Milwaukee County Mental Health System Redesign

Opportunity

To help Milwaukee County address a pressing need for a solution to systemic problems, we worked with partners at the Public Policy Forum and the Technical Assistance Collaborative to quickly assess the county’s adult mental health needs, service capacity and financing, and service utilization—and developed detailed, actionable recommendations for system reform.

Approach

Designing a modern mental health system

Facing challenges with mental health care service delivery and financing, public and private stakeholders in Milwaukee County initiated a comprehensive effort to redesign the county’s service system. In October 2008 the Milwaukee Health Care Partnership, the Medical Society of Milwaukee County, and the Milwaukee County Behavioral Health Division engaged HSRI in a multiphase project toward this end.

First, we worked with constituents—with a local expert, the Public Policy Forum, and our frequent research partner the Technical Assistance Collaborative—to clarify the goals for the redesign. We convened a group of representatives from consumer and advocacy communities, as well as mental health providers, system administrators, county and state officials, and individuals representing private health care organizations.

Next, we used a data-driven approach to examine services needed and received and the reasons for any gaps. We also examined access to and quality of services, along with outcomes. To do this, we:

• Developed and conducted surveys with case managers, consumers, physicians, and system administrators
• Conducted interviews with diverse stakeholders
• Analyzed county- and state-level Medicaid and administrative data

The results

Based on our findings, we recommended the County:

• Downsize and redistribute inpatient capacity
• Involve private health systems in a more active role
• Reorganize crisis services
• Reduce emergency detentions
• Expand and reorganize community-based services
• Enhance housing supports
• Enhance quality assessment and improvement programs

In the years following the study, the County worked to implement many of the recommendations, producing a report on the progress.

Projecting future service capacity needs

As a continuation of the project, in 2014 the county commissioned HSRI to conduct a detailed analysis of inpatient and outpatient behavioral health service capacity.

We analyzed monthly inpatient admissions data from public and private hospitals and cross-county utilization data from the Wisconsin Hospital Association and used a utilization-based formula to estimate the number of inpatient beds needed in the current system. We also projected future inpatient bed need, taking into consideration the system changes under way.

To identify barriers that service-seekers might encounter, we also conducted a “secret shopper” study with Medicaid HMOs and other providers, evaluating response rates and wait times for appointments for a first-appointment request.

Impact

Following our study and between the years 2010 and 2014, the Milwaukee County Behavioral Health Division experienced a 23% reduction in the utilization of psychiatric crisis services and a 30% decrease in admissions to its adult inpatient units.

As a result, and in line with our recommendations, the county reduced the number of inpatient beds in its mental health complex (including the closure of entire units) to shift resources to less restrictive settings and community-based services.

Related reports

• Milwaukee County Psychiatric Crisis Service Redesign: Environmental Scan, December 2018
• Milwaukee County Psychiatric Crisis Service Redesign: Phase 1 Adult Services Planning Summary, December 2018
• Milwaukee County Psychiatric Crisis Service Redesign: Outpatient Behavioral Health Capacity Assessment, October 2015
• Milwaukee County Psychiatric Crisis Service Redesign: Transforming the Adult Mental Health Care Delivery System, October 2010