Granite Hills will accept a payer mix that includes those with private insurance.
Once operational and fully staffed, Granite Hills leaders envision it becoming a training ground for future mental health professionals. Bergersen said she expects to partner with area higher education institutions to provide residencies and internships for students.
“We want to have contracts with various schools in the region so we can have students from all clinical backgrounds and disciplines come to our setting so we can help develop the future mental health experts that we need so desperately in order to do this valuable work,” she said.
