By Steve Schultze of the Journal Sentinel
Posted: Nov. 7, 2009
After nearly 15 years helping patients discharged from Milwaukee County’s Mental Health Complex cope with life in the community, occupational therapist Kari Held faces an uncertain future and coping issues of her own.
Like hundreds of other county employees, Held has a job that has been targeted for elimination next year by County Executive Scott Walker. Her $53,000-a-year pay is one small part of Walker’s overall plan to trim $80 million in costs to avoid a deficit next year without raising taxes.
Held also is blind. She has found ways to thrive in her chosen field, but her disability could make it harder to deal with a pink slip or transfer to a different county job.
The County Board votes on the 2010 budget Monday. If it follows a committee recommendation, Held’s job would be restored, but her program also could be scaled back. Walker also could veto money for Held and her colleagues.
Held’s job represents a microcosm of the larger drama over jobs and services playing out hundreds of times over in the budget, from outsourcing security and housekeeping jobs to outright cuts. Employee pay and benefit reductions also are on the line, as well as a new $20 motor vehicle registration tax favored by some supervisors as a means to lessen the trims.
Walker has defended hard choices – assorted cuts and restructurings – in his budget as a means of avoiding a property tax increase. His plan would hold the levy at the same $257 million level as this year’s.
Held’s seniority could work in her favor as far as shifting into another county job, but such a change would be disappointing and full of special challenges, she said.
“It’s really sad,” said Held, 43. “I’m pretty upset about it.”
She has run group therapy sessions at the complex’s day treatment program, working with schizophrenic and bipolar patients as part of a “stabilization and recovery team” that includes nurses, social workers, a psychiatrist and a psychologist. The patients she sees return to the complex after they’re discharged for half-day sessions four times a week on anger management, recognizing symptoms of their illness and other coping skills.
“We guide and we motivate,” is how Held describes her team’s work with patients.
Patients attend sessions for up to six months, with state medical aid covering about half the cost for low-income patients.
Held says she loves the job and values her co-workers, who sometimes help her with little tasks such as transcribing her patient notes. Her guide dog, Trista, accompanies her during the day and often helps makes an easy connection with patients, Held says.
Shifting to another job
Held might be able to “bump” a less senior therapist at the complex, likely in the adolescent treatment center. And while Held is willing to do that if necessary, others question whether that change coupled with her disability would expose her to danger.
Given her disability, another bumping option not likely to work for Held would be traveling to patient homes to provide outpatient care, said Stephanie Bloomingdale, public policy director for the Wisconsin Federation of Nurses and Health Professionals.
While Held’s job would cease at the end of the year under Walker’s plan, some of her colleagues’ jobs continue until they quit or retire.
Walker’s budget describes the changes in the day treatment programs as a redesign aimed at providing “best-practice treatment to high-risk individuals with serious mental illness.” Instead of two day treatment teams, the county would have one that uses a treatment model called “dialectical behavior therapy.”
That type of treatment has not been used in the past with the types of patients assigned to Held’s team. She’s skeptical it can work with them.
“This is kind of the end of day treatment as we know it,” Held said.
Patient advocates say that curtailing the day treatment for patients with schizophrenia and bipolar disorder when they are discharged worsens their recovery chances and likely will lead to relapses and more hospitalizations.
“This is leaving a gap in the continuum of care,” said Barbara Beckert, Milwaukee director of Disability Rights Wisconsin. “It doesn’t make sense from a fiscal point of view or from a perspective of human suffering.”
John Chianelli, administrator of the county’s Behavioral Health Division, said some of the patients with more serious illnesses might still be able to stay in day treatment. Others will likely have other programs through the county or elsewhere, Chianelli said.
He said abolishing one of the day treatment teams wouldn’t necessarily lead to more patient relapses and hospitalizations.
He also said dropping one of the day treatment teams was not prompted solely by budget concerns. The changes proposed for the day treatment program would save some $342,000 next year, including Held’s salary.
Walker issues his vetoes by Nov. 18, when the board considers possible veto overrides.