Public Policy Forum Blog

Local mental health planning effort can learn from others' mistakes

The need to engage in long-term strategic planning has been a consistent theme from the Public Policy Forum in our analyses of local government budgets, as well as our reports on local government policies in areas like economic development and housing.

It is important to note that our passion for planning does not stem from an idealistic belief that the problems of local government can be solved simply by getting people in a room for a day-long retreat. Rather, it is based on our concern that short-term election cycles discourage effective long-term decision-making; and our strong conviction that an effective and accountable government must establish clear objectives that are tied to measurable indicators and that emanate from a long-term strategic vision.

There are times, however, when government planning can backfire. A recent example comes from our neighboring state of Minnesota, where the Minneapolis Star Tribune reports that a restructuring of state mental health services has come under duress.

The overhaul was designed by the Minnesota Department of Human Services. Its main component was creation of a statewide network of community "mini-hospitals" to replace large institutions in caring for those with severe and persistent mental illness. It was thought that serving individuals close to their community and linking psychiatric care with medical care would provide superior treatment and shorten hospital stays.

An added bonus was the opportunity to receive partial Medicaid reimbursement for the cost of treatment. Under federal law, such reimbursement is not provided for most patients treated in large "institutes of mental disease", but is granted to smaller hospitals with 16 beds or less. {For this very reason, Milwaukee County explored the concept of creating 16-bed mini-hospitals as an alternative to its 96-bed mental health hospital a few years ago, but never moved past the discussion stage}.

In Minnesota, according to the Star Tribune article, this experiment has been a colossal failure. Nine of the 10 hospitals stand "half-empty" and the tenth closed for lack of use. Consequently, the state is now contemplating a new plan that would change the mission of the mini-hospitals and cut $17 million from the program's budget.

The article notes that while few Minnesotans appear to be questioning the need to develop a new plan, advocates are challenging the state's apparent intent to do so largely on its own. They say a fatal flaw in the previous plan was the state's lack of partnerships with local hospitals and community health organizations, and they are calling for inclusion of other key stakeholders.

Reports of the Minnesota planning mess arrive at a time when a planning effort surrounding Milwaukee County's adult mental health system is entering its final stages. The Forum is serving as local facilitator for this effort, which is being led by private and public sector entities that have made a concerted effort to involve all key stakeholders. Those include the major health care systems, the Medical Society of Milwaukee County, the Medical College of Wisconsin, county and state government, advocates, mental health consumers and civic leaders.

The project's objective is to redesign both the public and private systems that provide adult mental health care and treatment in Milwaukee County in a manner that will produce better coordination and better results. It's being led by a national consultant from Massachusetts - Human Services Research Institute - that has led similar efforts in other states. A project summary can be found here.

Stay tuned for the final report, which will be released sometime this summer.

Rob Henken