Milwaukee County Mental Health System Redesign

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 stakeholders—and 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.

Press Coverage

• "These crisis centers can save lives. Why does Milwaukee only have two?"

• "New report outlines redesigned Milwaukee County psychiatric crisis services"