This article includes mention of suicide. If you or someone you know is struggling or in crisis, help is available 24/7. Call or text 988 to reach the 988 Suicide & Crisis Lifeline, or use the chat feature at 988lifeline.org.

It has been 10 years since Patty Slatter’s last suicide attempt. When emergency personnel responded to the call, she was met with a level of compassion and understanding that had been sorely missing from her previous 20 years of experience with depression and hospitalizations.

“When the officers came I told them, ‘I did this on purpose. I need help,’ and they responded caringly and compassionately: ‘We’re going to get you help,’” Slatter said. “It wasn’t like I was a burden to them. Something changed in me then.”

Across much of Wisconsin, gaps in mental health resources mean vulnerable Wisconsinites don’t always receive the care they need in times of crisis. The job then falls to law enforcement to respond to mental health emergencies and sometimes transport patients hours across the state to Winnebago Mental Health Institute in Oshkosh— the only state-run mental health hospital for the general public.

The lack of mental health and trauma-informed care in standard emergency rooms means patients like Slatter sometimes do not receive the urgent support they need.

Democratic Gov. Tony Evers continues to push the message that 2023 is the “year of mental health” for Wisconsin and included funding for mental health crisis stabilization centers in his biennial budget proposal this year. Much of that was stripped by GOP lawmakers before the bill made it back to the governor’s desk.

This fall, a group of Republican senators released alternate legislation to establish a pair of mental health urgent care centers in underserved parts of the state. The crisis urgent care and observation centers, or Crisis Now centers as the legislation and Department of Health Services refer to them, promise to fill a significant hole in mental health care in the state.

Sen. Howard Marklein, R-Spring Green, was one of the introductory sponsors of the bill, noting the need is dire.

“My bill is similar to the governor’s proposal. We used the original budget language as the starting point for our bill, but made some changes to clarify legislative intent and incorporate input from stakeholders,” Marklein said. “We have been working directly with the governor’s administration and DHS for more than a year on this concept and the language in this bill.”

The state Department of Health Services will have purview over the certification process and operations surrounding the centers.

“Crisis urgent care and observation centers will help address a critical need in Wisconsin’s mental health care system,” said DHS spokesperson Elizabeth Goodsitt.

This is only the first step in the process, Marklein said.

“It is absolutely necessary to implement the Crisis Now model in Wisconsin, which we all agree is desperately needed,” he said.

From patient to peer

Receiving help at an urgent care center with trained mental health practitioners on staff would have helped her healing process immensely, said Slatter, 49. During many of the hospitalizations she experienced throughout her struggles with mental health, Slatter was not often cared for by providers with mental health experience, an absence she said stunted her healing.

Slatter lives in Milton near Janesville and grew up in Rock County. The closest psychiatric ward was in Madison.

She began experiencing depression in high school. But, back then, mental illness and especially the topic of suicide were not discussed, Slatter said.

Her challenges with mental health reached a boiling point when she was sexually assaulted on her 21st birthday. Her first suicide attempt followed exactly a year later.

“Little did I know that was the start for me, over two decades of just that revolving door of hospitals and ER visits,” Slatter said.

Slatter said she has survived a dozen suicide attempts over a period of about 20 years when she struggled with mental health the most. Her experiences with hospitalizations were not always warm.

“One time I went into the ER and I remember them saying, ‘I don’t want to take her, you take her, she’s always in here, she wants attention,’” Slatter said.

At one point years later, she was handcuffed after an involuntary detention following a suicide attempt.

“I was at the hospital trying to get help but treated like a criminal,” said Slatter, who has been hospitalized close to 50 times for mental health crises. “I was told by a psychiatric department nurse that I had to accept this was going be my life and I will always be in and out of hospitals. And then I overdosed right in her office. Words matter.”

The presence of trained mental health providers who would be involved in running the proposed Crisis Now urgent care centers would add a level of understanding and training Slatter said would have helped her. She supports the legislation.

“The less people have to go to the ER, the better,” Slatter said. “Especially to fill in the staff with more peer specialists, and people that have been there and gone through something, will help people in need in the long run.”

In reflecting on her last suicide attempt a decade ago, Slatter said the care she received served as a turning point.

After decades as a patient in need of support, she now offers that to others as a peer and advocate.

Slatter serves on the Wisconsin advisory committee for the 988 crisis line, works with the National Alliance for Mental Illness Wisconsin, provides crisis intervention training support for first responders in Rock County and surrounding rural areas, and works as a public speaker to share her experience as motivation for others who are struggling.

Expanding mental health resources in underserved parts of the state is an important aspect of her advocacy, she said, and establishing care centers that are staffed and supported by individuals trained in mental health care is a critical start.

“There’s a lot to do in the state of Wisconsin,” Slatter said. “And we need people with passion to make the difference.”

A gap in care

As it stands in much of the state, if someone experiences a psychiatric emergency, police officers are often the ones to respond. An individual is taken to the hospital or a medical facility and then transported, often hours away, to Winnebago Mental Health Institute.

The centers, once up and running, will operate as a psychiatric emergency room of sorts, according to Sita Diehl, public policy and advocacy director for the Wisconsin arm of the National Alliance for Mental Illness Wisconsin, or NAMI.

A person experiencing a mental health emergency can check themselves in, or be checked in by a first responder or family member, to receive a medical assessment, as well as psychiatric evaluation and substance use screening. The ability to have all of these services in one location is monumental in streamlining the treatment process, Diehl said.

The centers will be staffed with medical providers, prescribers, psychiatric providers, nurses and peer counselors, according to Diehl.

“You can get immediate psychiatric care,” Diehl said. “The reason that’s important is because right now, when you sit in the emergency room, you’re mostly just sitting there, sometimes with a law enforcement person next to you if you’re being involuntarily detained on an emergency detention, but you’re not getting care.”

Most psychiatric emergencies can resolve within 24 to 48 hours, Diehl said. With the creation of these centers — which will operate as entry points to some shorter term inpatient care — many mental health crises can reach resolution without a patient needing to be transported to Winnebago and held for a month or more, as is often the case.

Urban centers like Madison have the resources to provide shorter term care to people in need. For example, UW Hospital has a 20-bed psychiatric wing in which people in crisis are able to stay for just a few days to receive treatment and stabilize prior to release. Madison and Milwaukee also have dedicated teams of mental health professionals to respond to psychiatric crises alongside law enforcement.

Beyond the burden of a longer hold, patients who remain at Winnebago for longer periods of time often must work through their crisis without the support of friends or loved ones who are hours away.

As police are often the only ones available to respond to mental health crises in some areas of the state, officers face a difficult choice. They can detain someone in crisis and transport them hours to Winnebago — which can be traumatizing to a person in crisis who is uncomfortable interacting with police — or not intervene at all in areas without any local resources, which can mean a person in crisis who presents a threat to themselves or others can end up in jail.

Experts, like Diehl, say there needs to be a middle ground.

“These are an entryway, a way for you to get a thorough assessment and get psychiatric medication, and get counseling and peer support,” Diehl said, at which point a treatment team will decide if longer care is required and to what extent.

Many rural areas of the state suffer from health care deserts, including mental health care. Marklein said he has ideas for where the centers could be most useful but their locations will be decided down the line.

“The southwestern corner of the state desperately needs a regional option to provide care closer to home for those in crisis, but we do not have a specific site at this time,” he said.

The bill language stipulates that each of these centers must be at least 100 miles from Winnebago Mental Health Institute, to accommodate patients who live too far away from the state-run mental hospital.

A long-standing problem

The larger issue of gaps in mental health crisis services and resources across the state is nothing new. In 2019, Wisconsin Attorney General Josh Kaul held a summit that gathered mental health professionals, policymakers, law enforcement and those personally affected to discuss how the state can improve.

The summit focused on detention of people experiencing a mental health emergency and the role of law enforcement in responding.

The burden placed on small-town police to act in situations they might not be trained to handle is part of the push to improve mental health infrastructure.

“For far too long, Wisconsin’s law enforcement officers have had to respond to mental health crises with insufficient resources and inadequate options,” Wisconsin Professional Police Association Director Jim Palmer said at the summit.

The Ashland County Sheriff’s Office has three deputies on shift at any given time. That’s often enough for a typical day. But when someone in the county experiences a mental health emergency and Sheriff Brian Zupke or one of his deputies responds, the number of deputies on duty shrinks by one third.

Zupke is based in a community that has a behavioral health unit that people can be taken to in a crisis. But it’s very small and almost always full, he said.

“Our local medical units, they don’t have the structure for the high volume of patients, or the employees to handle it,” Zupke said.

Typically, one of the deputies or officers who responds to a call will provide an initial emergency assessment, transport a person in crisis to an emergency room or medical facility and wait for medical clearance to be established, all before driving hours to transport the person to Winnebago if further treatment is required.

Leading up to the attorney general’s summit, the state Department of Justice conducted a survey of law enforcement to gain insight from police officers and sheriffs on their role in mental health emergency response.

A total of 354 chiefs and sheriffs completed the survey, and 73% of them said they were concerned about the effect that the mental health emergency response process had on their agencies and 96% indicated that making additional facilities available would help alleviate the burden.

Survey responses also showed that responding to a mental health crisis incident can take nine hours or longer, including response and transport time.

Zupke said calls his department responds to can take much longer because of the distance between Ashland and Oshkosh — a drive that can take more than four hours one way.

That does not account for the time it takes to respond to a crisis, transport a person to a local medical facility for medical clearance and, in some cases, wait for that person to sober up before they can be transported to Winnebago.

Winnebago requires any incoming patients to be sober upon arrival.

Waiting for a person under the influence of drugs or alcohol to reach sobriety “can take anywhere from up to 12 to 24 hours,” Zupke said. “Where our officers are sitting at a local hospital waiting. All this time elapses before we even go to Winnebago and then back.”

If a person requires a court hearing back in Ashland County after being transported to Winnebago, Zupke or one of his staff often drives back to Oshkosh to bring them back.

Zupke has been working in law enforcement for more than two decades. Even so, responding to mental health emergencies remains hard for him, even after undergoing crisis intervention training — a requirement for all of his deputies, he added.

“It’s a difficult process,” Zupke said. “When you’re putting in 12 or 15 hours, drinking caffeine to try to stay awake, doing everything you can to make this process happen and then get back home.”

One of the goals of the proposed mental health urgent care centers is to help avoid situations in which police are tasked with response and transport of people in crisis, said Goodsitt with DHS.

“Beyond providing access to these additional services, the centers will help reduce the amount of time law enforcement and first responders currently must dedicate to emergency detention cases by offering a dedicated first responder drop-off location that accepts custody of emergency detention cases and does not require that medical clearances be completed before drop-off,” Goodsitt wrote in an email to the Cap Times after the bill’s introduction.

What happens next

Evers’ biennial budget bill included $10 million in supplemental funding to establish two crisis centers that, according to DHS, would provide the following services:

• Regional crisis receiving and stabilization facilities.
• Seamless transitions between levels of services offered at the centers.
• Transfer to more appropriate treatment options as needed.
• Coordinate the connection to ongoing care.
• Promote the effective sharing of information between providers to improve service delivery and patient outcomes.

Marklein’s bill in the Senate, and its Assembly companion, follows Evers’ inclusion of funding in his most recent biennial budget to establish crisis urgent care centers.

“The bill is what is called a trailer bill, providing details about implementation,” Goodsitt told the Cap Times. “It requires the Department of Health Services to establish a certification process for crisis urgent care and observation facilities and a grant program… to develop and support these facilities. It also provides rulemaking for DHS to administer the facilities and requires DHS to seek any necessary federal approval. We’re looking forward to continuing our work with the Legislature to develop the framework for the centers.”

The Senate bill and its Assembly version both sit in the mental health committees of each body, holding some bipartisan support, which Marklein said he hopes will expand.

After the bills theoretically pass both houses of the Legislature and are approved by the governor, DHS will then go before the Joint Finance Committee with a plan for the centers.

“DHS will be responsible for designing the structure within our legislative intent for the program before they return to the Joint Committee on Finance to release the $10 million we allocated in the state budget,” Marklein said. “I will continue to work with the department and administration as we roll this forward to contribute ideas and encourage swift action.”

Once the funding is approved and DHS presents a plan to the Joint Finance Committee, a grant proposal process will begin to decide where the centers will be and who will run them.

It will likely be another two years before the centers are up and running, NAMI’s Diehl said, but this legislation marks a pivotal moment in filling a significant gap in care.

“It’s going to take a while, but this is a huge step,” Diehl said.