Wisconsin nurses campaign to protect patients with mental illness

Mental health can be a fragile thing, and the health professionals who work with the mentally ill know that for some people mental health is illusive and sometimes lost forever. It is those people for whom the nurses at the Milwaukee County Mental Health complex are working.

Milwaukee County Mental Health, whose nurses are members of the Wisconsin Federation of Nurses and Health Professionals, is a place of respite and healing for many types of people suffering from both temporary and permanent mental disabilities. The facility has units for teenage girls, teenage boys, the elderly and for those who've fallen victim to alcohol and drug abuse. It is also a residential facility that has become home for many. Some of MCMH's long-term care patients have been there 40 to 50 years, says WFNHP member Bobby Staples, who has worked there for 21 years.

Unfortunately, the facility is downsizing--it's beginning to close units as it follows the county's master plan to deinstitutionalize its long-term patients. Staples says the thinking is that the mentally ill would benefit from being placed in community surroundings where, with the proper assistance and supervision, they could become more productive citizens and lead fuller, more satisfying lives. "I can't disagree, because there are some who are able to" go into community settings, but some who are not, says Staples. The resident patients who are scheduled for release have a very high likelihood of returning, she notes.

"The patients we're working with now are the ones who've been [discharged to the community] multiple times and it's hard to find placements for them," says Staples. "They have longstanding histories." Some have left before, only to return.

The problems are many for the perennially troubled who are discharged into the community, says MCMH local union chapter leader Barbara Kelsey. The state-run mental health facilities are closing down. "The problem is... where do these people go? There's reluctance in the community to have people with mental illness housed next door. And there's the problem of health care worker shortages: there aren't the community resources out there to adequately provide for the needs [of the mentally ill]." Or, says Kelsey, the resources that were once there to serve those released into the community are drying up. Two mental health facilities that served the community recently closed, disappearing overnight, she noted.

"So it becomes a difficult situation to move those who can be [moved] into the community and have the problem of people not wanting them next door. And what if no one provides the services?"

The other problem, as Staples has noted, says Kelsey, is that some of the patients now in county facilities have gone into the community before, only to find community support and appropriate services insufficient or nonexistent and, because of that, have returned.

Those who get recycled through the mental health system sometimes get recycled yet again through the criminal justice system, says Staples. "They don't have doctors or nurses to deal with them there." And then how will they get the services that will help them function to the best of their ability, she wonders. Those who find their way back to MCMH find overcrowding.

The long-term care unit on which Staples works, which is called the Institute for the Mentally Diseased (IMD), has four units, notes Staples. The MCMH is working on closing down one of those units by June 1. That will mean some 24 long-term residents will be released with no indication of where they will go, says Kelsey. The Child Adolescent Treatment Center has already downsized, and, she adds, they're contracting out with different facilities.

Enough is enough

"We're on a campaign to say enough is enough," says Kelsey. "Until there are resources available in the community to take care of these patients, they need to remain here. As money has been moved out of inpatient services and into the community, they have basically decreased staffing levels to where the patients that are housed are very volatile.

"As some of the structures in the community have failed, [patients] have recycled back in, so there is an over-census. There are three patients crammed in two-patient rooms." For the patients who pace, a jammed room becomes a problem. And, because of their illness, some patients think all the possessions in the room are theirs and start fighting because of the close proximity, says Kelsey.

The MCMH is even beginning to mix the types of patients coming in the door, because the MCMH is the only facility required to take "emergency detentions" and they're placed wherever a bed is available. That could mean a young, aggressive male with bipolar disorder, pacing up and down the units where there are elderly, says Kelsey. Management is not doing anything to ease that burden and is ignoring patient needs, says Kelsey.

So, as patient advocates, the WFNHP members have embarked on a campaign to protect patients and provide quality inpatient care until they can be assured of decent and appropriate community placements that won't disappear overnight.

The nurses are wearing buttons that call for an end to downsizing, and they've met with the mental health director to convince her to open units. They also are circulating petitions that insist that the downsizing and overcrowding be stopped, that units be opened until community placements are arranged and assured and that security be stepped up for the MCMH workers who have to face a crowded facility while dealing with mandatory placements who are often declared unsafe.

The WFNHP members will probably also meet with the county board and with the doctors to see what kind of support they can offer, says Kelsey. They will also meet with the union representing the LPNs, attendants and maintenance workers at the facility to see if there's some common ground that they can work on together.

"We believe the MCMH should stay open and we should become the best resource center around," says Kelsey. "We have a great staff and can do a really good job taking care of the needs of the mentally ill. We could become like a center with innovations if we had somebody who was willing to take on that challenge." And that, says Kelsey, is the case they're taking to the county administrators and to the public.

The next issue of Healthwire will take a closer look at how security measures have failed to protect mental health professionals who are now working in overcrowded facilities and understaffed units.