The stress of the COVID-19 pandemic and economic downturn have brought the need for more behavioral health crisis care, better access, and more preventative supports. This includes ensuring we can effectively care for individuals experiencing behavioral health crises. And we must also work to prevent those crises from happening in the first place. To recover together, Governor Evers’ budget invests in behavioral health and substance use disorder services because these services are essential to overall wellness. To ensure the right supports are available at the right time for all Wisconsin residents, we are building an integrated behavioral health system that provides prevention, intervention, and treatment services to individuals across their life span in their communities.
Increase access to behavioral health crisis care
Our current behavioral health system is inadequate to meet needs of Wisconsinites experiencing mental health crises. Between 2013 and 2017, crisis services provided to children and adults increased by 58%.
Psychiatric inpatient beds are concentrated in a few areas, making it difficult to meet need across our state.
- Between 2004 and 2017, the total number of beds decreased by almost 20%.
- Winnebago Mental Health Institute now serves a larger portion of the emergency detentions in our state.
- Emergency detentions have increased substantially at Winnebago Mental Health Institute, especially from certain regions. Between 2013 and 2017, the percentage of emergency detentions that Winnebago Mental Health Institute admitted for the 18 counties in the Northwest region of the state increased from 5% to 21%.
- Counties spent approximately $27 million on these services in 2017.
The system lacks culturally competent and translation services, which prevents many Wisconsinites from accessing services before a crisis.
Regional Crisis Centers
In the current system, people in crisis may receive treatment that does not best meet their needs, such as emergency detention, because facilities like hospital emergency rooms are not equipped to handle all crises. With better crisis community-based structure in regions, hospitals could be a last resort.
From intake through stabilization and potentially more intensive treatment, these two new regional centers will provide a continuum of care. This increases crisis diversion, stabilization, and more intensive, longer-term treatment options.
Centers will be able to serve people of all ages from across the state, and will provide support and clinical expertise to local mobile crisis units.
Regional Crisis Stabilization Facilities
Without facilities in every region of the state, many Wisconsinites cannot access services within their own communities. Facilities in all five regions of the state will support individuals within their own communities, allowing them to maintain social connections.
- The facilities will serve adults who seek care voluntarily.
- Year-round, 24/7 staff will provide short-term stabilization care.
While these facilities will not provide inpatient care, by providing adults in need of short-term support and observation care, they will reduce the need for future, more intensive care.
Forensic Assertive Community Treatment Teams
People with behavioral health concerns are overrepresented in our jails. Our goal is to keep people out of jail in the first place by providing preventative, community-based services to help individuals more effectively manage behavioral health challenges that could otherwise lead to involvement with law enforcement.
These services will help reduce future hospitalizations and prevent further incarceration.
Emergency Collaboration Grant
Law enforcement are often the first to respond to a mental health crisis, with referrals to behavioral health care providers coming later. The proposed grant program bases its provisions on similar program in Oregon that has shown success in de-escalation during crises.
By establishing collaboration programs between local law enforcement and local behavioral health providers, the program will make a joint response possible with both entities responding simultaneously to 911 calls.
County Crisis Phone Lines Clinician Staffing Support
In recent years, the number of crisis calls has increased while employee turnover and shortages have also worsened. Because helping callers access services immediately can save lives, we must ensure crisis phone lines are adequately staffed.
The qualified professionals who staff County Crisis Phone Lines provide valuable and immediate services. Funding additional clinicians, who will be available across the state and during non-business hours, will help counties maintain these services.
Crisis Intervention Training Grant
Law enforcement are often the first to respond to a mental health crisis, and yet many officers have not been trained in evidence based strategies to respond to these situations.
Crisis Intervention Training will prepare officers to respond more effectively to situations involving mental health crises. Crisis Intervention Training, facilitated by NAMI, has made a difference in the 26 Wisconsin counties where it is already offered.
Peer-Run Respite Warm Line Staffing Support
Staff at peer-run respite centers run the warm line; however, with increased calls, staff often has to choose between answering the phone and helping residents of the center.
By supporting at least two new positions at each of the respite centers, staff will be able to both serve residents and support callers (individuals and/or their family members) in non-emergency situations. Referring callers with significant concerns to local crisis services is a vital function of the warm line, which is one of the reasons we must ensure these calls are answered.
Behavioral Health Bed Tracker
Psychiatric hospital beds are scarce, and bed capacity is a dynamic situation. This provision will add to current efforts to track bed availability in Wisconsin.
Real-time bed availability for in-patient, peer respite, and crisis stabilization capacity will reduce wait time, improve quality of care, and make it easier for counties, law enforcement, and care providers to coordinate services.
Milwaukee County Crisis Mobile Team and Trauma Response Grants
The Milwaukee County Department of Health and Human Services continues to shift the behavioral health system towards a more community-based crisis services model.
Increasing funding will expand resources and make it possible to better respond to crises without involving law enforcement.
- The Crisis Mobile team is made up of clinicians and nurses who respond and assess crises, link people to services, and follow up to offer further support.
- Additional funds will expand coverage, making it truly 24/7 without the need to rely on contracted providers.
Provide access to proven treatment for substance use disorders
Many Wisconsinites struggle with serious substance use disorders, and without access to treatment services, the consequences can be serious and even deadly.
- Between 2014 and 2019, the rate of emergency room hospitalizations related to opioids increased by 69.5% in Wisconsin.
- In that same time frame, the rate of opioid deaths increased by 45%.
- The rate of overdose deaths in our state has drastically increased in the past 10 years.
Governor Evers’ budget takes significant action to respond to these tragic realities by funding treatment, benefits, and trainings with proven successes.
Medication-assisted treatment combines medications (methadone, naltrexone, or buprenorphine), counseling, and behavioral therapies to address substance use disorders through a “whole-patient” approach. It is an effective, evidence-based treatment that must be made more widely available.
- Increasing the Medicaid reimbursement rate helps increase access to medication-assisted treatment services.
- Higher reimbursement rates will likely increase the number of providers who will serve Medicaid members as well as the number of patients treated by existing providers.
- Providing grants to support existing treatment centers and mobile medication-assisted treatment units means medication-assisted treatment will connect more Wisconsinites to addiction treatment and harm reduction materials.
- Funding for a Tribal medication-assisted treatment provider will meet the specific prevention, treatment, and recovery needs of Wisconsin’s tribal communities.
- We will partner with tribes to find the most effective model for these services.
Room and Board for Residential Substance Use Treatment
Medicaid covers residential treatment for substance use disorders but we are prohibited under federal Medicaid law from using federal funds to reimburse providers for room and board expenses. These charges may be cost-prohibitive for Medicaid members, and that means many Wisconsinites cannot get the treatment they need. Currently, some counties cover these costs, but not all counties are able to do so, which results in uneven and inequitable availability of services.
- Wisconsin Medicaid now reimburses for substance use treatment services – but not room and board – provided in residential facilities. This is because federal law prohibits federal Medicaid payments for room and board outside of institutional settings.
- By funding these room and board costs with state dollars, Medicaid members will be able to access the new treatment benefit.
Medicaid Coverage of Acupuncture
Many people use acupuncture as an alternative to medication for managing chronic pain. However, Medicaid does not currently cover this service.
Reimbursement for acupuncture services will make it possible for Wisconsinites on Medicaid to access this method for pain management without paying out of pocket. Because acupuncture can be used to manage pain, making it accessible can help eliminate the need for more addictive opioid therapies.
Medicaid programs in many other states cover this benefit, as does the federal Medicare program.
Substance Use Harm Reduction Grants
Harm reduction strategies, like using fentanyl test strips, reduce the negative consequences associated with substance use.
- Because harm reduction should be targeted to communities and locations where they are most needed, providing grants to organizations already working with individuals struggling with substance use is an effective strategy.
- DHS will determine how these grant funds will be used and will support programs like NARCAN Direct, peer support specialists, fentanyl test strips, recovery residences, and planning assistance.
Methamphetamine Addiction Treatment Training Grant Program
Successful treatment for methamphetamine use disorder combines multiple evidence-based therapies, all focusing on reducing the potential for an individual to relapse. Utilizing a train-the-trainer process, the Matrix Model for Addiction Treatment will reach over 200 clinicians, improving treatment in communities across the state.
Addiction Treatment Platform
Navigating the options for addiction treatment in Wisconsin can be complicated. As a resource for Wisconsinites to learn more about treatment facilities, this web platform will make it easier to find an appropriate provider.
Prevent crises by providing access to services before a crisis occurs
To prevent behavioral health crises, we need to intervene earlier because intervention before the crisis occurs can save lives and improve both physical and mental health.
Wisconsinites are dying by suicide.
- Our suicide rate is higher than the national average, and it has been every year since 2005 except one.
- Our suicide rate – as a state and nationally – is trending up.
- The suicide rate is higher in rural areas of the state than in urban areas.
Struggles with our mental health can cause problems with our physical health, and struggles with our physical health can cause problems with mental health. COVID-19, as an illness and as a pandemic, will pose challenges in this space.
In addition to DHS budget provisions, Governor Evers’ budget prioritizes behavioral health across state government, including provisions to ensure access to telehealth services through a telehealth parity law, expanding support for veterans, strengthening services for Wisconsin’s farm families.
Increase Funding for Behavioral Health and Suicide Prevention Services
Outpatient behavioral health services, including psychotherapy and day services for children and adolescents, are critical to preventing crises and suicide. With a substantial rate increase to behavioral health providers, Medicaid members will be able to more fully access outpatient services and reduce reliance on crisis care.
Medicaid Psychosocial Rehabilitation Benefit
Currently non-county providers are unable to bill Medicaid for psychosocial rehabilitation. Psychosocial rehabilitation provides a wide range of treatments services for Medicaid members who need more support than what is usually provided in an outpatient setting.
By expanding it beyond county administration, the psychosocial rehabilitation benefit will improve the continuum of care available for mental health and substance use disorders. This expansion will reduce the need for crisis care services and improve health outcomes.
Behavioral Health Services for Individuals Who are Deaf, Hard of Hearing, or Deaf-Blind
Wisconsin does not have enough culturally competent resources for individuals who are Deaf, Hard of Hearing, or Deaf-Blind and in need of behavioral health services.
- Funding a statewide, culturally competent behavioral health provider will address this gap in services.
- The team will also provide the opportunity to train new behavioral health providers interested in serving Deaf, Hard of Hearing, and Deaf-Blind Wisconsinites.
Behavioral Health Technology Grants
Currently, only half of Wisconsin’s behavioral health providers use electronic health records. Electronic health records makes sharing of health records easier, which facilitates the integration of behavioral and physical health care.
Funding to help behavioral health providers implement electronic health records and connect to Wisconsin’s health information exchange will improve health care outcomes. We also anticipate changes to federal regulations concerning electronic health record adoption, and this investment will make meeting those future regulations easier.
Behavioral Health Treatment for People Involved in the Criminal Justice System
We manage programs and operate four direct care treatment facilities in Wisconsin that serve and support individuals with mental health and substance use disorder concerns who also have a history of criminal offense.
Despite adding treatment beds in recent years, there continues to be demand for more treatment capacity at Mendota. By increasing the number of beds and available staff at Mendota Mental Health Institute, individuals who are being treated to become competent to stand trial will spend less time in jail awaiting treatment.