Dane County needs a 24/7 crisis center: Here's why planning is behind schedule

Dec. 2—Despite initial calls for a 2023 opening, Dane County's plans for a 24/7 mental health crisis center are well behind that goal, leaving a major gap in local services even as other programs and reforms expand.

The facility, dubbed the Crisis Triage Center, has seen millions in investment in recent years and high hopes for its potential. Once opened, the center would serve as a "psychiatric emergency department," with stays of up to 23 hours, both voluntary and involuntary.

Officials have described it as a "no wrong door" facility where patients can simply walk in and get treatment and recovery services. The center aims to keep those facing mental health challenges from getting entangled in the criminal justice system.

In the budget for the upcoming year, County Executive Joe Parisi included $1.3 million for the center to help support ongoing planning. That's on top of $10 million already set aside by the county to buy property for the site and construct it. Total capital costs for the center are estimated at $11.7 million.

Originally, the County Board wanted a site for the center identified by early 2021.

But with 2022 coming to a close, the county has yet to even issue a request-for-proposal to identify a health care provider to operate the site. Officials involved in the center's planning have said they ultimately wanted to identify a provider before beginning the search for a site.

The rigors of planning, poor meeting attendance and an over-emphasis on the county jail project have all slowed progress on the crisis center, according to interviews with elected officials, activists and others who have worked on the initiative.

A subcommittee of the county's Criminal Justice Council tasked with overseeing planning for the center canceled half of its monthly meetings between August 2021 and August 2022 due to lack of attendance.

CJC's behavioral health subcommittee is made up of representatives from law enforcement, the court system and mental health advocates.

In recent months, the subcommittee has been meeting regularly.

Sup. Heidi Wegleitner, 2nd District, who chairs the board's Health and Human Needs committee, said he's concerned with the amount of work the board has delegated to the Criminal Justice Council.

"There needs to be more urgency around these issues," Wegleitner said. "I think we really need to take a more direct role in overseeing these initiatives that we have funded."

The RFP for the crisis center is on track to be released in the coming weeks, said Tanya Buckingham, a spokesperson for the county's department of human services. During a subcommittee meeting last month, Carrie Simon, a mental health specialist with the county, said concerns from the Wisconsin Department of Health Services about having people involuntarily committed to the center has delayed the process.

"It is not to say that a solely voluntary triage center wouldn't be of benefit, but I don't think it would fill the gap that we all see and feel," Simon said.

Buckingham did not respond to an email asking whether involuntarily admissions would be included in the RFP.

Closest facility hours away

Longstanding gaps in Dane County's mental health services prompted talks of building a crisis center. A 2019 report found that the county lacked a 24/7 facility, options for crisis response in rural areas beyond Madison and ways to divert people with mental health issues away from the criminal justice system.

Because Dane County doesn't have a dedicated crisis center, residents who have to be involuntarily committed can be taken all the way to Winnebago County, a nearly two-hour drive.

Madison resident Nikyra McCann went through the distress and terror of that experience during a mental health crisis in 2018.

"It was nighttime," McCann recounted of the drive to Winnebago. "I was scared. I thought they were going to kill me, and I was in handcuffs ... . I felt like I meant nothing to my community."

The trauma of those experiences also worsens mental health issues, McCann noted, not to mention the distance from family members who were crucial to her recovery.

To promote her story and help others with their mental health, McCann runs Still Standing Enterprise, a mental health service that offers therapy, seminars and workshops.

"We're lacking just a lot of services to help people be more stable," McCann said of Dane County's mental health system. "We could really benefit from this triage center."

The need for a crisis center continues to grow now that other crisis response programs have gotten off the ground in recent years and continue to expand, mainly the CARES program in Madison.

A county-run Behavioral Health Resource Center, opened in 2020, will see its staff expand, thanks to funding in next year's budget. At the Sheriff's Office, county officials put other funding toward expanding staff for a crisis response program similar to CARES.

In theory, crisis response programs are meant to work in tandem with a crisis center. Most successful CARES-like programs in the United States have a 24/7 facility to take patients, said Ché Stedman, an assistant chief for the Madison Fire Department who works closely with the CARES program. Otherwise, first responders are left with little else but an emergency room to take people, Stedman said.

"A center like this in Dane County where all local law enforcement and EMS and other providers can refer folks to that isn't the traditional hospital visit, it's going to benefit everybody," Stedman said.

In the aftermath of the demonstrations in the summer of 2020, Dane County pledged itself to a sweeping criminal justice reform package. The package included continued planning and development for a Community Justice Center, a mental health court and weekend court. The years-long delays for the jail consolidation project had not yet taken shape yet either.

But since then, the jail project has taken up countless hours of officials' time yet remains stalled and unfunded. A plan for the implementation of weekend court was to be completed by the Criminal Justice Council by March 2021. That report was never done, though the program is a regular topic of conversation on the body.

A feasibility study for a mental health court released this year hedged that while the county could benefit, it would not be a panacea and a more comprehensive overhaul of the county's criminal justice and mental health systems would go farther.

But progress on a Community Justice Center has been swifter, with the Criminal Justice Council securing a $600,000 grant from the federal government in October to move the initiative forward.

The center would take referrals from the court system and try to reconcile peace between offenders and victims, offer social services and put legal restrictions on people when necessary. Criminal charges that can't be referred to the county's Community Restorative Court, which takes on young people with misdemeanor charges and has expanded in recent years, would go into the new center.

A 2021 report recommended that the county create a core planning team, a community advisory board and a blueprint for potential spaces for the center's work.

But other language in the report hinted at dissatisfaction with the county's delays in following through with reforms.

"Community members and leaders are frustrated by the frequency and repetition of working groups and brainstorming sessions without tangible action steps and progress to follow," the report by the Center for Court Innovation concluded.

"Longtime community members feel let down by broken promises for change made in the past and fear that this planning process may end the same way."

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