In western Wisconsin’s rural Pepin County, there is one mental health therapist, no psychiatrist and a growing need for both.
Residents in the county of just over 7,000 people are used to traveling 25 minutes to Menomonie or 40 minutes to Eau Claire for mental health care, but it can take three months for patients to be seen in those cities, said Carol Pulkrabek, who supervises Pepin County’s child welfare programs and social workers. Those long waits and the lack of psychiatrists exacerbate people’s mental health issues, Pulkrabek said.
“And I don’t think that is unique to Pepin County,” she added.
Like most counties across Wisconsin, Pepin County is simultaneously experiencing a mental health care provider shortage and an increasing need for them.
“For most people in rural America, finding a place to get mental health treatment and then finding funding are the biggest challenges,” said Donna Juleff, Pepin County’s only mental health therapist.
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The problem is especially acute among children and youths. About a third of students across Wisconsin feel sad and hopeless almost every day, a 10% increase over the last decade, according to the Office of Children’s Mental Health. And half of Wisconsin youths with a diagnosed mental health condition receive no treatment, the office found.
“Our referrals right now for kids are absolutely increasing,” Pulkrabek said. “In our mental health programs, we serve more kids than we do adults. Getting a child psychiatrist is virtually impossible. They fill up immediately.”
Evers’ appeal
Citing such challenges, Democratic Gov. Tony Evers in his State of the State address last month called 2023 the “year of mental health.” He said he would seek to devote $500 million in his upcoming 2023-25 biennial budget to addressing deficiencies in mental health treatment. Over half of that would be directed toward children and youths.
But while lawmakers on both sides of the aisle agree on the need to address the problem, they remain sharply divided over the role government should play and how much taxpayer money should go toward addressing it. Responding to the governor’s proposal, which would need Republican support in the Legislature to become law, Assembly Speaker Robin Vos, R-Rochester, said Evers’ proposal to put over half of the mental health spending in schools is “not going to happen.”
Sen. Jesse James, R-Altoona, who chairs the Senate Committee on Mental Health, Substance Abuse Prevention, Children and Families, said the governor and the Legislature agree that “we need to do something.”
“Now, whether or not it’s $500 million, I think (a solution) still needs to be discussed and compromised and negotiated,” he continued.
What’s next?
More than half of Evers’ $500 million mental health proposal — $270 million — would go to the Department of Public Instruction for school-based mental health services. The money would be used to provide mental health care, hiring and supporting “mental health navigators,” and providing mental health first aid and trauma-based care training.
But James said the crisis isn’t an educational issue.
“I think there needs to be more discussions and seeing what the true big picture looks like when it comes to this type of money going in directly to our schools,” James said. “Maybe the Department of Health Services should take some. I think our hospitals and clinics should be able to use some.”
Other Republican lawmakers are open to the money going into schools.
While emphasizing he wanted to avoid government overreach, Rep. Pat Snyder, R-Schofield, who chairs the Legislative Children’s Caucus, said “the one thing we can do ... is make sure there is some extra funding for school counseling.”
Snyder said Evers’ math, however, “is based on unrealistic policies that he knows will not be part of the final budget.”
Pitch for schools
Assembly Minority Leader Greta Neubauer, D-Racine, said the money proposed for DPI is “absolutely necessary.”
“Students deserve a dedicated mental health professional they can reliably turn to in times of need,” she said. “If Republicans have alternative solutions, I’m interested in learning what they are, but I am unwilling to allow the mental health needs of Wisconsinites, especially our kids, to go unmet.”
Children and youths exposed to trauma are more likely to “perform poorly in school, have diminished educational and employment opportunities, and be at increased risk for chronic medical and mental health conditions, and early death,” a group of researchers found in an 2017 study published in the Journal of School Health.
Besides preventing trauma in the first place, “high quality, accessible and culturally responsive mental health screening and treatment services are urgently needed for children and adolescents, specifically within school settings,” the researchers stated.
If schools had more money to pay therapists, it would eliminate mental health providers’ worry about getting insurance companies to reimburse them for their services, Juleff said.
Bed shortage
Separate from the $270 million for DPI, Evers proposed 28 separate allocations to the DHS under the mental health umbrella. That includes $3 million for the 988 Suicide and Crisis Lifeline call center and a $1.8 million investment to establish a 25-bed psychiatric residential treatment facility for youths with “intensive behavioral health needs.”
About 35 psychiatric beds are needed per 100,000 people, according to a 2021 study in the International Journal of Environmental Research and Public Health. Wisconsin has fewer beds than needed, the study says.
One bright spot is in the Madison area. With Dane County’s population of about 565,000, it would need about 200 beds to meet the study’s standards. The Madison area is soon expected to have nearly 300 mental health beds, up from about 100 a few years ago.
But another study in the journal Molecular Psychiatry last year said 30 beds per 100,000 people is the minimum number needed, while the optimal number is 60 beds, which in Dane County would be about 340 beds. Few or no beds are available in rural counties near Madison, which arguably increases the need.
Under Evers’ proposal, another $4 million would go toward expanding the state’s Child Psychiatry Consultation Program, which provides training and support to primary care providers dealing with children’s mental health, into “a broader Mental Health Consultation Program,” according to the governor’s office.
Pandemic impact
The COVID-19 pandemic has put a spotlight on and, in some cases, exacerbated mental health challenges across the state.
“Children are anxious and depressed more so than before, especially those little ones that were isolated for ... a year and a half with the pandemic,” Juleff said. “The ones who are pre-K and kindergarten, I think, are struggling a lot.”
Noting that children’s mental health crises began before COVID-19, Wisconsin Office of Children’s Mental Health director Linda Hall said in the group’s annual report, “The effects of the pandemic continued to weigh heavily on everyone.”
“Children returning to in-person school faced the challenges of how to act in the classroom, how to be with peers, fill learning gaps, and manage the big feelings they were having because of these challenges and everything they and their families have been through,” Hall said.
In Pepin County, Durand-Arkansaw School District pupil services director Michelle Zagozen said the pandemic is to blame for many but not all of the mental health challenges students face. Students’ worry about the unknown increased during the pandemic, she said, and during school closures students were cut off from school services that could have helped them navigate their anxiety.
In spite of it all, students are still achieving success, she said.
“In a lot of aspects, kids are doing well, and they were very resilient through the pandemic,” she said. “We just have to help them with some of these issues that are popping up.”
Photos: Gov. Tony Evers' inauguration
Tony Evers was sworn in as Wisconsin’s 46th governor at the state Capitol on Monday. Outgoing Republican Gov. Scott Walker and four other former governors attended.
Wisconsin Chief Justice Patience Roggensack swears in Tony Evers as Wisconsin’s 46th governor at the state Capitol Monday, Jan. 7, 2019. Outgoing Republican Gov. Scott Walker and four other former governors attended. STEVE APPS, STATE JOURNAL
