Years after opening, a Milwaukee County psychiatric hospital is serving far fewer patients than expected

When Milwaukee County began working on the closure of its outdated mental health complex hospital a decade ago, part of the plan was for a private hospital to take over.

Even though the county was redesigning its mental health system to rely more on community resources and less on emergency care, it still needed an inpatient psychiatric hospital to serve as a safety net.

Pennsylvania-based company Universal Health Services won the contract , painting a picture of a modern, 120-bed inpatient psychiatric facility that would care for the county's most severely mentally ill residents.

Yet nearly three years after its after its opening , Granite Hills Hospital is struggling to match the number of patients the old county complex once served — much less reach the 120 beds it still advertises on its website.

Today, the hospital, located in West Allis, only has the staffing for 36 adult beds and 12 youth beds, according to Milwaukee County Behavioral Health Services Administrator Michael Lappen.

That's less than the old county hospital, which cared for 48 adult and seven youth patients on a typical day in 2019, Lappen said.

In addition, none of the beds at the hospital are reserved for county-referred patients. Under the terms of its contract, it is not legally bound to.

Some mental health advocates said the contract left too many decisions about patients’ care dependent on the private hospital, instead of the county. As a result, fewer people with severe mental illnesses are being admitted to treatment in Milwaukee.

“Right now, I don’t believe the system is working the way (the county) thought it would,” said Mary Kay Battaglia, the executive director of National Alliance on Mental Illness Wisconsin.

Universal Health Services and Granite Hills Hospital did not respond to multiple requests for comment. But amid a pandemic and a national mental health workforce shortage, Granite Hills is not the only psychiatric hospital that has struggled with capacity.

Given that, Milwaukee County Mental Health Board Chair Mary Neubauer said she felt the hospital is meeting expectations and that the priority is where it should be: on community-based resources instead of institutional ones.

"We have so many more services available in the community," said Neubauer. "The reason why we got out of the hospital business was to get people services in the community."

A private hospital serving as a safety net

When someone is seeking mental health care, they can be seen at a mental health clinic, a crisis center, or a psychiatric hospital.

In recent years, Milwaukee County has focused on adding more clinics and crisis centers to allow people access to early intervention care before their mental health needs become so severe that they needed to be institutionalized.

But when someone with severe mental illness does not want treatment, they may need to be admitted to a psychiatric hospital against their will, if they meet criteria for "emergency detention" under Wisconsin law.

Emergency detention patients are people in mental health crises so severe that they could be a danger to themselves or others. Under state statute, the county is responsible for getting them into involuntary treatment until they stabilize.

Although Granite Hills is not the only hospital in Milwaukee County that accepts emergency detention patients, other private hospitals generally only accept those with private insurance or certain Medicaid plans.

Granite Hills, on the other hand, is the only local facility where the county can refer and pay for a patient who is uninsured or on a basic Medicaid plan.

The county’s initial expectations in its request for proposal in 2015 were clear: an inpatient psychiatric hospital that would help the county fulfill its responsibility to take care of people placed under emergency detention.

One of the stated expectations was maintaining “a minimum of 60 licensed beds.”

But the final agreement that the county mental health board ultimately approved with Universal Health Services in 2018 makes no requirements about how many beds the hospital should maintain or the share of beds that should be reserved for county-referred patients.

By the time the old county mental hospital was set to close in September 2022, Granite Hills had just 24 staffed beds, according to Lappen — far fewer than expected.

But by then, the closure of the old mental health complex was set in motion. The county had already ended its contracts with temporary staff, and other employees had started taking other jobs or retiring because of the complex's impending closure.

“We (the county hospital) would have been unable to operate at that point,” Lappen said.

Today, Milwaukee County has 100 fewer inpatient psychiatric beds than it did five years ago, a time when Lappen said the number of inpatient psychiatric beds in Milwaukee was already "well below" national standards.

In its proposal to the county in 2018, Universal Health Services found 380 inpatient psychiatric beds in Milwaukee County. According to a recent Milwaukee Health Care Partnership report, the number of inpatient psychiatric beds was around 270 in 2023.

Battaglia questions why local psychiatric hospitals haven't found a way to create more inpatient beds for people who are acutely mentally ill.

“It is a unique patient that requires unique services,” Battaglia said. “But so does a gunshot wound or a cardiac arrest. The hospitals seem to be able to figure out how to provide that high capacity need to those patients, and I think they can figure out how to provide high capacity responses to emergency detention patients.”

From the archives: Milwaukee County mental health system traps patients in cycle of emergency care

Fewer county patients being admitted by Granite Hills

The change in the number of people admitted to inpatient mental health treatment under the old system and the new one is stark.

In 2019, around 3,500 patients were brought to the county under emergency detention, according to Lappen. The old county hospital admitted close to 1,400 of them, or around 40%.

In 2023, more than 3,300 patients were brought to the county under emergency detention. But Granite Hills accepted just around 700 of them, or about 20% — half as many as the county complex used to take in.

As a private facility, Granite Hills can refuse patients referred by the county if its doctors believe a patient is too sick for them to handle, or if the hospital does not have enough space or staff.

If a patient is rejected, the county has to find beds for them at other private hospitals or Winnebago Mental Health Institute, the state psychiatric hospital in Oshkosh. For uninsured patients, the state hospital is their only alternative.

Battaglia said being sent out of the county can be hard on family members and financially burdensome for taxpayers. Winnebago Mental Health Institute is an hour and a half away from Milwaukee.

And while the county has an agreement to pay Granite Hills around $1,000 per day for an acute, uninsured county patient, it has to pay almost double that at the state psychiatric hospital.

Battaglia feels the previous system for emergency detentions was more streamlined and better controlled.

“I think a lot of politicians and people high up in the county think it’s all a win,” Battaglia said. “And I think right now there are lots of family members who feel that they are now dealing with the consequences of a fragmented system that’s not working.”

According to Lappen, being sent to the state hospital is not always a bad thing. He said emergency detention patients who go to the state hospital often have more serious needs that can be better addressed there.

But he acknowledged that under the old system, few people placed under emergency detention were ever turned away from the county hospital.

Last year, the county sent 30 people to the state hospital, Lappen said. But in the years before the old county mental health hospital closed, few were ever sent there.

"We admitted everybody that was under our responsibility," Lappen said. "We cannot make a (private) provider do the same.”

Decisions made on a timeline

To Lappen, the county had a chance back in 2018 to secure more authority over patients' admission and treatment.

At the time, Universal Health Services had proposed two models for the county to choose from. The first option was for the county to pay Granite Hills for each day a county patient was treated there.

The second option was for the county to “lease” a block of about 40 beds at Granite Hills to be operated by the county. According to a presentation given by Teig Whaley-Smith, former director of the county's Department of Administrative Services, the drawback of the second option was having to pay for all 40 beds even if not all of them were being used.

Milwaukee County decided to go with option one.

Whaley-Smith declined to comment on the contract negotiations.

The difference between the two contract options is clear to Lappen. If the county paid for a section of Granite Hills, county physicians would have the decision-making power on whether or not to admit someone.

Instead, those decisions are now made by a private physician at the hospital.

Mental health advocate and former Milwaukee County Mental Health Board member Brenda Wesley feels much of the mental health system redesign process was driven by the county's desire to close its mental health hospital as soon as possible to save money.

Setting up everything else, Wesley said, was “on a deadline.”

Based on her experience on the county’s mental health board around that time, Wesley felt that her concerns about a robust inpatient psychiatric program for county residents went unanswered.

Discussions focused on the early-intervention programs in the community, but few decision-makers accounted for people who were severely ill and needed involuntary treatment, she said.

“No one really wanted to listen to the fact that even though we have all this system in place, people would still get sick,” Wesley said. “And if they get sick, what are we going to do with them?”

Eva Wen is a data reporter at the Milwaukee Journal Sentinel. She can be reached at qwen@gannett.com

This article originally appeared on Milwaukee Journal Sentinel: Years after opening, a Milwaukee County psychiatric hospital is serving far fewer patients than expected