Needles are seen littering the pavement in Glasgow, Scotland. (Photo by Jeff J Mitchell/Getty Images)
With Milwaukee County continuing to set and break records for drug-related deaths year after year, demand is high for new treatment options. A recent Wisconsin Policy Forum analysis found both trouble and hope for Milwaukee’s recovery and treatment network. Wisconsin stands to receive more than $400 million from legal settlements with drug companies, with Milwaukee expecting over $70 million of those payments. The county’s looming budget crisis, however, has left its Behavioral Health Services (BHS) under-resourced and unprepared.
The Wisconsin Policy Forum analysis was conducted at the request of BHS leadership, who approached the organization in late 2021. Services for people struggling with Substance use disorder are centralized under the BHS Community Access to Recovery Services program. It’s a network of providers that specializes in connecting people who are at or below 200% of the poverty level with resources to start the journey to recovery. Many of the individuals served by recovery services have no health insurance.
According to the analysis, the annual recovery services budget for substance use rests at nearly $12 million. Expansions of insurance coverage stemming from the federal Affordable Care Act helped financially support the county’s services. Still, each year the demand for expanding recovery and harm prevention options becomes more pressing.
Last year Milwaukee County experienced 644 drug-related deaths, with the vast majority linked to various forms of the synthetic opioid fentanyl. Statewide fentanyl-related deaths increased by 97% from 2019 to 2021. In late August, the Milwaukee County Medical Examiner’s Office tweeted that the county is expected to see over 700 drug-related deaths by the end of this year.
Yet, despite the growing tide of deaths and the demand for treatment, major gaps in services persist. Milwaukee County’s recovery services are consolidated under the BHS. A summary draft of the 2023 county budget showed that BHS could expect a 5.3% cut in its budget next year. The Wisconsin Policy Forum analysis highlighted concern that BHS is unable to track whether people who enter a detox service are receiving follow-up services like therapy.
The Policy Forum analysis noted that “BHS has largely lost its ability to track the imbalance between demand and supply of residential treatment — including for special populations like women with children — because providers now bill Medicaid directly and maintain their own waiting lists.”
The analysis also found that BHS, “is challenged by the restrictions attached to its various funding sources, which often prevent it from allocating resources to populations and services that are most in need.”
Wisconsin Policy Forum interviewed six longstanding participant organizations in BHS’ addiction provider network. Many interviewees stressed a need for more residential treatment beds and a better way of coordinating their use. Bridge housing for those who have been discharged from residential treatment but need stable though temporary housing is also in high demand.
In addition to substances like fentanyl or heroin, alcohol is also an increasing concern among providers. In 2019, Wisconsin ranked third in the nation among adults who reported binge drinking within the last month. In Milwaukee County, alcohol-related deaths occurred at a rate of 63.2 deaths per 100,000 residents, above the statewide average of 49. Peer support, as well as support for peer support specialists, was also something interviewees emphasized. Burnout in the field is rampant. For hospital-based providers, gaps in the availability of detox beds and a demand for a centralized database of community-based providers were top of mind. Increasing sober housing and bridge programs, as well as workforce shortages, are also challenging hospital providers.
In conclusion, Wisconsin Policy Forum described Milwaukee County’s recovery landscape as “a fragmented and incomplete array of services by dozens of providers who operate largely in their own respective service lanes.” The analysis recommends that BHS invest in addressing these issues, particularly as funds from the opioid settlements are made available. Not only should gaps in services be addressed, but the analysis recommends that BHS accept its role as a “coordinator and gatekeeper” for these services.
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