Republicans’ budget means the continuation of Wisconsin’s mental health crisis

In his annual “State of the State” address, Gov. Tony Evers declared 2023 to be the “year of mental health.” Citing a “quiet, burgeoning crisis” that would have “catastrophic consequences” if not treated immediately, Evers said he would seek hundreds of millions of funds from the state legislature to fill workforce shortages, expand access to critical services, and bolster the prevention of suicide and self-harm. 

That was in January. 

Last week, nearly half a year later, both chambers of the Wisconsin Legislature passed a government funding package that leaves out the vast majority of the mental health reforms Evers proposed – without including substitutes.

Today, Evers has signed a state budget that contains few if any of the measures he has described as urgently needed.

The number and the size of programs that Republicans have eliminated from the budget is substantial. While party leaders have advertised the legislation’s $3.6 billion tax cut, targeted primarily at the wealthiest filers, their budget eliminates over $478 million in spending on mental health programs proposed by Evers. Notably, that figure does not include Evers’ proposal to expand access to BadgerCare – Wisconsin’s Medicaid program – to individuals living at up to 138% of the Federal Poverty Level, which would be almost entirely financed by the federal government.

At this point, Republicans’ refusal to expand BadgerCare is not a surprise. In a recent interview, Assembly Speaker Robin Vos said he would “sooner resign” than give in to supporting the expansion, which has the support of a supermajority of Wisconsin voters, and has been adopted in all but 10 states. But Republicans did more than reject the “big ticket” programs primed to engender ideological backlash. Instead, they deleted from the budget numerous modest but meaningful reforms that aim to expand mental health services into parts of the state where the lack of available treatment options has created crisis conditions.

An important example here is support for Wisconsin’s strained mental health workforce. Even before the COVID-19 pandemic, 52 of the state’s 72 counties were designated as “Health Professional Shortage Areas” for mental health, meaning that the ratio of residents to psychiatrists is 20,000:1 or higher. Since then, things have only worsened, with serious provider shortages throughout the state. This is one reason why the Wisconsin chapter of the National Alliance on Mental Illness (NAMI) has supported increasing Medicaid reimbursement rates for behavioral health providers, bringing compensation “on par with surrounding states and into alignment with costs.”

Inadequate reimbursement rates are a significant contributor to the state’s ongoing provider shortage, notes Mary Kay Battaglia, NAMI Wisconsin’s Executive Director. What does that mean on the ground? “On a daily basis, it means I get a phone call from a mom whose teenage son has just attempted suicide and they can’t get an appointment with a psychiatrist for nine months,” Battaglia said.

Evers’ budget included $17 million to support raising reimbursement rates for behavioral-health providers. Republicans on the Joint Finance Committee deleted this provision. GOP leaders did not justify their decision or its potential impact on mental health beyond vague statements about the Governor’s “reckless spending” of “Monopoly money.”

This is just one small, but significant, example. As the Wisconsin Legislative Fiscal Bureau’s 664-page Comparative Summary of Budget Recommendations shows, there are numerous others. In one case, the Joint Finance Committee zeroed out a proposal to enhance funding for the state’s Community Support Programs (CSPs), through which county and tribal governments “offer coordinated professional care and treatment for adults who live with severe mental illness.”

CSPs provide a range of services in the community that can prevent the need for admission to a more restrictive, institutional setting. Advocates for mental health, including NAMI Wisconsin, had requested additional funding for the program. The Wisconsin County Human Service Association reports that small, rural counties face fiscal limitations that prevent them from making adequate investments in CSPs. Yet the Joint Finance Committee stripped additional funding for the programs out of the budget.

Battaglia said she was “very disappointed” in the Legislature’s failure to provide CSPs with the support they need, especially given that these programs actually help to reduce the need for crisis services, which are often costly as well as traumatizing for people experiencing mental health crises. “You can either pay for it now, or you can pay twice as much later,” Battaglia said.

That brings us back to the Governor. In a brief ceremony this morning, Evers signed the budget, while issuing 51 partial vetoes and urging the legislature to “complete their work on this budget.” But while partial vetoes will allow Evers to block and reshape some key provisions of the legislation, they will not restore the level of funding for mental health Evers proposed in his budget, and which organizations like NAMI Wisconsin have been calling for. And, if special sessions of the legislature in previous years are any indication, it will be difficult for Evers to force Republicans to go back to work on mental health, a subject which barely received a mention during his signing ceremony, despite being at the center of his State of the State address in January.

So for now, Wisconsin’s “quiet, burgeoning crisis” in mental health seems likely to continue.

If you or someone you know is struggling with mental health, substance abuse problem and/or thoughts of suicide, call the free and confidential 988 Suicide & Crisis Lifeline. You can also text HOPELINE to 741741 for the free and confidential Crisis Text Line.

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This is a guest column by Phil Rocco, a political scientist and the author of Obamacare Wars: Federalism, State Politics and the Affordable Care Act. He regularly writes about Wisconsin politics at The Recombobulation Area.