Psychiatric Crisis Redesign in Milwaukee County

Phase I Report

December 2018



For the past several months, the Forum has partnered with the Massachusetts-based Human Services Research Institute to facilitate a project aimed at redesigning the psychiatric crisis service system in Milwaukee County. The project stemmed from the impending outsourcing of Milwaukee County Behavioral Health Division (BHD) inpatient services and the anticipated closure of the county’s Mental Health Complex, including BHD’s psychiatric emergency department. It was steered by an Advisory Committee comprised of public and private sector behavioral health leaders and administrative representatives.

In our role as facilitator, we publish two reports – the Phase I adult behavioral health care delivery system conceptual plan developed by the committee and the “environmental scan” report that guided the planning effort. The child and adolescent psychiatric crisis system has yet to be fully evaluated.

Key consensus items, supported by both Milwaukee County and the private health systems leadership, are reflected by the conceptual plan and include:

  • To the maximum extent possible, psychiatric crisis treatment and resolution should occur “upstream.” The redesigned system will emphasize and invest in crisis prevention and resolution at earlier stages of a crisis, before more intensive, costly, and potentially restrictive interventions are required. Toward that end, substantial improvement and expansion of community-based resources like crisis resource centers, mobile crisis teams, crisis stabilization houses, and community-based access clinics is recommended, as well as the creation of enhanced crisis communications, navigation, and patient tracking systems.
  • A dedicated psychiatric emergency department still will be needed as part of the continuum of psychiatric crisis services. That facility is expected, however, to serve a much smaller number of persons than BHD’s current psychiatric emergency department and a narrower population limited largely to individuals on petitions and those who require highly specialized, intensive care for their complex needs. It is recommended that the future psychiatric emergency department be jointly managed and financed by BHD and the private health systems, while BHD will retain its Treatment Director role per state statute. Additional details regarding location, funding, governance, etc. still need to be determined.
  • An increase in private hospital emergency department service capabilities is also recommended, although better front-door triaging and back-door coordination should reduce private hospital ER admissions and lengths of stay and improve care continuity. Also, transporting individuals from the emergency department to a separate facility for evaluation will be avoided by successfully resolving more crises in the community.

The psychiatric crisis redesign planning effort was jointly commissioned and funded by Milwaukee County and the health system members of the Milwaukee Health Care Partnership.