Mental Health Complex cited for restraint use
State officials cited the Milwaukee County Mental Health Complex in August for excessive use of physical restraints on children and adolescents in acute care and ordered immediate action to reduce that practice, the Legislative Audit Bureau says in a report released Tuesday.
The county Behavioral Health Division reported using physical restraints on children and adolescents at the institution 19.3 times longer than the national average, and on adults 6 times longer than the national average, the audit report says.
The national average for children in acute mental health care is 0.27 hours in physical restraints per 1,000 hours of inpatient care, according to the national Centers for Medicare and Medicaid Services. Youths in the county institution were physically restrained an average of 5.2 hours per 1,000 hours of inpatient care.
The national average for adults is 1.2 hours in physical restraints per 1,000 hours of inpatient care. Adults at the Mental Health Complex were physically restrained an average of 7.2 hours per 1,000 hours of inpatient care, according to the audit.
Behavioral Health Division officials at the time of the August inspection said they would discontinue use of ambulatory restraints — in which a patient can walk but arms are cuffed to the waist — to comply with the citation, county officials said Tuesday.
While other types of physical restraints may still be used at the acute care institution, Behavioral Health Division officials told state inspectors that they would enhance staff training on the need for restraints and more closely monitor their use.
In other findings, the audit report says the Behavioral Health Division and its oversight board failed to set performance standards for all private contractors providing community-based care as of 2015 even though the division approved such deals with hundreds of vendors to provide the services.
Spending by the county’s Behavioral Health Division increased 1.3% from 2014 to 2015, up to $173.5 million, as the division reduced institutional care and increased mental health services in less restrictive, community-based programs, the audit report says.
“We found that BHD’s contracts for community-based mental health services do not generally contain provisions for assessing vendor performance, describing what constitutes acceptable performance, or delineating what actions the Behavioral Health Division may take in instances of inadequate performance,” the audit report says.
Milwaukee County Executive Chris Abele said Tuesday he was surprised by the finding that not all contracts with program vendors included performance standards. Many of the community-based mental health programs are funded with federal and state grants that require specific performance measures, according to Abele.
Even so, Abele said he welcomed outside scrutiny of the programs by state auditors. He described the report as “a useful tool that we can use to improve what we’ve done.”
Abele said he will ask state auditors to meet with the Mental Health Board and Behavioral Health Division administrators to review the Audit Bureau’s findings and recommendations for changes in administering the programs, and progress already made in implementing many of the recommendations.
State auditors asked the Behavioral Health Division to provide a progress report by June 1, 2017.
Officials in Abele’s administration confirmed Tuesday that the changes implemented this year include modifications to certain mental health service contracts that establish specific performance-based standards, beyond grant requirements, and mandatory annual assessments of each vendor’s work.
Planning to move long-term care patients out of the Mental Health Complex and into the community began in 2012. There were five patient deaths at the Mental Health Complex that year. In 2011 and 2012, there were 19 reported patient sexual assaults.
The county’s institutional approach to mental health care trapped patients in a cycle of emergency care, as chronicled by the Journal Sentinel’s investigative reports.
In February 2013, Abele set a threeyear deadline for moving all patients out of the county’s long-term care units at the Mental Health Complex.
The complex closed both of its longterm care wards for patients with chronic mental illnesses by January 2016. Residents had been moved out of the institution and into group homes in nearby communities.
The county continues to provide emergency and acute care for people with mental illness at the institution on Watertown Plank Road, but the Mental Health Board plans to close the complex in 2018 or later. The board is searching for a private company to provide those services.