Mental Health of the Missing: Systemic Inequities Persist

The Milwaukee man was 25 years old when he disappeared. He left behind a 4-month-old son. He was wearing a black jogging suit with gray patches and white Adidas sneakers when he left the house with no word to his family.

With the support of community activist and radio host Tory Lowe, his family made signs, planned rallies, held search parties, and spoke on radio shows as they longed for their loved one to return.

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Then, after a long 39 days, the man came wandering back. Lowe said he was wearing the same clothes he had left in, was extremely dehydrated, lost a lot of weight, and his arm was extremely bruised. Hortman had made it all the way to Chicago and back before he returned safely to his family.

But what this completed story doesn’t tell is the suffering that he faced. He was diagnosed with schizophrenia and had forgotten to take his medicine before he left. Media Milwaukee is withholding his name for his privacy.

“I don’t even think he knows what happened…they don’t take their medicine and they get into this world where they may get delusional,” Lowe said.

The man’s case brings up a larger issue in missing persons cases: mental health in minority communities.

Lowe said this is all too common in the missing persons cases he helps with. He estimated that roughly 30% of the cases he deals with are because of mental health issues. When asked how many mental health resources there are in the black community, he simply responded with, “Zero.”

“I started to notice that even when I would get them back home, the family would call me because the person that left out of the door didn’t come back the same and they didn’t have resources or people to connect to,” Lowe said.

It’s not just the people that Lowe advocates for, but larger inequities for minorities in mental health care. Whether it’s stigma or systematic structures, minority communities face unequal mental health struggles.  

Stigmas around Mental Health

Dr. Lakeia Jones, who is a leader with Black Clinicians Milwaukee, says while mental health stigma affects many people, because of the lived experiences of African-Americans, the stigma can be worse.

“In the African-American community, we still struggle with the notion of speaking up and talking about what we’ve been through,” Jones said. “History tells us that when African-Americans would talk about these things, we were more likely to be separated from our families. We would talk about something that happened in the home and we would be taken away from our parents.”

This stigma was seen in the case of Javeoni Buford. The 21-year-old African American man was close to his family, who described him as “fun,” “hard-working,” and “family-oriented.” They also said he was well-dressed and took pride in caring for his locs.

But his family knew something was off when Buford cut off his locs and stopped dressing nicely. These mental health issues spiraled in the months before he went missing, although it’s unclear whether they ultimately led to his disappearance, which hasn’t been resolved.

Fortunately, Jones says she’s seen improvement around these stigmas.

“These new generations, Generations X and Z, they do not care about what people were saying back in the day,” Jones said.” “They are so much more open to talking about things they have been through, experienced, and witnessed…they have been very instrumental in breaking those barriers.”

Structural Inequities of Mental Health Services

While stigmas are beginning to change, structural inequities in access press on. Minority communities often face discrepancies when seeking help with mental health. Dr. Gabriela Nagy is a professor at UW-Milwaukee who studies this inequity.

“What we tend to see is that the people who need the services the most are oftentimes the people who have the least amount of access,” Nagy said.

While minority communities can face language and immigration status barriers, Nagy said much of the problem lies with health insurance. Many low-income families are dependent on healthcare through the Affordable Care Act, better known as “Obamacare.” Healthcare providers have the ability to choose what insurance they do and don’t accept. For low-income communities who must rely on these programs, this means they are often left out of quality services.

“What happens is that usually the insurance that pays less tends to be offered to people who have lower resources, and so they might have fewer providers to work with right there that are available to them,” Nagy said.

This lack of access has fueled what Nagy calls a “mental health crisis.”

“Even if there was an increase in mental health care providers, the demand has been so high that we still have a lot of issues with people getting the care that they need,” Nagy said.

Online Telehealth

Meanwhile, because of the COVID-19 pandemic, healthcare providers have begun to shift their programs to online telehealth. Nagy says that access issues press on.

“The same kind of barriers that there were [pre-pandemic] for accessing mental health systems tend to still be there, especially for minority communities,” Nagy said.

Even while telehealth has become more available in recent years, concerns continue due to internet access in low-income communities. The Wisconsin Examiner reported that as of 2021, 18% of Milwaukee County residents didn’t have internet. These resources are typically drawn on many of the same boundaries as racial segregation, which largely remains active today.  

While this was combatted with the passing of the Affordable Connectivity Plan at the end of 2021, the U.S. Census Bureau’s most recent data says 14.7% of Milwaukee County families still don’t have broadband internet access.

Nagy also added that because of these large barriers to mental health treatment, patients will often go longer without treatment. This can lead to a “longer chronicity of symptoms,” where issues can become worse over time.

Jones adds that lack of treatment can make the issues worse, even leading to crime.

“When people don’t know how to deal with their mental health needs in a healthy way, it will result in unhealthy patterns of coping, which is drinking, smoking, doing other kinds of drugs, which of course will trickle down to crime,” Jones said.

This issue compounds itself for victims of crimes as well.

“If you have the victim, getting them in counseling right away is one of the most important things you can do,” Jones said.  “When these types of things happen, the first thing these people need to do is be connected with someone and someone they can talk openly about it.”

The Council on Criminal Justice found that in 2023, Black Americans were the most likely racial group to be the victims of violent crime.

Racial Validation in Mental Health Spaces

Jones was one of the creators of Black Clinicians Milwaukee. The website is a database and networking team of black therapists in the Milwaukee area.

“We would always hear, ‘I want someone that looks like me,’ there’s not a lot of black professionals in the field, so we created Black Clinicians Milwaukee,” Jones said.

But for Dr. Ajeng Puspitasari, the former Regional Executive Director of Clinical Services at Rogers Behavioral Health, racial validation in larger health systems still needs work.

“We need to definitely do better jobs in training our clinicians and system leaders to know how to welcome underrepresented minorities,” Puspitasari said.

This mishandling of the lived experiences of minorities can lead to what she calls “medical trauma.”

“Patients who went through complex medical systems and actually got traumatized in the process,” she said when defining the term. She added that this is often identity-related.

Puspitasari said that through her experience with Rogers Behavioral Systems, she’s seen small pockets of moves towards equitable practices, but not directly in systems she’s been involved in.

Milwaukee County Mental Health Systems

Lowe said that he had seen some good things from Rogers Behavioral Health, but felt many resources dropped with the discontinuation of Milwaukee County’s Mental Health Complex and Psychiatric Crisis Services (PCS), which closed in 2022.

“I guess they’re depending on individuals to make up the difference,” Lowe said.

PCS shutting down was part of a plan to redesign mental health services at the county level. The County’s Health and Human Services website says the Mental Health Complex and PCS were built over 40 years before their closure, and they were intended for patients to live there.

Because of “best practices in care and laws have changed,” the county transitioned to “community-based,” programs. This included a shift to reliance on the Granite Hills Hospital and the County’s Mental Health Emergency Center.

The Granite Hills Hospital is privately owned and operated by United Health Services, Inc., and is located in West Allis. The project cost $33 million, according to a press release by UHS. According to the U.S. Census Bureau, West Allis is a community that is almost 70% white, has a lower poverty rate than Milwaukee County’s average, and only 6% of residents are without healthcare.

The Mental Health Emergency Center is located close to downtown Milwaukee, in Milwaukee’s King Park neighborhood; the area code of 53205. The project received an investment of $18 million, just over half of the investment towards Granite Hills. According to the U.S. Census Bureau, the area code where the center is located, citizens have a 44% poverty rate, are almost 80% African American, and over 8% don’t have healthcare.

Where to Move Forward

Lowe sees these facilities as an issue that needs to be improved. He advocated for more crisis spaces for those who need them, adding that a family member should be a part of the process.

“If it was up to me, I would get like 16 acres, put a facility specifically for issues that are strictly not being dealt with, which is missing, PTSD trauma, families that are dealing with the trauma from homicides,” Lowe said. “I would have temporary facilities where they can come and spend 30 days and get them back out in society.”

He also criticized many of the advocacy over action positions common today.

“It seems like the only solution they have now is ‘I’m going to pay this guy a lot of money to bring awareness to mental health issues.’ With the money you spent to pay him, you could have put up a building,” Lowe said.

For Puspitasari, investment in research is critical.  

“It’s a multi-layer approach. I think number one is to strengthen our research infrastructure first, to understand what these communities are needing. What does culturally humble care look like for these communities?” Puspitasari said.

She added that training clinicians is important, but especially leaders of systems, who make decisions that affect all care.

“The second [layer] is to train, because we also don’t want to say, ‘all right, we can treat you,’ and then when they come, we worsen their traumatic experiences,” Puspitasari said. “So, train the workforce and the clinicians and the leaders first…providing or co-developing or co-learning with the communities on what type of interventions and services that these communities need.”

But for now, Jones sees hope in the future of mental health services.

“Being in the field for 25 years, I’ve seen a great increase in people reaching out for services and trying to get help and wanting to make changes in their lives,” Jones said.

If you or someone you know is struggling with mental health issues, please call 211 for mental health resources.

If you or someone you know is experiencing suicidal thoughts or ideation, please call (414) 257-7222, Milwaukee County’s Crisis Line.

Contributions to case studies by Carter Evenson and Tory Lowe

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This story is part of a semester-long investigative reporting project into missing people’s cases in Milwaukee and Wisconsin. It was created by an advanced reporting class in the Journalism, Advertising, and Media Studies program at UW-Milwaukee. Other stories from the project are available here.