For Bonnie Richardson, taking her medication is an important part of staying out of trouble.
The 52-year-old Stoughton resident reports being treated for anxiety, attention deficit disorder and bipolar disorder. She has gone to prison twice, for drug trafficking and drunken driving.
But obtaining her prescribed medications is a constant struggle.
“I’m really worried now that I got a doctor, I can’t afford my meds,” said Richardson, who has no permanent address. “Now they want to put me on another mood stabilizer, because I worry.”
Despite the wake-up call sounded nationwide by recent mass shootings, huge gaps remain in how Wisconsin treats people with mental illnesses who run afoul of the law. State and county officials blame a shortage of psychiatrists, growing demand for services and high medication costs.
About a third of the men and two-thirds of the women in Wisconsin prisons have mental health conditions, according to a 2012 state prison report. Of the approximately 21,700 prisoners in the state system, more than 5,000 are taking medications to treat mental illnesses.
State prison inmates are generally released with two weeks of pills and a four-week prescription. County jail inmates often get less than that, as little as three days of pills. They may run out before they get through the wait lists for county mental health services.
Jule Cavanaugh, reentry director for the Wisconsin Department of Corrections, acknowledges that many inmates with mental illnesses are not getting sufficient post-incarceration care.
“At the end of the day, they need psychiatric care in the community and access to medications,” Cavanaugh said. “Without being stable, it’s very difficult for them” to address their criminal histories and tendencies.
Keisha Russell, founder of Infallible Helping Hands in Milwaukee, an advocacy group that aids female offenders, said newly released inmates must jump through numerous hoops and may prioritize food and shelter over refilling their psychiatric medications.
“A lot of times (offenders) end up going back to get drugs, and end up reoffending,” Russell said. “It’s a vicious cycle that keeps going and going.”
Four years ago, a state Legislative Audit Bureau report concluded that “recidivism may be reduced by improved management of mental illnesses and continued emphasis on release planning.” But advocates for people with mental illnesses say reentry services remain inadequate.
“When they leave here, most people don’t have insurance. Most people don’t have a doctor,” said Dan Barth, a social worker at the Portage County Jail. They may struggle to prioritize mental health needs and “rekindle an interest in drugs and alcohol” on release.
“To keep them properly medicated is really a challenge,” said Barth, who helps get inmates on waiting lists for county mental health services before their release. “If we haven’t connected with a psychiatrist, got on that waiting list, that’s where there can be a problem.”
Barth said county mental health services in and out of jail “have shrunk because of fiscal pressure.” The wait lists in some counties, including Dane, can extend for months.
Kristin Kerschensteiner, managing attorney for Disability Rights Wisconsin, a nonprofit advocacy group, said the state’s pool of psychiatrists is already small, and a significant portion do not accept patients on BadgerCare, the state’s Medical Assistance program, because of low reimbursement rates.
“It all comes back to the dollar,” she said, referring to psychiatrists. “If you got the money, they got the time.”
Kerschensteiner said ex-prison inmates have a better shot at getting mental health resources than those exiting county jails. The state’s Disabled Offenders Economic Security Project helps selected prison inmates sign up for Social Security or health insurance upon release.
But Barth said only a few of the state’s county jails have someone like him working to help former inmates find services. Often, Kerschensteiner agreed, “when someone leaves jail, they get nothing in terms of support.”
Mina and Tony Esser of Madison said their 22-year-old son, who has been repeatedly jailed for charges including theft and drug possession, always struggles to get connected with services. He suffers from depression, anxiety and attention deficit hyperactivity disorder.
“Every time he’s released, he’s just in survival mode,” Mina Esser said.
“It was easier to get street (drugs) than go to a doctor,” Tony Esser added.
Getting the treatment
Dr. Kevin Kallas, mental health director for the state Department of Corrections, said the state tries to bridge the gap between prison and the community. For instance, the Milwaukee region’s Community Corrections office employs a psychiatrist and the Dane County region contracts with a psychiatrist.
According to Kallas, “every state struggles with this as an issue” and few if any states offer more than a month of medication in hand to released inmates.
“The longer the prescription for medication, the less incentive there is to follow up with community providers in a timely fashion,” Kallas said.
Kallas and Cavanaugh, the DOC’s reentry director, agree that Wisconsin needs more mental health resources in the community.
Following the 2009 Legislative Audit Bureau report on the advantages of treating inmate mental illness, the Legislature created the Becky Young Community Corrections Recidivism Reduction Plan. This $10 million annual appropriation helps medium and high-risk offenders with significant mental illnesses transition back to their communities.
One initiative, Opening Avenues to Reentry Success, began in the Fox Valley and southeast Wisconsin in 2010. OARS seeks to connect individuals with housing, employment and psychiatric resources. In 2011 the estimated cost was $15,000 a year per person, compared to $32,000 for incarceration.
The program had served 176 offenders by mid-2013, Cavanaugh said.
And Green Lake County is using a grant from the Becky Young fund to improve the mental health treatment of county jail inmates.
“What we’re trying to do is create a milieu that facilitates recovery,” said Philip Robinson, the county’s deputy director for health and human services. “We partner together on behalf of inmates and see much better outcomes.”
Obstacles against them
Mark Schulke of Plainfield is an alcoholic and a repeat-offense drunk driver. He said his diagnoses include bipolar disorder, agoraphobia and depression.
He has managed to stay out of trouble for years at a time. But in 2012, he lost his health care coverage under Medicaid, and things went downhill fast.
“We were struggling,” said Schulke, 51. “I borrowed money from friends and family to pay for my prescriptions. I ended up not getting them.”
Schulke said he sought help from his psychiatrist and Waushara County human service officials, to no avail. He spiraled back into drinking and depression.
In April 2012, in what he calls a suicide attempt, Schulke drunkenly drove his truck into a tree. That led to his 10th conviction for driving while intoxicated.
James Hawk, resource specialist for Madison-Area Urban Ministry, an interfaith organization that offers support to offenders, said ex-inmates need help in major “life areas” like housing, work, social and family support, as well as physical and mental health.
“All these areas need to be addressed when an individual is coming out,” Hawk said. “Especially with obstacles that are against them, the landlords, the employment issues.”
Bonnie Richardson’s last offense, in January 2011, was for drunken driving. She was released in April 2012 after spending time in Taycheedah Correctional Institution and the Dane County Jail. She is homeless and moves from house to house among friends and the elderly clients she cleans for.
Richardson, who used to be treated for bipolar disorder, is now seen at the Shalom Holistic Health Services in Stoughton for attention deficit disorder and anxiety. She fidgets and seems slightly agitated as she shares her experiences in an interview.
“Right now I can focus, but it was really bad when I first got out,” Richardson said. “I was just setting myself up for a failure again, because of mental health.”
Richardson is optimistic that her situation may improve under the Affordable Care Act, which will allow her to obtain health insurance. And Wisconsin, while cutting Medicaid eligibility for some, is expanding it for others who are very poor. (See sidebar.)
On Oct. 1, Schulke was sentenced in Portage County for his 10th OWI. Circuit Court Judge John Finn gave him five years in prison followed by five years on extended supervision, saying he hoped Schulke would get the treatment he needs in prison.
“County jails,” Finn said, “are not places for rehabilitation of persons who have long standing problems.”
Schulke said he is committed to staying sober. In a letter from jail, before his sentencing, he wrote, “I only hope to get medication when I get out.”