In Milwaukee, like many communities across the nation, deinstitutionalization of the mentally ill produced some significant problems. The release of thousands of the chronic mentally ill from institutions began in the early 1970s without sufficient reallocation of resources. Without adequate intervention and support services, the untreated chronic mentally ill soon began to show up in large numbers in already overcrowded local jails. Law enforcement officials, finding that access to health care systems was severely limited, had few options beside arresting and confining the mentally ill when their behavior became disruptive or dangerous, even though such behavior was often directly related to their illness and treatable.
In response, the Wisconsin Correction Service (WCS) developed a treatment program known as Community Support Program (CSP), which seeks to keep mentally ill offenders out of jail and out of the hospitals, and allow them to live independently in the Milwaukee community.
WCS-CSP, established in 1978, provides a resource for the judiciary that allows court officials to make reasoned judgments about treatment needs. It also expands opportunities for the mentally ill to be released from custody because court officials are confident that the basic needs of the client will be provided for, adequate treatment will be furnished and compliance with treatment will be monitored to enable the person to reside safely in the community. The WCS-CSP provides a workable, affordable response to the long-standing problem of deinstitutionalizing the mentally ill.
The WCS-CSP has also developed a system of specialized casework services that enable its clients to successfully reside in the community. A core team of casework specialists is augmented by housing coordinators, money managers, a psychiatric nursing team, a SSI/public assistance coordinator, a medical director, and the only free standing pharmacy in the state of Wisconsin dedicated to a CSP modality. Clients are chronically mentally ill residents of Milwaukee County who are involved in the criminal justice system as defendants in criminal cases, prisoners in local jails, or under the supervision of a state probation or parole agent. Consistently, 1,000 are involved in the local criminal justice system. A gatekeeper system has been developed by WCS in the Milwaukee County criminal justice system that identifies mentally ill offenders and intervenes on their behalf. Approximately 400 offenders are enrolled in the WCS-CSP on an annual basis. The program has an ongoing caseload capacity of 250 clients.
The ratio of mentally ill offenders in the jail population evidences the success of the program. In Milwaukee County, only 3 percent of the jail population in 1989 and 5 percent in 1988 were diagnosed as mentally ill while in other communities, the ratio of mentally ill in the jails is closer to 15 percent and poses a serious problem. The other important indicator of success is the program's ability to engage clients in its services. The measure that best indicates performance in this area is client attendance. Clients are asked to visit the CSP on various schedules, based on their stability in the community and type of medication. There are typically over 900 scheduled medication visits for clients in a one-week period. In both 1988 and 1989 the attendance rate averaged 94 percent.