People in mental health crisis now could get cuffed and taken far from home. This bill could change that.
Natalie Eilbert
Being handcuffed and put into a patrol car for what could be an hours-long trip to Winnebago Mental Health Institute would distress just about anyone, but it's one of the few options available for Wisconsinites experiencing a severe mental health crisis.
That's because under the current emergency detention process, a patient is taken either there or an emergency room to be evaluated and admitted. But going to an emergency room for a severe mental health crisis is no guarantee the patient will receive local care.
The patient can still be transferred to another private facility or Winnebago by law enforcement if the emergency room doesn't have the space for overnight admission, according to HJ Waukau, legislative director for Wisconsin Department of Public Health, who wrote a testimony for information only to the Senate Committee on Mental Health, Substance Abuse Prevention, Children and Families last fall.
A new bill would establish additional regional crisis urgent care and observation centers, replicating what is available at Winnebago so that patients can be treated closer to home.
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The bill also relieves law enforcement officers who are tasked with handcuffing and driving patients to Winnebago Mental Health Institute.
State Sen. Howard Marklein, R-Spring Green, and Rep. Clint Moses, R-Menominee, who introduced the bill, both said police officers responsible for these trips end up spending hours or entire days driving to and from Oshkosh, an expensive process that also takes officers out of the communities they serve.
"Law enforcement officers have shared tales of 10-hour processes to safely transport individuals to WMHI, requiring hospital clearance before the journey, often with the individual handcuffed in a squad car's back seat," Moses said last fall at the Senate Committee on Mental Health, Substance Abuse Prevention, Children and Families.
Here's what to know about this bill and other bills related to mental health in Wisconsin being discussed on the Assembly and Senate floors this session.
Why do so many patients end up at Winnebago Mental Health Institute, even if they don't live near Oshkosh?
"Because there's basically no other place to send them" Marklein said. "If you're in a mental health crisis, there's not any action for that person and I don't know where else law enforcement would take them."
Winnebago Mental Health Institute is considered a safety-net provider by DHS, meaning it must accept all referrals under Chapter 51 emergency detention once the patient's county of residence authorizes the admission.
Patients experiencing severe mental health crises sometimes have limited access to psychiatrists and behavioral health providers in emergency rooms. It may take hours of sitting in a waiting room before someone in crisis is seen, which could make their condition worse.
If a hospital determines a patient's conditions merit admission, the hospital needs to find a bed for them at a local psychiatric hospital. A patient is sent to Winnebago by law enforcement if the local hospital lacks beds.
Other times, people experiencing a mental health crisis are taken to jail and booked. The only recourse after that is moving them to Winnebago.
"Transfer by law enforcement can exacerbate a person’s mental health crisis as they are handcuffed and placed in the back of police vehicle for what can be a long and arduous trip," Waukau wrote to the Senate Committee. "This process is harmful and dangerous for both the individual in crisis and law enforcement personnel and does not adhere to best practices for crisis intervention."
Why do police get involved when someone is having a severe mental health crisis?
Involuntary detention occurs when a person who is mentally ill, drug dependent or developmentally disabled meets one of the statutory standards of dangerousness to themselves or others. If a person is fit for treatment but refuses, that's when law enforcement or crisis responders deem it necessary to initiate a process for involuntary detention.
Under a Chapter 51 emergency detention, law enforcement must accompany any involuntarily detained person for the entire process, from the hospital emergency department to Winnebago.
Does Winnebago Mental Health Institute have the capacity to admit Wisconsinites in crisis?
While Winnebago Mental Health Institute has highly trained staff and robust resources, the surge in mental health crises has presented capacity issues.
Since 2019, the facility has seen a 10.5% year-over-year increase in emergency detentions. Put another way, the number of emergency detentions in 2022 was more than 30% higher than in 2019, according to data from DHS.
And although the number of emergency detentions dropped from 3,089 in 2022 to 2,912 in 2023, these numbers are still higher than they were pre-pandemic, according to DHS.
Routinely, its admissions exceed staffed bed capacity. As a result, the facility has had to raise compensation rates for critical staff, hire contracted staff and figure out new strategies to limit overtime, which some staff members are forced to take.
"While WMHI has been able to address the current needs of Wisconsin’s patients, hospitals, counties, and law enforcement, the current situation is not sustainable long-term and requires innovative solutions," Waukau wrote to the Senate Committee.
Who is going to Winnebago Mental Health Institute?
The lions share of Winnebago Mental Health Institute's emergency detentions comes from northeast Wisconsin, but numerous residents outside the northeast region are being sent to Winnebago each year.
Here's how many patients ended up at Winnebago Mental Health Institute as a result of emergency detentions in 2022, by Wisconsin region:
- Northeastern: 940
- Northern: 236
- Southeastern: 808
- Southern: 744
- Western: 361
Where would the other facilities be located?
The facilities would be spread across DHS' five regions: northern, northeastern, southeastern, southern, and western.
It isn't clear at this point what specific cities they would be located in.
When will we know more about this bill?
During the Assembly Floor session Feb. 20, lawmakers passed an amendment to the bill. Marklein said the bill will make its way to the Senate Floor session in March.
The bill, Marklein said, has "incredible bipartisan" support, which includes 50 co-sponsors.
Other mental health-related bills being considered this session
Assembly and Senate Floor sessions began Feb. 20 and will continue for the coming weeks. Here are other bills involving mental health currently being considered in Wisconsin Legislature:
- Assembly leaders on Wednesday morning passed a bill to exempt xylazine testing strips from being considered drug paraphernalia, in the same way that Wisconsin, not long ago, legalized fentanyl testing strips. Xylazine, known by its street name "tranq," is a powerful sedative used on large animals like cows and horses that, in humans, prolongs the euphoria associated with fentanyl, cocaine and methamphetamines. It's not possible to reverse its overdose effects through drugs like Narcan. And, if that weren't enough, one of the tell-tale marks of taking tranq is rotted flesh, or necrosis, around the injection area, which increases the likelihood of amputation.
- Assembly leaders passed a bill Tuesday that would create a rural pharmacy practice grant program, incentivizing recent pharmacy graduates to practice in rural, often underserved communities. Administered by the Higher Educational Aids Board, 10 eligible pharmacists a year may be provided up to $30,000 annually in financial assistance for up to three years when they move to a rural area. This would give rural residents better access to doctoral-trained experts in medication management. With opioid addiction especially plaguing rural areas, more pharmacists means being able to administer injectable medicines used in opioid use disorder.
- Assembly leaders passed a bill Tuesday that would move unhoused people illegally camping on the streets to structured, sanctioned areas of public land, far removed from dense commercial and residential areas. Many agencies who work with the unhoused opposed the bill, stating it would create additional barriers to care, further criminalize a population already subjugated and disenfranchised, and most importantly, exacerbate the challenges of someone finding work, mental health and substance use disorder treatment, and a permanent home. Temporary residence at the camping structure requires people to complete mental health and substance use evaluations, another point of contention with the bill. More than 20% of all people experiencing homelessness have a severe mental illness, according to the U.S. Department of Housing and Urban Development's 2023 homelessness report.
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Natalie Eilbert covers mental health issues for USA TODAY NETWORK-Wisconsin. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her Twitter profile at @natalie_eilbert. If you or someone you know is dealing with suicidal thoughts, call the National Suicide Prevention Lifeline at 988 or text "Hopeline" to the National Crisis Text Line at 741-741.