Monday, July 22, 2013

Silent No More

Last Wednesday, the Milwaukee County Board's Health and Human Needs Committee held a meeting. It was already going to be a lengthier meeting with ten items to take up. Furthering to the length, a few of the items were rather controversial and needed a lot of discussion.

One of the lengthier topics was the closing of one of the county's two crisis respite centers. The executive director of Community Advocates, Joe Volk, had some choice words to say about it. His agency is the one that had been running the center:
The director of a now-closed Crisis Resource Center on Milwaukee's north side blasted county officials Wednesday for ending the agency's contract for a program meant to divert patients from the Mental Health Complex.

Joe Volk, executive director of Community Advocates, said his program had succeeded in caring for its clients but failed to accomplish all the bureaucratic requirements.

Based on the county's action to terminate the Community Advocates' $850,000 contract, "you'd think we had sexual assaults and patients with broken necks," Volk said. "And that we might even have people beating each other up many, many times."

The remark was a sarcastic reference to problems that have been noted by state and federal inspectors at the county's inpatient programs at the complex.

"The reality is we had none of that," Volk said at a meeting of the County Board's Health and Human Needs Committee. He said county officials wanted the Crisis Resource Center to be operated like a miniature version of the Mental Health Complex. Community Advocates instead offered "cutting edge service" that was praised by clients, Volk said.
The skinny on this is that Milwaukee County Emperor Chris Abele kept changing the conditions of the contract in order to have a reason to fire Community Advocates and give the contract to the Milwaukee Center for Independence, who has been getting an inordinately large percentage of the county's business. It's been reported that this one issue took up almost two hours as Volk got into a give and take with Abele's staffers.

The saddest part is that, due to Act 14 - the Plutocracy Law, there wasn't anything the Board could do. But at least it's now on record that Abele's power grab wasn't about efficiency or best practice, but on favoritism and cronyism.

The other big topic was the closure of the mental health complex.

Emperor Abele is in a hurry to close the mental health complex so that he can sell the land that the complex sits on to his land developer friends in the Greater Milwaukee Commission before the value of the land climbs any higher.

In order to force the moving of the patients of the complex out into the community, Abele is promising that there will be a ton of community services to help them, even though he knows better.  As mentioned above, he is forcing a respite crisis home to close.  He's also cut services for a whole group of people getting help at the ACCESS Clinic.

Furthermore, there are not facilities that have sufficient resources to keep the patients of the complex or other safe.  And if there is a facility that would be able to keep everyone safe, the cost of such services is much more than Family Care is willing to pay.

This all came to light during the meeting. The following is a prepared report which was presented to the committee by Dave Eisner of AFSCME District Council 48, which represents many of the staff at the mental health complex:
The proposed 2014 Departmental Budget of BHD has now been released. Plans are to place 24 clients from Rehab Center-Central into community-based settings by July 1, 2014. The Center for Independence and Development (formerly Hilltop) is expected to close in 2014 by placing all of its 48 residents in community based settings by November 1, 2014.

As of June 12, 2013, the Center for Independence and Development (formerly Hilltop) has placed 8 clients into community based settings. 2 of these clients have returned to BHD, 1 back to CIDS and 1 to Acute Care. The 2013 Adopted Budget called for 12 clients to be placed into the community by April 1, 2013 and an additional 12 clients to be placed by July 1, 2013 from the Center for Independence and Development. So out of the goal of 24 client placements by July 1, 2013, six (6) have been placed.

It has been observed and reported that Rehab Central patients who have been placed into the community are returning to BHD through the Psych Emergency (PCS) and are ending up in Acute Care. That raises the question as to how those placements are then counted?

The apparent lack of success in placements into community settings and the limited amount of placements does not bode well for BHD's optimistic plans in their 2014 Budget request.

It has been reported to us that there is a severe shortage of proper group homes and appropriate facilities to send residents to, in the community, contrary to what Administration has been reporting. Many of the residents are scared. The majority of them have no family support.

We are hearing that Long-Term placements where clients have been inpatients at BHD for decades are having problems. There are supposed to be visits and transition done over a period of time to be able to acclimate the clients to a community setting and to community staff. This is not occurring and clients are just being placed. This uncertainty has heightened some of the clients behaviors and is causing them much anxiety.

We are hearing that Guardians are upset also. Because this is being approached as a closure and not a downsizing, the Guardians have no choice in the placement of their wards.

All of this information has been reported to us by staff who work at BHD.

While it is recognized that reforms are needed at BHD, we strongly urge you as policymakers for Milwaukee County to thoughtfully review all aspects of this plan, and to proceed with an approach that provides high quality care, treatment, and safety for all patients, includes Guardians and front-line staff at BHD in the discussion, and that whatever is ultimately decided should be done in a cautious manner with achievable results.
It should be noted that the only issue that Abele's people argued out of all of these statements was the number of patients returning to BHD or being shuffled around. Supervisor Peggy Romo West, Chairwoman of the Committee, quickly shut that down, stating that she had received independent emails from different people saying similar things. She said that it's not clear what it was yet, but something negative was happening at the complex.

There was no denial that patients were being placed recklessly or that there was a severe shortage of available facilities and resources to meet the needs of these vulnerable adults.

Yet this is what Abele wants to do to these poor people.

The reason these facts are significant is that in his lust for austerity, Abele is cutting the number of staff for BHD in his 2014 budget, working on the false presumption that enough people will be safely placed in the community so he can go about laying off workers.  But he's as close to his goal of people out as his hero Scott Walker is at creating jobs.  And without enough workers to care for the people who have not moved out or have returned, there will be an increase in mandated overtime, which is already mind-boggling huge.  And as it  has been repeatedly shown throughout the years, this increase in mandatory overtime can cause all sorts of problems, including an increase in attacks by patients, an increase in people being hurt and mistakes being made which can have grave consequences.

One of the main reasons for this happening is that as Abele made his grandiose plans to shut down the complex, the group commissioned to plan and implement this closure consisted mostly of Abele's administration and the profiteers who just wanted to feed on a new trough of cash.  One of the groups most noticeable by their absence were the workers, the front line people that do this work day in and day out and knows what will work and what won't, regardless of the results of all of the studies Abele and GMC commission the Public Policy Forum to do to get their desired results.

In response to this neglectful omission, the leadership of Local 170, which represents the caregivers at the complex, had gathered 116 signatures - and not just from their local, but others as well, including nurses and non-union members - in just a few days, asking the Board to come to BHD and see how things really are for themselves and to listen to the workers.

The following is a prepared statement from the officers of Local 170:
Local 170 represents over 200 front-line caregivers who provide care for our community's most vulnerable citizens.

Working conditions at BHD are difficult. State and Federal Surveyors are constantly in the buildings and BHD is attempting to become accredited. The former Administrator [Kathleen Eilers - who had just been rejected by the County Board for her poor performance] put out a memo last month threatening to discipline staff as a result of State findings. The same Administrator at Town Hall Meetings advised staff that the closure was a done deal and if they didn't like it to find other jobs. Many staff took her up on it and left. This has resulted in staff shortages and mandatory overtime/double shifts. A private concern has been hired to provide a Nursing Pool for Rehab Central. There are 19 vacant part-time CNA positions that are not being filled that could offer some relief. Morale is low.

Quality care is a challenge under these conditions created by Administration. Closure and placing our patients into community care is being planned by the County Executive and he has brought many people into the process, but the front-line caregivers have been left out. Too much is at stake in our community. The workers have decided that they will be silent no more.

Many wanted to be here today, but because of staff shortages and Mandatory overtime were unable to attend. We are submitting a petition signed by 116 of our co-workers requesting this Committee schedule listening sessions at BHD to hear the employees concerns. Thank you.
It is my understanding that Supervisors Russell Stamper and David Bowen have tentatively agreed to hold these meetings to find out what is really going on at BHD instead of relying on the dishonest Abele for their information.  The only thing Abele wants from the workers is their signature on a pink slip.

What really brings this all home is the fact that Meg Kissinger of the Milwaukee Journal Sentinel just came out with a four-part article regarding the struggles one family is having with the inadequate community-based support system that Abele is trying to tell people is all we need. Adding to the irony of the timing is the fact that the case manager in the story is from Milwaukee Center for Independence, the same agency that Abele is contracting with for the majority of services.

The end game of all of this is that if Abele continues on his amoral, irresponsible course, there will be hundreds, if not thousands, of people in the community receiving inadequate services, and presenting a danger to themselves or to others. After several contacts with police and various psychiatric service agencies, many of these people will end up in jail, in prison, in state institutions or, worst of all, dead.  These are prices in both the human and the fiscal sense that we should not have to take on, especially when it is all for the money grubbing of some of Abele's closest cronies.


  1. shame on all these politicans and administraters. The last time they closedNorth division they sent all the guys to the rescue mission. I know because I worked as an AODA counselor on 4th and Brown and we would get visits from these guys for free coffee. with their little bag lunchs. Its always on the backsof the most vunerable. Lots of those guys froze to death that first winter. We going to do that again?

  2. After many years working in mental health I am so severely traumatized that I have to leave. It will only get worse in both private hospitals and residential based facilities. The state has reduced open beds to save money resulting in dangerous individuals cycling through county and private units until there is a bed open, and then they only keep them for 3-4 days unless they are urinating on staff or throwing feces, so low functioning and violent they require near constant restraints, that kind of thing. The staff in County and private inpatient units are subjected to physical assaults nearly daily. The first time I was attacked for saying hello to a teen girl I was encouraged to not report it to the police. I was new and young then believing it wasn't a crime if they were being treated for mental illness. The verbal threats, disrespect, taunting and all that jazz toughens you up enough that you learn to not pay it much mind. You see men and women who have sexually assaulted children although chances are it was never reported by the victim and because of HIPAA laws and the no proof of immediate threat to others (say no kids in the home) you can't report it to anyone in law enforcement. You also meet teens and kids who have sexually assaulted other kids and teens, more often due to their own sexual assault as a child. You meet the barely no longer toddlers who are oversexualized because their mom traded sexual favors with the child for crack or meth. You also meet the children who've been so severely neglected physically and emotionally that they attach to you nearly immediately. You meet the teen girl who was the product of a gang rape, whose mother reminds her of this dark reality every day, and this was her 6th or 7th suicide attempt and her mother has subjected her to DNA tests as well as threats to move while she's in the hospital because mom is sick of dealing with these attempts that have gone on since 8 years-old. You meet the man who reminds you of Charles Manson who has nearly lived on inpatient units since diagnosed with schizophrenia as a teen, he's been violent in the past so the instructions are to basically give him what he wants because he has severely hurt staff Kb the past, he returns because he refused to take his meds. This tiny snippet of the thousands of clients I have personally helped care for doesn't paint the grim reality adequately.

  3. (cont)
    Most of them are wonderful people caught up in awful circumstances as PTSD can be implicated in nearly 96% of all admits and none have been in combat. Although they do live in a warzone of poverty being the most common denominator in this county. The sad thing is the system for these clients is already so badly broken. Staff are not only mistreated by some of the clients, it is worse by hospital administrators who haven't worked a day in mental health in their lives on the floor. Staff are also subject to the lateral violence that comes with poor working conditions, poor compensation, and constant overtime. These individuals that are chronically acutely ill will be in our backyards, city parks, and they will overcrowd our jail. I could go on for days the potential disaster closing MCMH will be, but I've already taken up so much space. With that I will say, the dark angry cynic in me wonders if concealed carry was implemented before all of this was hoisted on an unsuspecting public, with even the Sheriff of Milwaukee County telling us to arm ourselves because it is a matter of time once MCMH closes until someone in a psychotic state either shoots up a clinic, store, or Psych hospital. Perhaps this was the purpose of CC to "take care of" the mentally ill. One area facility has no security either, by design to reduce the temptation to get violent or be triggered by the uniform is what I was told when I heard those working conditions. Some nurse who cannot arm herself inside will likely get shot in the face first and the rush to evacuate before more die will be on the nightly news. I opened the comment stating after all these years I am leaving, I have to for my sanity. Those admitted are getting sicker, I am terrified of the reality of who will be let out of the facilities with scant resources. Thank you for allowing me to take up so much of your space, I hope citizens will get as angry and fearful as I.