Legislative committee studying whether to create long-term youth psychiatric care facilities » Urban Milwaukee

A study committee on Thursday reviewed proposals to create new long-term mental health facilities for youth, expand those that could initiate emergency detention and change consent requirements for minors over the age of 14.

Wisconsin kids sailed significant mental health challenges in recent years, and the state has been exploring ways to improve support. The Legislative Council Study Committee on Emergency Detention and Civil Employment of Juveniles, which includes four state lawmakers and other stakeholders, mental health providers, law enforcement, has been meeting since August to specifically focus on the current state of Wisconsin’s Emergency Detention and Civil Commitment Laws. as they applied to children.

Under state law, emergency detention is a process that allows law enforcement officers to initiate an emergency “detention” of up to 72 hours if they reasonably believe a person is unable or unwilling to cooperate with voluntary treatment. Civil commitment is the involuntary restriction of a person’s liberty through a civil proceeding, based on the fact that the person needs treatment or care for certain mental health problems, developmental disabilities, or substance abuse, to protect the person or others from harm .

The committee discussed six bills that would change the shape of current trials. The committee will meet again in December to further discuss priorities before voting on bills that should be considered by the Legislature.

“The idea here is really to roll up our sleeves and work together as a committee to turn these bills into something viable and that Joint Legislative Council feels comfortable being introduced in the next legislative session,” committee co-chair Sen. Jesse James (R-Altoona) said at the start of Thursday’s meeting.

One issue the committee has focused on is limiting the number of children with serious mental health problems who are sent out of state for care. right Wisconsin Department of Children and Familiesfrom 2019 to 2023 there were 517 children placed outside the state. Of these, 78 of them were placed out of state in 2023.

The committee discussed several versions of the bill that would help the problem by supporting the creation of psychiatric residential treatment facilities — or PRTFs — in Wisconsin. The Legislative Fiscal Office described them as long-term facilities that typically provide treatment for children diagnosed with psychiatric conditions, including bipolar disorder, disruptive behavior disorder, substance use disorder, severe emotional disturbance or post-traumatic stress disorder.

Wisconsin has three youth crisis stabilization facilities, but they are short-term facilities with a maximum of eight beds. Currently there are no PRTFs in the state.

James and Govt. Tony Evers both proposed initiatives to create the facilities in the last legislative session, but neither was successful.

The committee considered three variants of the projects that would allow the creation of the facilities. The first would allow the Department of Health Services (DHS) to certify facilities to provide inpatient psychiatric services for people under the age of 21. Another would require DHS to establish five of the facilities. The final measure allows DHS to certify facilities, limit the number of certifications it grants to operate a PRTF, and would require DHS to request $500,000 in each year of the 2027-29 biennium state budget to implement PRTF certification. Some specific numbers are placeholders and may change.

Committee members recognized the role that the cost of facilities could play in building them. Sharon McIlquhamassistant corporate counsel for Eau Claire Countysaid facilities should be mandated by law.

“If DHS is not required to do it, it’s not going to happen because I don’t know that those incentives are going to be enough for a private entity to take on the responsibility, the cost,” McIlquham said. “I understand there’s a huge budget impact, but … if we don’t need them, I don’t think it’s going to happen.”

“We don’t create things we can’t support,” Jill Chaffeesaid Wisconsin Lutheran Social Services vice president of community services. “A really big problem that we have is that you have a grant and yes, it’s very useful and appreciated to start a program, however, then you’re completely dependent on fee-for-service billing or different payers.”

Sen. LaTonya Johnson (D-Milwaukee) pointed out that securing state money could be the biggest obstacle to creating the facilities. Wisconsin expects to they have a budget surplus of 4 billion dollars through the end of the current fiscal year and will be a major talking point in next year’s budget-writing cycle, however, Republican leaders have warned that the money would not be used to increase the size of government.

“There is no money in the budget to specifically implement … and we all understand why. They should rely on Joint Finance putting these funds specifically for this cause, and as a member of Joint Finance I can honestly say that we don’t always do what we should be doing or we don’t appropriate some money on which we should do,” Johnson said. “They’re already operating on a shoestring budget, but because of this bill, if it were to pass, they would be forced to make do with that shoestring budget, and that puts other programs at risk.”

Johnson added that the program is needed, but without a set dollar amount and a guarantee that the money will be allocated, the proposal will face an uphill battle.

James agreed, saying he didn’t think any of their colleagues would support a mandate.

Modification of minor consent requirements

Another proposal would change the juvenile consent law when it comes to emergency detention.

Currently, state law requires that both a minor 14 years of age or older and the minor’s parent or guardian consent to outpatient or inpatient mental health treatment. If consent is withheld by the parent or child, the other party may seek review and approval of the treatment.

The proposal discussed by the committee would change that to say instead that either a minor 14 years of age or older, or a parent or guardian, can agree to outpatient or inpatient mental health treatment.

Green Bay Police Department behavioral health officer Sheila Carlson said the change should help solve the problem of parents having to go home with a child if they refuse treatment and have to file a petition.

“Once the child goes home, that’s when things start to get a little hairy, when parents are worried and not really sure what to do,” Carlson said.

deputy state public defender Katie York said she was concerned that not requiring consent could reduce the effectiveness of the treatment.

“If the statute says you don’t need the child’s consent, is that going to encourage practitioners to … not seek consent enough and that’s going to have a negative impact on treatment going forward? I would imagine if you can get buy-in from the kid, it’s going to be a lot more successful than, well, we don’t even need your consent, your parents have approved it,” York said. “I don’t know if that works in the real world.”

Expanding who could initiate minor emergency arrests

The committee also considered creating an alternative way to initiate emergency detention of a juvenile by allowing physicians and behavioral health practitioners to initiate emergency detention of a juvenile. Currently, only law enforcement officers are allowed to initiate the detention of an individual whom an officer believes to be “mentally ill, developmentally disabled or addicted to drugs” based on observable behavior that the individual is “dangerous” to themselves or for others and for a county department of the community. programs must approve the need for detention and the need for assessment, diagnosis and treatment.

The draft the committee reviewed would define clinicians as psychologist, psychiatrist, psychiatric nurse practitioner, physician, physician assistant, private practice school psychologist, marriage and family therapist, professional counselor, advanced practice social worker, independent social worker, social worker clinical. , substance abuse clinical counselor or independent clinical supervisor. It would also require a “clinician” to be in good standing and can initiate an emergency detention only if the clinician has been certified to do so by DHS.

McIlquham of Eau Claire County said the list included in the bill is too broad and expansive.

“You start small and you can always expand later,” McIlquham said.

Carlson of Green Bay, however, said she has been involved in many cases with children where the police aren’t necessarily needed.

Children “are not combative,” she said. “They’re just reluctant and scared and confused, and then you bring in a police officer and then there are combative components.”

Wisconsin Psychiatric Association chairman Tony Thrasher noted that some health systems may not allow employees to do so.

“I don’t think they will take responsibility. I don’t think they will agree to that. Now that about 93% of all doctors are employed by large health systems, I just don’t think they’ll let them do it. I think there’s a liability, once you start withholding them, that’s going to cause financial conflicts and placement conflicts, and if you’re allowed to withhold them, why can’t you treat them where they’re at? How can you have the power to detain them and then not care about them and ship them somewhere else?”

The committee also discussed a bill that would standardize the creation of a safety plan, which would be created by a juvenile with behavioral or emotional challenges and a facilitator, and then require DHS to develop and maintain a portal that is available statewide to facilitate the sharing of safety plans among safety plan partners.

The study committee is considering the creation of new mental health treatment facilities was originally published by the Wisconsin Examiner.