Héctor Colón, director of the Department of Health and Human Services, leads Milwaukee County’s efforts to improve a fragmented, complex mental healthcare system. (Photo by Matthew Wisla) For many central city residents suffering from mental illnesses such as depression, a diagnosis is just the beginning of a long journey to treatment and healing. According to a new report, the mental healthcare system run by Milwaukee County is complex, fragmented and fraught with barriers preventing or limiting access to care. “There is a shortage of mental healthcare providers serving low-income people on Medicaid and sometimes where there is capacity in the system it is not well used,” said Rob Henken, president of the Public Policy Forum, which recently published the report, “Milwaukee County Outpatient Behavioral Health Capacity Assessment,” in conjunction with the Human Services Research Institute and the Technical Assistance Collaborative. Mental healthcare providers such as Dr. Julie Schuller, executive vice president of clinical affairs at Sixteenth Street Community Health Center, 1032 S. Cesar E. Chavez Drive, say part of the problem with the current system is that it doesn’t locate services where people need them. “There needs to be more mental healthcare clinics out in communities,” she said. “Building access is a priority issue.” Under the current system, getting in to see a doctor can take a while. “Wait times, especially for people with urgent needs, are very disturbing,” said Barbara Beckert, director of the Milwaukee office of Disability Rights Wisconsin, an organization focusing on people with severe conditions that works with the state to advocate for patients. Do you have feedback on Milwaukee NNS's reporting? Take our survey to let us know how we're doing! The mental healthcare system is transitioning from county-run centralized institutions to a community-based model with services provided at clinics such at the Sixteenth Street Community Health Center in Clarke Square. (Photo by Matthew Wisla) The challenges typically begin when primary care physicians refer patients for mental healthcare and they are given a list of providers to call for an appointment, the report found. Researchers attempted to make an appointment with 249 organizations or individuals identified as mental healthcare providers. The list included clinics, psychiatrists, federally qualified health centers and private practice clinicians. After making at least three calls to each, researchers reached only 142, or 57 percent, of providers. The rest of the time calls were unanswered or messages were not returned. When appointments could be made, the average wait time was between 10 days and a month, with the longest being 75 days. Waits of approximately two months were not uncommon. David Hughes, vice president of the Human Services Research Institute, helped lead the recent study and has researched mental healthcare systems around the country. Comparing the situation here with other cities Hughes said, “It is challenging (in Milwaukee) to find a provider and then you’re faced with wait times that are reasonable but not ideal.” As Beckert pointed out, “It’s a pretty complex system to navigate, especially when you’re not feeling well.” There is a human cost as people search for a provider or wait to begin treatment. “The longer you delay, the more people suffer,” said Dr. Jon Lehrmann, chairman of the psychiatry and behavioral medicine department at the Medical College of Wisconsin and a member of the Milwaukee County Mental Health Board. According to Lehrmann and others, people navigating the system can become discouraged and give up on finding a provider. But getting treatment at the earliest possible time helps prevent conditions from worsening, which can result in people receiving short-term treatment in hospital emergency rooms. Without ongoing care the “emergency room treatment and release” cycle often repeats. The problem people face in finding providers may be based, at least in part, on a low acceptance rate of Medicaid payment among providers. Wisconsin has one of the lowest Medicaid reimbursement rates in the country, according to Hughes. The report found that despite a significant increase in Medicaid enrollment in 2014, Medicaid recipients used behavioral health outpatient services at about the same rate as in previous years. The providers with whom researchers were able to make appointments accepted Medicaid and were taking new patients. Those who did not respond may have been unwilling to accept Medicaid patients.