Legislative Committee Studying Whether To Create Long-Term Youth Psychiatric Care Facilities

Wisconsin State Capitol. Photo by Mariiana Tzotcheva.

A study committee considered proposals Thursday to create new long-term mental health facilities for youth, expanding who could initiate an emergency detention and changing consent requirements for minors over the age of 14.

Wisconsin children have been navigating significant mental health challenges in recent years, and the state has been exploring ways to improve support. The Legislative Council Study Committee on Emergency Detention and Civil Commitment of Minors, which includes four state lawmakers and other stakeholders, mental health providers, law enforcement, has been meeting since August to specifically focus on the current state of Wisconsin’s emergency detention and civil commitment laws as they applied to children.

Under state law, emergency detention is a process that allows law enforcement officers to initiate an emergency “hold” for up to 72 hours if they reasonably believe a person is unable or unwilling to cooperate with voluntary treatment. Civil commitment is the involuntary restriction of a person’s liberty by a civil proceeding on the basis that the individual is in need of treatment or care for certain mental health, developmental disability or substance dependency issues in order to protect the individual or others from harm.

The committee discussed six draft bills that would change the shape of the current processes. The committee will meet again in December to discuss the priorities further before voting on which bills should move forward for consideration by the Legislature.

“The idea here really is to roll up our sleeves and work together as a committee to turn these bill drafts into something that is workable, and that the Joint Legislative Council feels comfortable introducing in the next legislative session,” committee co-chair Sen. Jesse James (R-Altoona) said at the beginning of the meeting Thursday.

One issue the committee has focused on is limiting the number of children with severe mental health challenges who are sent out of state for care. According to the Wisconsin Department of Children and Families, from 2019 through 2023 there were 517 children placed out of state. Of those, 78 of them were placed out of state in 2023.

The committee discussed multiple bill draft variations that would help the issue by supporting the creation of psychiatric residential treatment facilities — or PRTFs — in Wisconsin. The Legislative Fiscal Bureau has described them as long-term facilities that typically offer treatment for children diagnosed with psychiatric conditions, including bipolar disorder, disruptive behavior disorders, substance use disorders, severe emotional disturbance or post-traumatic stress disorder.

Wisconsin does have three youth crisis stabilization facilities, but those are short-term facilities with a maximum of eight beds. There are currently no PRTFs in the state.

James and Gov. Tony Evers both proposed initiatives for creating the facilities in the last legislative session but neither was successful.

The committee considered three variations of drafts that would allow for the creation of the facilities. The first would allow the Department of Health Services (DHS) to certify the facilities  to provide inpatient psychiatric services for individuals under age 21. Another one would require DHS to establish five of the facilities. The final measure allows DHS to certify the facilities, to limit the number of certifications it grants to operate a PRTF and would require DHS to request $500,000 in each year of the 2027-29 biennial state budget for the purposes of implementing PRTF certification. Some of the specific numbers are placeholders and could change.

Committee members acknowledged the role that the cost of the facilities could play in whether they would be built. Sharon McIlquham, assistant corporation counsel for Eau Claire County, said that the facilities would need to be required by law.

“If DHS isn’t required to do it, it’s not going to happen because I don’t know that those incentives are going to be enough for a private entity to take on the liability, the cost,” McIlquham said. “I understand there’s a huge budget impact, but… if we don’t require them, I don’t think it’s going to happen.”

“We don’t create things we can’t sustain,” Jill Chaffee, Lutheran Social Services of Wisconsin’s vice president of community based services, said. “A really big issue that we have is that you have a grant and yes, that’s super helpful and appreciated to start a program, however, then you are fully dependent upon the billing of fee for service or different payers.”

Sen. LaTonya Johnson (D-Milwaukee) pointed out that securing state money could be the biggest obstacle to creating the facilities. Wisconsin is expecting to have a $4 billion budget surplus by the end of the current fiscal year and it will be a major point of discussion in the budget writing cycle next year, however, Republican leaders have cautioned that the money will not be used to grow the size of government.

“There is no money in the budget that specifically enforces…and we all understand why. They would have to rely on Joint Finance putting those funds, specifically for this cause, and as a member of Joint Finance, I can honestly say that we don’t always do what we are supposed to do or appropriate some money that we should,” Johnson said. “They’re already operating on a limited budget but then because of this bill, if it did go through, they would be forced to do with that limited budget and that jeopardizes other programs.”

Johnson added that the program is necessary but without a set dollar amount and the guarantee that the money will be allocated the proposal will face an uphill battle.

James agreed, saying that he doesn’t think any of their colleagues would be supportive of a mandate.

Changing minor consent requirements

Another proposal would amend the minor consent law when it comes to emergency detention.

Currently, state law requires that both a minor age 14 or older and the minor’s parent or guardian consent to outpatient or inpatient mental health treatment. If consent is declined by the parent or child, the other party may petition for review and approval of the treatment.

The proposal discussed by the committee would change this to instead say that either a minor age 14 or older, or a parent or guardian, may consent to outpatient or inpatient mental health treatment.

Green Bay Police Department behavioral health officer Sheila Carlson said the change is supposed to help address the issue of parents having to go home with a child if they refuse treatment and need to file a petition.

“Once kiddo goes home, that’s when things start to get a little hairy, where parents are concerned and not really sure what to do,” Carlson said.

Deputy State Public Defender Katie York said that she was concerned about whether not requiring consent could reduce the effectiveness of treatment.

“If the statute says you don’t need consent from the kid, is that going to encourage the practitioners to… not sufficiently seek consent, and is that going to negatively impact the treatment going forward? I would envision, if you can get buy-in from the kid, it’s going to be much more successful than, well, we don’t even need your consent, your parents signed off on it,” York said. “I don’t know if that works in the real world.”

Expanding who could initiate minor emergency detentions

The committee also considered creating an alternative way for initiating the emergency detention of a minor by allowing medical and behavioral health clinicians to initiate the emergency detention of a minor. Currently, only law enforcement officers are allowed to initiate the detention of someone an officer believes is “mentally ill, developmentally disabled or drug dependent” based on observable behavior that the individual is “dangerous” to themself or others, and a county department of community programs must approve the need for detention and the need for evaluation, diagnosis and treatment.

The draft that the committee looked at would define clinicians as a psychologist, psychiatrist, psychiatric nurse practitioner, physician, physician assistant, private practice school psychologist, marriage and family therapist, professional counselor, advanced practice social worker, independent social worker, clinical social worker, clinical substance abuse counselor, or independent clinical supervisor. It would also require a “clinician” to be in good standing and may initiate an emergency detention only if the clinician has been certified to do so by DHS.

McIlquham of Eau Claire County said the list included in the draft was too broad and expansive.

“You start small and you can always expand it later,” McIlquham said.

Carlson of Green Bay, however, said that she has been involved in many cases with children where police aren’t necessarily needed.

Kids “are not combative,” she said. “They’re just reluctant, scared and confused, and then you bring in a cop and then there’s combative components to it.”

Wisconsin Psychiatric Association President Tony Thrasher noted that some health systems may not allow their employees to do it.

“I don’t think they’re going to take on the liability. I don’t think they’re going to agree to it.. Now that roughly 93% of all physicians are employed by large health systems, I just don’t think they’re going to let them do it. I think there’s a liability, once you start detaining them, that’s going to cause financial conflict and placement conflict, and if you’re allowed to detain them, why can’t you treat them where they’re at? How can you have the power to detain and then not care for them and ship them somewhere else?”

The committee also discussed a bill draft that would standardize the creation of a safety plan, which would be created by a minor with behavioral or emotional challenges and a facilitator, and then require DHS to develop and maintain a portal that is available throughout the state to facilitate sharing of safety plans among safety plan partners.

Study committee considers creation of new mental health treatment facilities was originally published by Wisconsin Examiner.