Republicans and Democrats agree: Wisconsin needs to improve its mental health system

RACINE — There is bipartisan consensus that the nation's mental health infrastructure is insufficient for the need, especially compared to the more robust infrastructure in place for physiological health.

There's a shortage of mental health professionals. There aren't enough medical beds for mental health treatment for the number of people who need them — if you break your leg, you can probably be in the hospital that day; for mental illness, you're much more likely to end up on a waitlist. There remains stigma that discourages some from seeking mental health treatment they could benefit from. Those suffering from serious mental illness remain more likely to end up in handcuffs than in treatment facilities.

It still feels like the legislation surrounding the establishment of an effective mental health infrastructure in Wisconsin is in its infancy.

State Rep. Bob Wittke, R-Wind Point, said, "I think the biggest thing that I've learned so far (as a state legislator since 2019) is that it's kind of easy to think that you can solve a problem all at once, (but) it takes a lot of hard work and focus to keep going and possibly (taking) smaller steps at a time to reach a larger goal. I think that's something that people in the community have to understand as well."

Wittke said that Wednesday evening during a panel at the Racine Public Library hosted by NAMI Racine County and moderated by The Journal Times' editor. Also on the panel were Anthony Hammes, the Democrats' nominee challenging Wittke for his seat representing Wisconsin Assembly District 62; Assembly Minority Leader Greta Neubauer, D-Racine; and Assembly Speaker Robin Vos, R-Rochester.

Looking forward, Wittke said he hopes the Legislature can "continue the work that we started" on improving mental health offerings in Wisconsin.

Added Vos: "I think we've made good first steps," including by introducing student loan forgiveness programs for psychiatrists who practice in Wisconsin after graduating from state colleges.

Still, "It's very clear that we have work to do," Neubauer said, a sentiment each of the other three panelists agreed with.

Watch Now: Racine County candidates discuss state of mental health in Wisconsin in panel led by NAMI, Journal Times editorParticipating in the Oct. 5, 2022, panel were Anthony Hammes, Greta Neubauer, Robin Vos and Robert Wittke.

Getting more professionals, beds

In 1955, there was one psychiatric bed for every 300 people in the U.S., according to the Treatment Advocacy Center; but by 2005, there was one psychiatric bed for every 3,000 Americans.

According to AsylumProjects.org, Mendota Mental Health Institute — the state's oldest mental hospital — had a peak patient population of 2,528 in 1950. Today, Mendota has fewer than 300 patients. In 2014, state legislators nearly closed Mendota, looking to move all of its inmate/patients to the 170-bed Winnebago Mental Health Institute in Oshkosh, the state's only other primary mental health institution.

Wittke noted that the Legislature just since he was elected four years ago has already allocated millions to improve the state's existing mental health treatment facilities.

"We don't have enough beds in the state right now to be able to house some of the people that need mental health services," he said. "As part of the Building Commission, in our capital budget, we have allocated monies toward refurbishing places at Winnebago, Mendota; and then we've honored I believe all the requests from the Department of Corrections to be able to upgrade many of their health services facilities within our prison system."

Licensing

There's a serious backlog of soon-to-be health care workers and professionals waiting to have their applications to practice in Wisconsin approved. This is particularly true for mental health professionals, considering their shortage is perhaps more potent than the shortages of other nurses and doctors.

"There is a huge problem in the licensing process, and the licenses are taking way too long for people. One of the top groups that is not getting licensed quick enough is the social workers that we have … They are sometimes waiting months for an agency to give them a license," Wittke said.

The Evers administration has faced the brunt of the criticism for this slowness.

The Department of Professional Services "says it receives an average of 13,000 applications a month and blames staffing shortages and an outdated, paper-driven processing system on wait times," the Milwaukee Journal Sentinel reported last month. "Republicans say the situation and department are examples of the current administration's 'failed leadership,' likening it to the long wait times Wisconsinites experienced in 2020 with the state Department of Workforce Development's processing of unemployment benefits."

Jails, prisons, police

Speaking to Neubauer following a question about the incarceration of those with mental illness, Vos said, "I agree with you that unfortunately people who are having a mental health crisis shouldn't be going to jail …

"But, if you commit a crime, you commit a crime. You have to go to jail and pay the price for having that happen. So, I don't think it should be an either-or (situation) … We do not want to use jails as … an overflow place for people having mental health challenges. But I also don't want to simply say that 'We want to reduce incarceration' and have all those people who commit a crime on the streets."

He added, "We are letting too many people out of jail. There are people who should stay in jail because they committed crimes and they are certainly not ready to come out with society … There are serious problems with the criminal justice system."

Again, Vos and Neubauer agreed that "We need to increase pay" for prison staff in order to make incarceration facilities safer. In December 2020, more than 14% of the state's adult prison positions remained unfilled.

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Neubauer said that, after multiple ride-alongs and conversations with area first responders, "They will be the first to admit that they are not social workers" and they support the creation of programs that would involve a social worker responding to 911 calls involving individuals with mental illness.

Vos pointed to funding approved in the last legislative session to fund mental illness training for police. Hammes said he would support requiring all police officers to undergo crisis intervention training. Through NAMI (the National Alliance on Mental Illness), each CIT training takes 40 hours.

To prevent incarceration of those with mental illness, Wittke said there needs to be more treatment available for the general population so that those who may turn to violence or crime can get help "before they reach the criminal justice system."

Guns

The Republicans on the panel remained staunchly opposed to enacting further gun control measures, particularly red flag laws.

Vos said he doesn't believe the state should tell people they have to give up their gun "before they've done anything wrong. Imagine if we said: You look like you might drink, so we're going to take away your car."

Wittke said he does support a proposal through which family members could legally take a loved one's firearm and bring it to a gun shop where it could be locked up until the concern regarding the owner of a firearm — such as the individual threatening violence or self-harm — had passed.

Schools

Neubauer pointed to a bill proposed by Democrats that stalled in the legislature earlier this year that she said "would expand the ability for school districts to be reimbursed for hiring counselors, social workers, psychologists and nurses." Currently, schools can be reimbursed by the state if they increase their spending on social workers; Democrats want to expand that reimbursement program to include more mental health professionals.

"I think we all know," Neubauer continued, "when you talk to young people, how long it takes for them to talk to someone at school — if there's someone even available for them to talk to — about these really deeply personal issues: trauma, things going on at home that they need to work through. So, really we need to make sure that we've got those professionals in school, and we know that that's going to help kids right now."

The National Association of School Psychologists recommends having one school psychologist for every 500 students; in Wisconsin, the ratio is closer to 1:836. EdWeek reported earlier this year that 12% of American public school students attend a school district that doesn't employ any psychologists. Madison's NBC-15 reported last month that "data from Wisconsin's Department of Public Instruction shows one in five students will face a mental health issue and its website states that 'over 80% of incidents go untreated. For those who do receive treatment, roughly 75% of the time it's administered at school.'"

Hammes sees schools as a place where seeds could be planted to counteract workforce shortages. "I want to ensure local leaders are reaching out to high school students in all parts of the state to introduce mental health services at an earlier age," he said, "and we need to insure that providers of tomorrow are diverse, and reflect the culture and ethnicity of the communities they serve."

Vos noted pre-existent loan forgiveness programs for people who become psychiatrists and other medical professionals in Wisconsin. Psychiatrists along with physicians are eligible for the most student loan forgiveness in Wisconsin, up to $50,000 through the Wisconsin Office of Rural Health.

"We've only had a relatively small number of people graduate from UW institutions with a degree (in psychiatry)," Vos said. "So, while it's been successful, we certainly could do more in that area."

Vos pointed to Act 131, which became law earlier this year and made it easier for a psychologist licensed in another state to start practicing in Wisconsin.

Still, Vos pushed back against unilateral pushes to get more and more and more health care offerings in schools.

"It is not the responsibility of the taxpayers to provide an additional service for every single child. That's what people have private insurance for," he said. "I don't want to treat mental health as if it's somehow different than somebody who has a traditionally thought of health care issue … Schools can help provide those resources, but they should not ever be the primary care provider. That is the job of the traditional system that we have."

Gaps

An August 2020 report prepared by the University of Wisconsin Population Health Institute analyzed Wisconsin's behavioral health system gaps. It found that "the most common workforce gap identified in mental health" is a lack of psychiatrists and psychiatric prescribers.

But the biggest barriers to access, rather than a lack of providers, were found to be "both insurance limitations/cost and physical distance to said facilities in the current state of the system."

The report continued: "Rural areas struggle with transportation barriers and hiring challenges due to better wages in the private system and across state lines, and that medical transportation is currently ineffective in closing geographic gaps in facilities. In urban areas, long waitlists and lack of sufficient workforce diversity were highlighted as key challenges."

The report's top three priorities were:

1. Increase accessibility.

2. Develop the workforce.

3. Improve funding.

Vos spoke highly of the systems already in place for poor people seeking mental health help.

"If you're in poverty … you have access to BadgerCare, which basically is free: no copayments, no deductibles, premium insurance fee … At the end of the day, we do have a good social safety net. It can always be better. We need more providers. We need to make sure we have better access."

According to the UW report, this isn't enough.

It advocated for increasing the Medicaid reimbursement rate for behavioral health services in order to "reduce service gaps, improve workforce recruitment and retention, and encourage innovative approaches to care." It also called for expanding the kinds of treatment Medicaid can cover costs for, including peer specialist outpatient services, psychiatric telehealth consults and "holistic care like yoga and acupuncture."

One psychologist in solo practice who spoke with researchers said the following: "The Medicaid provider portal is extremely user-unfriendly for solo practitioners who do their own billing. It is not intuitive, needlessly complicated, and seems to be designed to discourage its use by providers. If this was fixed and I would reliably be paid for straight Medicaid, I would see more Medicaid clients. As it is, I really can only see BadgerCare or Medicaid clients who are on one of the HMO (health maintenance organization) plans because I can use their portals which are very user-friendly."

Added Hammes: "The key is access"

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