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A panel of legislators and experts will soon begin meeting to review a section of Wisconsin law some say is long outdated and a detriment to Milwaukee County – the chapter covering emergency detentions for psychiatric care. The law, largely unchanged since the 1970s, severely limits the length of time suicidal patients or others facing psychological crises can be held against their will in the county.

In Milwaukee County, such a patient can only be held in a hospital or within the Milwaukee County Behavioral Health division for 24 hours without a psychiatrist’s opinion certifying the person poses a serious threat to themselves or others. Only with that opinion may Milwaukee County patients be held for the full 72-hour emergency detention as allowed by law.

 In all other counties in the state, psychiatrists are allowed the full 72 to hours to review a patient. The review serves as a second opinion. The first opinion comes from a police officer, and it was the Milwaukee police department that prompted the state Legislature to craft a different set of standards for Milwaukee County in the late 1970s.

Then Milwaukee Police Chief Harold Breier objected to the emergency detention procedure adopted earlier in the decade, arguing that police should be left out of the process.  According to the Milwaukee Journal, the department went to great lengths to avoid handling commitments to mental hospitals, instead booking many potential patients into jail on minor charges. As a result, the state law put less emphasis on the role of police by requiring a psychiatrist’s opinion to be delivered more quickly in Milwaukee.

This placed a burden on the county’s mental health system. “Within those 24 hours, because of funding available, there may not be someone to do that second evaluation,” says State Rep. Sandy Pasch (D-Whitefish Bay), the former psychiatric nurse who requested the special legislative committee. She says the 24 hour time limit is too short.

To make matters more difficult, the clock begins ticking on the 24 hours as soon as patients are brought to any hospital that could potentially offer them psychiatric care, according to a 1998 ruling by the Wisconsin Court of Appeals. Following a suicide attempt, says Dr. Jon Berlin, medical director of Milwaukee County Crisis Service and a member of the committee, the deadline can even expire before the patient is capable of speaking with a psychiatrist.

The Crisis Service at the county’s Behavioral Health Division handles about 9,000 emergency detentions a year, he says. The 24 hour time limit, he says, means there are still more patients released from hospitals before BHD can conduct a review. “We don’t have the staff to get out to all those people within 24 hours,” Berlin says.

Without a change in the law, the 24-hour rule could soon apply to Dane County. The law, aimed at Milwaukee County, applies to any county greater than 500,000 people. In 2008, the U.S. Census Bureau estimated there were about 483,000 people living in Dane County.

Pasch says hospitals should be more willing to treat patients in crisis. “It’s the policy too often in hospital emergency rooms if someone comes in that’s suicidal to call the police to do an emergency detention,” she says. Hospitals sometimes avoid patients because their insurance offers limited mental health benefits, but new state and federal parity laws taking effect this year requiring equal coverage for mental and physical health should encourage hospitals to take on more of the patients, she says.

Berlin says that hospitals may call police even for suicidal patients who go to the emergency room voluntarily seeking care – because state law doesn’t limit detentions to patients who refuse treatment. As in other detentions, they are typically handcuffed and placed in the back of a police car. “It’s not the way to treat people who are asking for help,” he says.

Pasch worries that people who go to the emergency room because they’re suicidal, only to be detained by the police, are less likely to seek help in the future. Police don’t like the process very much, either, she says, since it can involve long waits, taking officers away from other duties for extended periods. Police still sometimes opt for a minor criminal charge and a quick stop at jail over waiting hours for a psychiatrist’s evaluation, she says.

For decades, patient advocates, governments and mental health providers have debated the balance between a patient’s right to refuse care – and their need to receive it anyway when they’re incapable of making sound judgments. “Doctors try to balance both rights, but we recognize society has set a standard, based on science, that sometimes people benefit from involuntary treatment,” Berlin says.

 The old days of mental commitments spanning months or even years are long gone. “Now people are committed for a few days, maybe a week and a half in the long term,” according to Pasch.

The committee also plans to review a section of law governing the authority of parents to admit their children to hospitals for psychiatric care or to facilities for treatment of drug and alcohol abuse. Until a 2006 law, parents could only admit children up to age 14, but a 2006 expanded that to include all minors. But health care providers apparently didn’t get the memo. Pasch says very few she’s spoken with in recent months knew of the change.

Michael Kiefer, father of Madison Kiefer, a 15-year-old girl who died of a drug overdose in 2009, will serve on the committee. She overdosed on prescription drugs just days before she was scheduled to enter treatment. Providers told the Kiefer family, incorrectly, that she had to agree to the treatment.

A Milwaukee County judge sentenced a 23-year-old Whitefish Bay man in July to 12 years in prison on charges of reckless homicide related to the girl’s death. Prosecutors alleged the man had provided the prescription medication to Madison and other teens.

Pasch will chair the panel, and State Sen. David Hansen (D-Green Bay) will serve as vice-chair. For a full list of members, go here. Monthly meetings are expected to begin later this month and continue in January, when the committee will issue recommendations to the full state Legislature.

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