Update 2: A Milwaukee County Bureaucrat’s Immoral Utilitarianism

I’ve posted twice before about the disordered policy of John Chianelli, who runs Milwaukee County’s Mental Health Complex (The MHC is now named the Behavioral Health Division, and those writing about this issue may use one term or the other.)

Chianelli implemented the policy of mixing female mental patients with potentially violent male patients, on the perverse theory that the presence of women would work a trade-off between male on male violence for male on female sexual assault. See, A Milwaukee County Bureaucrat’s Immoral Utilitarianism and Update: A Milwaukee County Bureaucrat’s Immoral Utilitarianism.

There’s yet more to this story….

Persistent Patient Fears. The Milwaukee Journal Sentinel reports, in a story entitled, Advocates seek reform at County Mental Health Complex that

Former patients of the county’s psychiatric hospital often greatly fear the possibility of a return stay because of a hostile and sometimes unsafe atmosphere, said Melissa Butts, who coordinates the complex’s Office of Consumer Affairs.

“All we want is the suffering to stop,” Butts said. She works for Our Space Inc., which runs the office under contract with the county.

She spoke at a Milwaukee Commission on Domestic Violence and Sexual Assault subcommittee, which discussed fallout from a federal investigation into sexual assault of patients by other patients at the complex.

The federal Center for Medicare & Medicaid Services in January found multiple reports of assaults and threatened to cut off the county psychiatric hospital’s federal funding. The threat was lifted in April after corrective measures were taken, including staff retraining and better patient monitoring.

Abuse victims and advocates should urge county officials to consider major changes in the way mental health services are offered, said Barbara Beckert, manager of the Milwaukee office of Disability Rights Wisconsin. The group, designated under state law to protect patient rights, is conducting its own investigation of the complex.

Understandably, as the Journal Sentinel reports, patient advocates would prefer that this issue be kept from politics. Readers will note I have emphasized principally Chianelli’s policy, rather than that of Milwaukee County Executive Scott Walker. Chianelli should and must go; Walker should consider what it means to allow Chianelli to stay. The imperative rests with removing Chianelli, as a part of a reform effort.

Nevertheless, incumbent county executive and gubernatorial candidate Walker’s prompt defense of Chianelli’s policies was sadly predictable, presumptuous, and tainted of politics.

Chianelli’s Dodgy Scholarship? Curiously, a psychologist’s preliminary review of literature supporting the practice of trading male-on-male violence for male-on-female violence apparently finds…no scholastic corroboration. From a post entitled, When Violence Strikes on a Psychiatric Ward, John M Grohol, PsyD writes that

Taking John Chianelli at his word, I went and combed through the research literature to see where I might find data to support his hypothesis that men in an inpatient setting would be less violent if housed with women. After spending about an hour and putting more than a dozen different queries into PsycINFO, a common research database, I couldn’t come up with anything (In contrast, usually it takes me about 5 minutes to find a citation I need to support a hypothesis I’m interested in).

What the research does show is that ward crowding leads to higher incidents of violence. It’s not clear if ward crowding is just the lack of physical space in such a facility, or also the lack of ‘psychological space’ ? that is, privacy.

Now, certainly Mr. Chianelli is entitled to his opinion. But unless he has some scientific data to back up his hypothesis, he should not be experimenting on human subjects in this manner. I’m certain Mr. Chianelli’s ego can take the hit in consideration of putting his patients’ safety concerns first.

Patients aren’t guinea pigs. If your patients are suffering from sexual or violent assault at the hands of your other patients, it’s human management 101 to separate out the two groups until you’ve gotten the situation under control.

It’s a sad situation in Milwaukee County and I hope the County Board gets a handle on this important public mental health issue sooner rather than later. Why put patients in harm’s way when an easy solution [separation by gender] is readily available?

Note also that Chris Liebenthal of Cognitive Dissidence
has two thorough posts on the mismanagement and perverse policy imposed on vulnerable mental patients. The first, Walker Could Have Avoided BHD Problems Three Years Ago summaries the practical and political environment nicely: “But even more important than Chianelli’s future with the County is that Scott Walker needs to be held accountable for again putting his political aspirations before the best interests of the county that he is supposed to be leading.”

Liebenthal has a longer, and detailed, account entitled, BHD Problems Could Have Been Avoided Three Years Ago. Here’s just a portion of it:

But then Dr. Wiedel [Chief Psychologist and Director of Legal Services at BHD from 1999 to 2008] told me something I [Liebenthal] was not been previously aware of.

In 2007, in response to the increasing number of incidents of physical aggression, Dr. Wiedel took it upon himself to design and write up a full proposal for a secure unit to deal with the more aggressive patients that they had been dealing with.

The proposal made it through the various levels of bureaucracy until it actually made it to Scott Walker’s desk for his consideration for the 2008 budget. Unfortunately, Walker chose to reject the proposal, which would have prevented the horrific events that are currently being played out.

Dr. Wiedel told me that in January 2008, he learned from Chianelli that Walker rejected the plan, in part, due to Chianelli speaking against the plan. A couple of months after this, BHD was cited by the state for having too many incidents of physical aggression, making the citations this year the second time in three years that the security and staffing at BHD was found to be inadequate.

I would urge readers to visit Milwaukee First and read Liebenthal’s entire post, linked above.

Reaction. I have no preference among the three major candidates running for governor this year. Of them, Scott Walker defends Chianelli’s policy, Tom Barrett opposes it, and Mark Neumann doesn’t want to comment. Too funny, though, are Neumann’s remarks about not commenting (as the Journal Sentinel story I’ve cited above reports those remarks):

I prefer not to take another opportunity to say something negative about my opponent,” Neumann said at a campaign stop in Madison.

Another opportunity”: that’s very clever, actually. Walker’s on the wrong side of both policy and politics in this matter.

The Journal Times of Racine has an editorial, entitled, Abuse for abuse not a good trade that describes Chianelli’s detestable policy:

Chianelli reportedly told the committee, “It’s a trade-off. Putting 24 aggressive male patients into a male-only unit would increase the level of the violence in the unit.”

So you compromise the safety of female inpatients and put them at greater risk of sexual assault in order to reduce male-on-male violence in a segregated unit?

What a bizarre and frightening “trade-off” – a Faustian bargain if ever there was one….

How cynical is that?

….But there are more problems than that at the Mental Health Complex.

The federal government earlier this year threatened to withhold millions in Medicaid and Medicare funds after it found multiple instances of improper patient sexual contact. It then cleared the health complex after another inspection in March.

County board members have also expressed dismay over Chianelli’s communication with them, saying he hasn’t kept them promptly informed of the rise in sexual assaults last year, the federal investigation or a $3.6 million deficit in his division.

Clearly, Chianelli faces a host of problems and will have to answer for them. There is nothing illegal about mixed-sex housing of patients at mental health facilities and there may be therapeutic value to that.

But to take a stance that one patient’s right to be free from sexual assault risk can be bartered away to less expensively reduce the overall violence among males in such a facility goes beyond callous.

If Milwaukee needs to spend additional money to make its facilities secure and keep patients from harm – male or female – it should do so.

Chianelli doesn’t appear to be the right administrator to get that done.

He should be asked to choose between the lesser of two personal evils: resign or be fired.

That’s a better trade-off than he offered his patients.

Yes, go he must, and the sooner the better.

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