How does a new mental health facility fit into the county's infrastructure picture?

The decision last week by Milwaukee County's Health and Human Needs Committee to "put the brakes" on planning for a new inpatient mental health facility - as reported in the Milwaukee Journal Sentinel - was welcomed by many mental health advocates, who have been urging the county to prioritize community-based care and substantially shrink its inpatient capacity. That sentiment is largely consistent with the recommendations of a national consultant - the Human Services Research Institute - contained in a 2010 report co-authored by the Public Policy Forum.

But also embedded in the committee's decision - as reflected by comments from the county executive - is the encouraging recognition that any possible new mental health complex must be considered within the context of the county's overall infrastructure needs.

For the past several years, as supervisors and administrators have argued over where and how large to build a new mental health complex, they have done so without the perspective of an overall facilities management and capital financing plan. Such a plan is needed not only to provide a clearer picture of the breadth and cost of the county's total infrastructure challenges, but also to assess how a potential significant investment in a new mental health complex will jive with the county's limited borrowing capacity.

The need for such a plan also was hammered home last week by a new report from the county's parks director, which recommended spending $15 million in each of the next five years to address a significant infrastructure backlog.

To put that request into context, the county currently has a policy that caps annual borrowing for capital needs at a little over $30 million. That means if policymakers heed the recommendation and want it to be part of the county's annual general obligation bonding, then almost half the annual allotment would be used simply for repairs and maintenance in the parks. That, in turn, would leave little room for capital needs related to the Zoo, Courthouse Complex, corrections facilities, information technology, transit, economic development, and county trunk highways.

The good news is that per a recommendation of its Long-Range Strategic Planning Committee, the county has hired a consultant to perform a comprehensive analysis of its existing infrastructure and help develop a master infrastructure plan. It is within the context of that planning process and the ongoing deliberations about the nature of the county's mental health care delivery system that the discussion about a new mental health complex would best proceed.