Rep. Sandy Pasch, a Democratic leader in the Wisconsin Assembly on health issues and expert practitioner in the mental health field, sounded the common-sense warning February 4. But the interviewer, she says, headlined her offhand political observation. Then the copy desk backed away from its first heavily politicized headline and then the whole story quickly disappeared from online prominence in the Milwaukee Journal Sentinel.
|Rep. Sandy Pasch has long advocated for|
statewide improvements in mental health.
While pointing out there are good things in the Milwaukee mental health “reform” bill that Gov. Scott Walker is pumping through the state legislature for instant passage in the next few weeks, Pasch was raising specific concerns about the contents of the bill itself – or the lack thereof. Inevitably that touched on Walker’s political purpose, facing re-election for governor in November as a building block for a presidential run in 2016. The side answer she gave to substantive questions quickly became the political centerpiece of the tale, she detailed in an interview. Pasch hadn’t intended to beat the political tree. She was just continuing her long-term advocacy for improvement in the entire state’s mental health operations -- and yes, as a Democrat in the minority, she was asking why the sudden haste on an issue where the GOP had long dragged its feet.
Why was Walker pushing so hard to impose a questionable Milwaukee-only solution on a long-range Wisconsin problem? She also asked: Wouldn’t citizens be better off weighing the pros and cons over a less aggressive time frame – say not in a vital election year for him? Isn't what is good for Milwaukee mental health good for the entire state --so why is so-called reform so narrowly drawn as to cut out politically influential Milwaukee county officials (in the other party)? Why only one out of 72 counties? Shouldn’t there be racial and income diversity on a non-elected board that decides policies and treatment methods?
When pressed, she speculated that it was an election year – and the JS broke out of the gate as if she had shot off a partisan gun. The implication that Walker had a desire to get mental health off the table -- before his November election -- became the centerpiece of the story. That twist may have deeply bothered Pasch, she told me, but it sure woke up the community.
The dust had barely settled when others pointed out that Pasch may have nailed the reason for speed. Walker, many are now realizing, is rushing through a bill that does little for patient outcomes but a great deal on the political front to quiet public outrage – something he needs to bolster his national credentials.
Milwaukee Supervisor Gerry Broderick, one of the veteran lions of the county’s legislative arm who has lived through such battles, on February 6 pinpointed why Walker’s sudden rhetorical embrace of rapid reform was not going to be trusted.
“(His) recent comments comparing Milwaukee County’s mental health system with a ‘natural disaster’ should remind us of the mental health plan he proposed as County Executive to house mental health programs at the old – and now razed – St. Michael Hospital,” noted Broderick. “That foolish idea cost the County a few years of delay in taking on sensible reforms of the system – a fact the major media have conveniently ignored in their criticisms of the Milwaukee County Board’s actions on the issue. “
Broderick has his facts right. While most of the deaths and failures discussed in the series took place during his watch, Walker as county executive didn’t respond to mental health as a crisis. So why now?
SERIES TOUCHING BUT TOO EAGER TO BLAME THE BOARD
In a major long-term series of JS articles movingly titled Chronic Crisis, the St. Michael death dance was not laid at Walker’s door, though it reflected the same sort of “house all the mentally ill” approach that current advocates for community involvement scorn. The series called, as portions of Walker's new bill seems to, for professional experts to be intricately involved. The JS series, humanely written, stirred the state community with the individual failures of a Milwaukee mental health system that has stumbled for more than 40 years.
Reading between the lines, though, much of the reasons for the delay fell on the citizens as well as the press and state and local elected officials far beyond the Milwaukee County Board. There was resistance to community involvement, the kneejerk fear of the mentally ill – those good old automatic days when the police were called in and expected to deal with any odd or antisocial behavior – and widespread neighborhood skepticism over less centralized warehousing of the mentally ill.
(As a reporter and editor back in those times, I recall seeing squads of police cars with citizens dragged from their homes lined up waiting for beds outside the Mental Health Complex – that, in sum, was the system. Having suffered through those times and having deep respect for some of the veteran former colleagues who wrote the series, I was glad to see the issue tackled in the Chronic Crisis series – until I realized that a few editors had badly warped the blame game, apparently for ideological motives.)
The series shortchanged the complexities of the opinions circling mental health needs for four decades, the adjusted research and behavioral examples over that time, the lack of agreement among experts advising public officials and the genuine reluctance of neighborhoods for local outreach housing or family living for many citizens facing mental health issues. The difference between those in need of hospitalization and those who could respond to therapy and medication was not much realized or addressed by the public at large.
As a point of history, the Milwaukee county executive’s office, going back even before Walker, got in the way of clear decisions or engaged in political appointees rather than medical expertise. The legislative wing, the County Board, was clearly pulled in several directions and, like most legislative debating societies, was crippled by conflicting opinions while the media pumped out horror stories that demanded action. So you can argue with Broderick’s statement that “the Board has consistently worked to improve the mental health system,” since whether that was the intent or not, conflicting movements paralyzed public officials too long.
As Pasch noted in an interview, “It is a good idea that other people than elected officials, people who have medical expertise, should be part of the process. But it is also important that a range of concerns, from race to income to experience with public health, be included, and it is not in the current bill. It was the substance that I was most concerned about, not a political ploy.”
But so far the bully pulpit for haste has belonged to Walker and his allies. The power of patients dying in custody or denied medication resonates with the public far more than complexities or changing medical and bureaucratic advice. A local press that can sell newspapers on suffering can color over such intricacies, noted several mental health experts (hardly left wingers, since many on the left are also demanding action without concern for process).
In general, these experts agree, failures cannot be laid upon the board or even the executive. They point to the pace of our democratic system, the complexities of such major institutional adjustments, the philosophical debates and, frankly, the resistance of the local communities to house marginal mental patients in their neighborhoods. The mentally ill badly needed advocates, and they were not there on all sides. But that’s not to say that action isn’t needed, they added.
The bill would give the governor enormous control of the future of the Milwaukee mental health system, and fewer brakes on County Executive Chris Abele’s financial authority. It does so by cutting out local input through the elected supervisors. Such a bill obviously wouldn’t fly in other counties where Republicans control elected local offices, and that “Milwaukee only” tendency in the state legislature clearly angers many Milwaukee officials.
NEGLECTED CONSERVATIVE FINDS NEW ROOST
Not surprisingly one of its main sponsors in the Assembly was an ineffectual conservative gadfly when he served on the county board – Joe Sanfelippo, a member of an influential and wealthy cab company whose profit methods were recently ruled unconstitutional in the city of Milwaukee, which is changing its taxi quota system set up with Sanfelippo’s help.
|Wealthy Joe Sanfelippo, now plaguing the board that didn't|
agree with him the job was part-time.
Though treated with respect, Sanfelippo couldn’t win his arguments in open debate at the county board, but now his money and influence in a GOP dominated legislature allow him to work around the local democratic representation of his former colleagues. The gadfly seems comfortably housed in a sympathetic nest.
Sanfelippo turned to state Sen. Leah Vukmir (R-Wauwatosa) to establish the basic concept of the bill -- a mental health board of 13 volunteers. They would by mandate be doctors, patients and advocates but so decreed and appointed by the governor to oversee funding and policies in Milwaukee County.
Pasch acknowledged that it has taken too long to address the mental health needs and system in Milwaukee County, but as a nurse who practiced and taught in this field, she suggests the problem is too important to become a political football, to neutralize mental health as a campaign issue by rushing a bill through. Her side comment became the lightning rod of press coverage, she noted.
Though it sounded like basic common sense, Sanfelippo criticized Pasch’s view as unjustified -- “way off base,” he told the press. In contrast, he said, letting Walker choose the 13 members and give them the authority, not the elected officials, over mental health and drug treatment would remove mental health from the political arena.
“You mean free of politics like WEDC?” snorted Broderick, referring to the Walker controlled commerce agency that has been riddled with corruption, fraud and disaster. He too wants experts involved but he noted how many Walker appointees are under indictment or in prison. “Somehow putting Walker in charge of appointees does not fill me with confidence,” said Broderick.
The bill would remove authority from the public through its elected representatives on the board, said Supervisor Peggy Romo West, the chair of the board’s Health and Human Needs Committee, which has been pushing County Executive Chris Abele to exercise more authority and enterprise in picking trained overseers.
Currently, the responsibility for running county mental health operations resides in the executive, noted Romo West. A board of mental health advocates, she added, would certainly be useful for advice but not necessarily to decide alone how to run a complex medical system.
The board’s chair, Marina Dimitrijevic, and Supervisor Jason Haas, chair of intergovernmental relations, also want county citizens to have a say in the matter, which might not be conducive to the Walker vision of speed. In a Feb. 5 letter to Sanfelippo and Vukmir, they urged a joint committee hearing on AB 718 in Milwaukee County “where the people impacted directly by the legislation live.” They noted that changes so complex and of such magnitude deserve the opinions of the citizens affected.
So far the only hearing discussed would be quite quick and brief in comments -- and take place in Madison.