More mental health patients being transferred from Mendota Mental Health Institute to Sand Ridge – Milwaukee Journal Sentinel

In an effort to free up more mental health bed space in the state’s overwhelmed criminal justice system, the Wisconsin Department of Health Services is sending more of its mental health patients to a facility that has traditionally treated sex offenders.
In February, the Department of Health Services established an inpatient unit at Sand Ridge Secure Treatment Center, a treatment facility in Mauston traditionally meant for sexually violent persons. The unit will serve 20 male clients for competency treatment, a program typically provided at Mendota Mental Health Institute in Madison instead.
Competency treatment is for people who are deemed unable to stand trial due to mental illness, substance abuse, or developmental disabilities, and must be given treatment before their court proceedings can continue. They have not been found guilty.
On the other hand, people in the sexually violent persons program at Sand Ridge have been convicted of sex offenses and have already served their prison sentence. They are sent to the facility to reduce their risk of reoffending before being released.
Since February, 12 people have been sent to Sand Ridge for competency treatment under the new program.
In an email, the Department of Health Services said the decision to transfer patients to Sand Ridge is in response to “increased need.”
From 2016 to 2023, the number of people referred to the department for competency treatment has increased drastically, from 352 to 877. According to attorneys who represent clients in competency proceedings, hundreds are on the waitlist for inpatient treatment, sometimes waiting for months for a bed space.
“As staffing allows, a key piece of our overall plan to address the needs of forensic patients includes opening up more of our seven facilities to them,” the statement said. “This gives patients access to the care they need as quickly as we can provide it.”
Starting in 2018, the Department of Health Services also began sending another type of patient — those found not guilty by reason of mental disease or defect, or NGI — to Sand Ridge. Sand Ridge currently has 60 beds for those patients, all men.
Over the years, 107 people who were found not guilty by reason of mental disease or defect have been sent from Mendota to Sand Ridge.
The decisions have concerned some who say Sand Ridge is not historically designed for the type of patients that the state is increasingly sending there.
Criminal defense attorney Craig Mastantuono believes the transfer could be a way to alleviate the strained system, but he said he would have concerns if patients from Mendota were subject to the same program and were mixed with patients from Sand Ridge.
“I don’t think you want to mix those populations,” Mastantuono said.
According to the Department of Health Services, the three types of clients at Sand Ridge are housed in separate housing areas, each with 20 units. Depending on individual circumstances, programming such as education can be shared.
Many attorneys and forensic psychologists say the transfer of patients to Sand Ridge is a reasonable solution to get more people into urgently-needed mental health treatment.
University of Wisconsin-Madison criminal justice professor Kenneth Streit said the new unit will allow people on the waitlist for Mendota and other state mental hospitals to get treatment at a civil facility sooner, with more access to personal space and state-trained medical professionals. Many are currently languishing in county jails.
“A person’s going to have much more contact with people who are aware of what their symptoms are and aware of how that person should be behaving,” Streit said.
Historically, Mendota Mental Health Institute and Sand Ridge Secure Treatment Center have served very different types of people. While Mendota Mental Health Institute serves people in a variety of circumstances, Sand Ridge handles a much more specific population.
As a result, experts said the mental health needs of the patients at the two facilities are very different.
According to forensic psychologists and criminal defense attorneys, patients at Mendota more often live with mental health disorders such as bipolar and paranoid schizophrenia.
In comparison, people at Sand Ridge more commonly struggle with sexual disorders such as sexual sadism and pedophilia, according to Michael Caldwell, psychology professor at University of Wisconsin-Madison and former staff psychologist at Mendota Mental Health Institute.
For people found not guilty by reason of mental disease or defect, also known as NGI, “your mental disorder has to be so disabling that you lack substantial capacity to control your actions,” Caldwell said. “In the [sexually violent persons] world, there has to be some amount of inability to control in there, but it’s nowhere near the level of the NGI situations.”
That being said, Caldwell believes some of the therapy and psychiatry skills required to treat people with sexual disorders are transferable to treating competency clients or people found not guilty by reason of mental disease or defect.
Many competency clients need education on how the court system works before they can stand trial, and Caldwell believes most counselors should be able to treat competency clients once they get training on the specifics of court proceedings.
Staff at Mendota are currently conducting training for staff at Sand Ridge, according to the Department of Health Services.
Given the wider range of mental health treatments and expertise Mendota affords, Mastantuono said Sand Ridge should have similarly-trained staff in place before more patients are transferred there.
“Post-convicted, sentence-served, civilly-committed, allegedly sexually-violent persons, with a very specific need to go through sexually-violent persons treatment programming, is entirely different from that,” Mastantuono said.
Criminal defense attorney Mindy Nolan says mental health needs vary greatly even within a group of people committed under the same program.
Nolan believes that treatments always need to be individualized and that extra training and care need to be taken to treat the new clients being transferred to Sand Ridge.
“If people are trained as psychologists or psychiatrists, they can adapt and work in a lot of different areas,” Nolan said. “But I also think that it is important to just recognize that this is a very different type of treatment.”
Even before COVID-19, the number of people in need of mental health services in Wisconsin was increasing. But the pandemic put even more strain on both the mental health and criminal justice system.
Mastantuono says he is seeing more criminal cases stemming from acute mental health crises than ever before.
“The country’s having a mental health crisis, and it’s definitely bringing more people into the criminal justice system, exacerbating the cases of those already involved in the criminal justice system (with) backlogs, delays,” Mastantuono said.
Given the cost and time it would take to build a new mental health facility, some experts say that opening more space at Sand Ridge is the best short-term solution under the circumstances.
“If you can temporarily find some other physical space and find the staff to do that, that’s generally a better approach than saying, ‘Let’s build ourselves a new facility,’” Streit said.
Of course, bringing new people to an established facility can lead to uncertainty and the risk of violence, but experts believe the risks are likely lower than if the patients were in other settings.
“It’s not a zero risk for any kind of violence in any kind of institution,” Caldwell said. “But places like Mendota or Sand Ridge are safer than most jails and prisons by far.”
Eva Wen is a data reporter for the Milwaukee Journal Sentinel. Reach her at


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