Mentally ill ex-inmates lack treatment, meds
For Bonnie Richardson, taking her medication is an important part of staying out of trouble.
The 52-year-old Stoughton resident reports being treated for anxiety, attention deficit disorder and bipolar disorder. She has gone to prison twice, for drug trafficking and drunken driving.
But obtaining her prescribed medications is a constant struggle.
“I'm really worried now that I got a doctor, I can't afford my meds,” said Richardson, who has no permanent address. “Now they want to put me on another mood stabilizer, because I worry.”
Despite the wake-up call sounded nationwide by recent mass shootings, huge gaps remain in how Wisconsin treats people with mental illnesses who run afoul of the law. State and county officials blame a shortage of psychiatrists, growing demand for services and high medication costs.
About a third of the men and two-thirds of the women in Wisconsin prisons have mental health conditions, according to a 2012 state prison report. Of the approximately 21,700 prisoners in the state system, more than 5,000 are taking medications to treat mental illnesses.
State prison inmates are generally released with two weeks of pills and a four-week prescription. County jail inmates often get less than that, as little as three days of pills. They may run out before they get through the wait lists for county mental health services.
Jule Cavanaugh, reentry director for the Wisconsin Department of Corrections, acknowledges that many inmates with mental illnesses are not getting sufficient post-incarceration care.
“At the end of the day, they need psychiatric care in the community and access to medications,” Cavanaugh said. “Without being stable, it's very difficult for them” to address their criminal histories and tendencies.
Keisha Russell, founder of Infallible Helping Hands in Milwaukee, an advocacy group that aids female offenders, said newly released inmates must jump through numerous hoops and may prioritize food and shelter over refilling their psychiatric medications.
“A lot of times (offenders) end up going back to get drugs, and end up reoffending,” Russell said. “It's a vicious cycle that keeps going and going.”
Four years ago, a state Legislative Audit Bureau report concluded that“recidivism may be reduced by improved management of mental illnesses and continued emphasis on release planning.” But advocates for people with mental illnesses say reentry services remain inadequate.
“When they leave here, most people don't have insurance. Most people don't have a doctor,” said Dan Barth, a social worker at the Portage County Jail. They may struggle to prioritize mental health needs and “rekindle an interest in drugs and alcohol” on release.
“To keep them properly medicated is really a challenge,” said Barth, who helps get inmates on waiting lists for county mental health services before their release. “If we haven't connected with a psychiatrist, got on that waiting list, that's where there can be a problem.”
Barth said county mental health services in and out of jail “have shrunk because of fiscal pressure.” The wait lists in some counties, including Dane, can extend for months.
Kristin Kerschensteiner, managing attorney for Disability Rights Wisconsin, a nonprofit advocacy group, said the state's pool of psychiatrists is already small, and a significant portion do not accept patients on BadgerCare, the state's Medical Assistance program, because of low reimbursement rates.
“It all comes back to the dollar,” she said, referring to psychiatrists. “If you got the money, they got the time.”
Kerschensteiner said ex-prison inmates have a better shot at getting mental health resources than those exiting county jails.
Only a few of the state's county jails, Barth said, have someone like him working to help former inmates find services.
Mina and Tony Esser of Madison said their 22-year-old son, who has been repeatedly jailed for charges including theft and drug possession, always struggles to get connected with services. He suffers from depression, anxiety and attention deficit hyperactivity disorder.
“Every time he's released, he's just in survival mode,” Mina Esser said.
“It was easier to get street (drugs) than go to a doctor,” Tony Esser added.
Getting the treatment
Dr. Kevin Kallas, mental health director for the state Department of Corrections, said the state tries to bridge the gap between prison and the community. For instance, the Milwaukee region's Community Corrections office employs a psychiatrist and the Dane County region contracts with a psychiatrist.
According to Kallas, “every state struggles with this as an issue” and few if any states offer more than a month of medication in hand to released inmates.
Kallas and Cavanaugh, the DOC's reentry director, agree that Wisconsin needs more mental health resources in the community.
Following the 2009 Legislative Audit Bureau report on the advantages of treating inmate mental illnesses, the Legislature created the Becky Young Community Corrections Recidivism Reduction Plan. This $10 million annual appropriation helps medium and high-risk offenders with significant mental illnesses transition back to their communities.
One initiative, Opening Avenues to Reentry Success, began in the Fox Valley and southeast Wisconsin in 2010. OARS seeks to connect individuals with housing, employment and psychiatric resources. In 2011 the estimated cost was $15,000 a year per person, compared to $32,000 for incarceration.
And Green Lake County is using a grant from the Becky Young fund to improve the mental health treatment of county jail inmates.
“What we're trying to do is create a milieu that facilitates recovery,” said Philip Robinson, the county's deputy director for health and human services.
'Right now I can focus'
Bonnie Richardson's last offense, in January 2011, was for drunken driving. She was released in April 2012 after spending time in Taycheedah Correctional Institution and the Dane County Jail. She is homeless and moves from house to house among friends and the elderly clients she cleans for.
Richardson, who used to be treated for bipolar disorder, is now seen at the Shalom Holistic Health Services in Stoughton for attention deficit disorder and anxiety. She fidgets and seems slightly agitated as she shares her experiences in an interview.
Richardson is optimistic that her situation may improve under the Affordable Care Act, which will allow her to obtain health insurance.
“Right now I can focus, but it was really bad when I first got out,” Richardson said. “I was just setting myself up for a failure again, because of mental health.”
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OBAMACARE COULD HELP RELEASED OFFENDERS
Wisconsin inmates may soon have a better chance of getting health coverage, thanks to the federal Affordable Care Act, or Obamacare.
“We feel optimistic that more released offenders will be eligible for Medicaid under the ACA,” said Dr. Kevin Kallas, mental health director for the state Department of Corrections. “It's potentially a game changer for us.”
Beginning Jan. 1, 2014, all Wisconsin residents whose income falls below the poverty line will become eligible for BadgerCare Plus, Wisconsin's Medicaid program. The 2013 poverty level for a household of two is $15,500 a year and $23,500 for a household of four.
Previously, eligibility in the program was determined not exclusively by income but by certain categories: disabled, elderly, children and guardians.
Kallas noted that people who have been incarcerated for long periods have little or no income. This means many offenders may qualify for BadgerCare.
Keisha Russell, founder of Infallible Helping Hands, a Milwaukee-based nonprofit that advocates for female offenders, believes the Affordable Care Act might also benefit former offenders above the poverty line, by allowing them to obtain coverage through the health care exchanges.
But Russell worries that people exiting jail or prison who do not qualify for Medicaid might not be able to afford their monthly insurance payments.
— Nora G. Hertel