For decades, Milwaukee County’s mental health services were based on an institutional model. Today, more and more patients are receiving their care through what’s known as a community-based system.
Through the community-based method, patients are treated as individuals in settings such as their own apartments and group homes. Research shows that patients do best under the least restrictive circumstances.
Since 2010, the County has made strides in offering this kind of care. However, many people in the Milwaukee area not seeking or receiving treatment.
According to the Milwaukee County Behavioral Health Division, about 180,000 people in Milwaukee County struggle with mental illness, yet only around 20,000 of those people are receiving treatment. The County attributes this gap to factors such as insurance coverage and stigma, however, its says they are taking steps to close it and provide better outcomes for the participants.
Milwaukee County closed two long-term care units and invested more than $20 million in expanded and enhanced community-based programs and services. The County says developments are also being made on building a new acute psychiatric hospital, which will be run by a provider that follows the community-based method.
"We're looking at different mechanisms of delivery of care and I think that the more we experiment and have successes, the more innovative we can become," says Dr. Maria Perez, a member of the Milwaukee County Mental Health Board and director of Behavioral Health at the Sixteenth Street Community Health Center.
Dr. John Schneider, executive medical director for the Milwaukee County Behavioral Health Division, notes that societal attitudes and institutional attitudes are hard to overcome for anyone suffering from a mental illness. "If you're brought up in a very under-reactive invalidating set of circumstances, you have a harder time advocating for yourself and you feel like you're to blame," he explains.
Despite the success they've seen in individuals already transitioned to community-based care, they say community awareness is still lacking.
The stigma associated with mental illness is the main obstacle to seeking and receiving care. "The remedy to stigma really is communication and open dialog and a willingness to hear divergent perspectives. Fear is, I think, always the primary barrier and fear comes in many forms," says Dr. Perez.
"Persons who suffer a mental illness are among us. If we're all honest with ourselves, we all know someone with a mental illness," she continues. "So we really need to come to terms with that and embrace all of the strengths that these individuals can bring to communities."
For the director of the Department of Health and Human Services in Milwaukee County, Héctor Colón, it was his experience with his sister suffering from mental illness that drove him to spearhead this change in the system. Colón is not only adamant in his view that this is "the right thing to do," but has seen how a different system of care can encourage people to seek help, rather than be subject to the interventionist care his sister underwent.
"Once (my sister) realized that she in fact did have a mental illness and that it was treatable and that she could recover through active treatment and through medications - it was at that point that she began to do better in her life," he says.
Dr. Schneider notes that the most important thing that they can accomplish as health care providers, as doctors, as therapists, is to be a witness to the individual and encourage them.
"I think we underestimate how important it is to be the silent witness to somebody's experience and to go farther to cheerlead for them," he says. "To help them achieve what they really want to is such a great privilege - to be allowed into people's lives that otherwise no one wants to work with and do that."