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BHD Needs A Thorough Vetting

Posted by Chris Liebenthal on May 23, 2010

From Milwaukee County First:

On Friday, in his Executive Update, Scott Walker said that he had met with Barbara Beckert, the Director of Disability Rights – Wisconsin.  Walker went on to indicate he was ready to cooperate with DRW and the County Board in creating  a Community Advisory Panel for the Behavioral Health Division.

This is a sound idea and I am very glad to see that Walker is willing to do that much.  However, my pleasure was soon to turn sour.

Later that same day, Walker appeared at an event in downtown Milwaukee.  At this event, he showed that he still doesn’t get it:

Walker said he didn’t think a state audit was needed to look into problems at the Milwaukee County Mental Health Complex because the Milwaukee office of Disability Rights Wisconsin, a group designated under state law to protect patient rights, is conducting its own investigation of the complex. Walker said he met with Barbara Beckert, manager of the Milwaukee office and others on Friday.

This smells more and more like a cover up.

Last week, DRW issues a preliminary report that was pretty damning of the mental health system and raised many alarms on how bad it was there:

Patients at Milwaukee County’s Mental Health Complex are not kept safe from sexual predators, and comments by administrators and staff claiming otherwise reveal a disturbing indifference, says a watchdog group that has reviewed patient files.

Of 17 patients whose records were reviewed, 10 had improper sexual contact with other patients and five were sexually assaulted at the complex during the last half of 2009, according to a blistering report compiled by Disability Rights Wisconsin.

The advocacy group rushed early findings to print because of concerns over patient safety at the complex. A more detailed report from the group is expected this summer.


The 18-page report, titled “an update to the community,” lists five major areas of concern about the care at the Mental Health Complex. They include:

• Failure to keep patients safe, including inadequate physical exams and the lack of proper monitoring.

• The overuse of restraints.

• Failure to connect patients with services in the community once they are released.

• The lack of viable options for patients and their families to report complaints about the care.

• Inadequate monitoring by state inspectors.

Even as alarming as these findings are, that’s not the end of it.  Courtesy of the Milwaukee Journal Sentinel, we have access to the actual initial report by DRW (pdf), and what that contains is even more stunning as it finally sheds light on the secrets that Walker and his staff have been keeping from the public.

Besides fleshing out some of the problems listed in the paper’s article, it also shows that they were able to find so many alarming problems without receiving all of the necessary and requested information* from BHD administration:

Due to the delays we continue to experience in obtaining some of the necessary documents and contact information, and the resulting delay in requesting and conducting interviews, it will be some time before we can release a comprehensive analysis and final recommendations regarding the Acute Care Unit. However, because of the urgency of the concerns regarding safety and care at the Mental Health Complex, and requests from consumers, families, and policy makers, we are sharing this update to the community on our investigation, and our initial assessment of safety and treatment concerns, as well as some initial recommendations.

Now, I have had the opportunity to have professional contact with DRW in the past, and I have full confidence in their ability to do the project that they have undertaken fully and completely.

That said, there are two immediate reasons why the state should do their own audit as well.

The report from DRW points out the first reason (emphasis mine):

We raise these concerns and questions not as clinicians, but as advocates for people with mental illness who believe our community can and must do more to address patient safety and quality of treatment, to engage patients as true partners in their care, and to link them with the community supports and services which will enable them to maintain their health and well-being in the community. We are committed to working in partnership with Milwaukee County, the state, consumers and families, and other stakeholders to address these concerns and work together to implement recommendations and ensure better outcomes for people with mental illness in our community.

What my concern is that the focus will be all on patient safety and nothing towards the staff.  I am not faulting DRW for this in any way, because staff safety is not their primary concern. 

However, and I am sure that the staff at DRW would agree, there needs to be equal attention paid to both patient safety as well as the safety of the workers.  Remember that just a couple of years ago, it was reported that there was a 50% jump in assaults on staff.  The problem was directly related to a shortage of staff due to Walker’s continuous budget cuts as well as the lack of a secure ward for the most violent patients.

The problem with staffing shortages continue to this day.  And remember it was Milwaukee County First that first broke the news that Walker had a chance to put in a secure ward years ago, but rejected that opportunity to prevent the abuse and neglect that the patients have suffered since then.

The other problem with the work being done by the DRW is the limit of its scope.  Their study is strictly focused on the acute care wards.  However, there are two different long-term rehabilitation centers (one for the chronically mentally ill and one for people with developmental disabilities) as well as the Psych Crisis/Observation Unit.  It would make sense that if BHD policy and/or staffing shortages are causing these many problems on just the acute wards, there very well may be similar issues on the other care units at BHD as well.

Given the issues cited above, Milwaukee County First would recommend the following:

  • Disability Rights – Wisconsin be asked to expand their investigation into the other parts of BHD to make sure all of the patients are being protected, regardless of what type of unit they are on.
  • The state complete a full audit, keeping an eye on not only whether patients are being kept safe, but with a clinician’s assessment on whether the current policies and staffing levels are appropriate to keep patients and staff alike as safe as possible.
  • A study on whether a secure ward is clinically appropriate and implementation of said unit if it is found to be so.

The above studies and any recommended actions should take place immediately before more people are put in harm’s way.

MCF would further recommend that a study be done, perhaps by the University of Wisconsin – Milwaukee, on whether the number of psychiatric beds available in Milwaukee County are sufficient to meet the needs of the community.  Given the number of reports of mentally ill people hurting and/or killing themselves and/or others, I have to believe that there are not enough beds to meet the current needs.

*Depending on the reason for the delay in providing the necessary information, or for clamping down on information regardless of who is asking the questions, could be in violation of county ordinances.  Chapter 56.24 of the County Code of General Ordinances deals specifically with the County’s Anti-Secrecy Policy and reads, in part:

(3)   Implementation.  It is ordered that all boards, commissions and department heads do all things reasonably possible to recognize the foregoing purpose and policy, and to take appropriate steps to comply not only with the technical terms of the state open meeting and public record laws (s. 19.8 et seq., Wis. Stats.), but do everything reasonably possible to comply with the spirit of such laws.


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