How Madison Catalyzed Milwaukee’s New Psych ER

The carve-outs strike again.

State law is riddled with provisions that apply only to Milwaukee County, and one of them just helped to cement plans for a new psychiatric emergency department on the north end of Downtown.

In Milwaukee County, and only here, police officers who detain someone believed to be a threat to themselves or others under state “emergency detention” law must get a doctor’s endorsement within 24 hours, otherwise the person is free to go. (In other counties, police can hospitalize someone for up to 72 hours.) According to Michael Lappen, head of the county Behavioral Health Division, this effectively mandates an ER where police can get a doctor’s so-called Treatment Director’s Supplement, or TDS.


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Currently, that place is the county Mental Health Complex’s aging Psychiatric Crisis Service facility, which the county plans to close over the next year as it transitions to a more community-based model of mental health care. The inpatient facility replacing the complex, run by Universal Health Services, won’t have an emergency department at UHS’ request.

Because of the need for a TDS, local health care providers had a choice to make. Either they join forces with the county to fund a new psychiatric facility where police could take patients, or invest millions, individually, in upgrades and staffing, says Lappen.

In the end, the county and four networks – Aurora, Froedtert, Ascension and Children’s Wisconsin – brokered a deal to build and run the new, standalone $12 million psychiatric ER. Without such a facility, police would take detainees to the nearest hospital. “Anyone who walks through the door, you’re responsible for,” Lappen says.

This story is part of Milwaukee Magazine‘s March issue.

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Matt has written for Milwaukee Magazine since 2006, when he was a lowly intern. Since then, he’s held the posts of assistant news editor and, most recently, senior editor. He’s lived in South Carolina, Tennessee, Connecticut, Iowa, and Indiana but mostly in Wisconsin. He wants to do more fishing but has a hard time finding worms. For the magazine, Matt has written about city government, schools, religion, coffee roasters and Congress.