Mental health advocates ‘optimistic’ about reforms in Michigan

Lawmakers have released six recommendations for easing the state’s behavioral health bed crisis
Meanwhile, a trio of bills aimed at early intervention passed the House in March, mirroring Senate efforts
Advocates say the moves signal a potential improvement of capacity and a shift toward proactive, community-based care

Policymakers are gaining bipartisan traction to reform Michigan’s mental health system with the introduction of new legislative recommendations and proposed reforms. The recent measures are renewing hope that Michigan’s efforts to bolster the state’s psychiatric care services will reach a critical mass.

A Michigan House of Representatives report on the state’s behavioral health system was published Tuesday, outlining six recommendations to improve care capacity for the estimated 1.4 million Michiganders who have a mental health condition.

Read the report here

Separately, a trio of bills recently passed by the state House aims to reshape how Michigan treats mental health cases and improve early intervention by loosening referral rules and widening who can authorize care.

Judge Milton Mack has been advocating for mental health reforms for several years. (Courtesy photo)

The Republican-led effort matches a similar set of bills passed by the Democratic-run Michigan Senate last year. Lawmakers say the package has buy-in on both sides of the aisle and among the state’s top mental health advocates.

“I’m optimistic,” said former Wayne County Probate Court Judge Milton Mack, chair of the state’s Mental Health Diversion Council, which helped draft many of the legislative recommendations.

Mack, who also previously served as a state court administrator, has worked to “decriminalize” Michigan’s response to mental health emergencies by promoting early intervention before a crisis and access to outpatient care.

Mack said the recently passed package of bills “will complete the transition of Michigan’s mental health system” following the widespread closure of state-run behavioral health facilities in the 1960s. He said the state’s mental health system has relied on hospitalization and incarceration of people experiencing mental health crises ever since.

“It’s only been 60 years or thereabouts,” Mack told Bridge Michigan. “But we’re getting there.”

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A spokesperson for the Michigan Department of Health and Human Services said the agency is committed to ensuring residents receive behavioral health care, but was noncommittal on supporting the specific efforts.

“The department is happy to partner with the legislature and remains in communication regarding efforts to expand and improve behavioral health care access for all Michiganders,” said agency spokesperson Lynn Sutfin in an email.

Representatives for Gov. Gretchen Whitmer did not respond to Bridge’s inquiry in time for publication.

Six recommendations

The House Oversight Subcommittee on Public Health and Food Security’s report follows a series of meetings last summer to investigate Michigan’s widening mental health crisis.

More than a dozen law enforcement officials, physicians and behavioral health advocates outlined the challenges they face from some of the worst psychiatric bed availability in the country and an overall lack of staffing and financial resources.

Among the report’s recommendations:

Creating a behavioral health campus in northern Michigan
Giving Community Mental Health providers more flexibility to reallocate and reorganize bed capacity within facilities
Changing policies for the state’s Medicaid-supported mental health administrators to offer them more leeway in treating severe behavioral health crises
Targeting state funding for staff training and safety measures
Investing in modernizing electronic health records
Enhancing “local control and flexibility in behavioral health business decisions”

Decades-old challenges

Many have traced today’s problems to the closure of several state psychiatric facilities in 1997 under former Gov. John Engler and say the problems compounded during and following the pandemic.

The House report was delayed for months before being published this week, with committee leadership citing the need to lay out accurate and achievable goals instead of offering “far off pipe dreams” as solutions.

“Sometimes we get distracted,” state Rep. Matthew Bierlein, R-Vassar, told Bridge ahead of the report’s approval out of committee. “I didn’t want to put out a report and say this is what’s going on and then just get no buy-in whatsoever from my caucus or leadership.”

The House subcommittee’s support of a northern Michigan behavioral health campus has been championed by Kate Dahlstrom, president for the Grand Traverse branch of the National Alliance on Mental Illness. She said there’s a persistent lack of resources in rural areas, where care options are few and far between.

“I don’t think there’s a law enforcement agency anywhere in northern Michigan, and probably not many in the state, that don’t think we need more beds,” Dahlstrom said ahead of the report’s publication.

Dahlstrom said such a campus could be placed on state-owned land in Kalkaska and operate through an integrated university partnership.

The report’s recommendations come at a transitional time for the state’s 10 Medicaid-supported behavioral health plans — also known as Prepaid Inpatient Health Plans, or PIHPs — which collectively manage the services for some 300,000 individuals with intellectual and developmental disabilities, substance use disorders and serious mental illnesses.

A Michigan health department effort to reform the state’s PIHPs died when it hit a legal roadblock, after the state paid millions in consulting fees to rework the system.

The state is moving forward with a new proposal to overhaul Michigan’s PIHPs, according to remarks made by state attorneys at a Monday Court of Claims hearing.

Care before crisis

The recently passed “outpatient mental health treatment” package by the state House would ease involuntary-admission procedures, extend court-ordered care, shift more authority to community mental health agencies and create a pathway to divert misdemeanor defendants into treatment.

Assisted outpatient therapy has been successful in managing Michigan’s shortage of mental health beds and staff, according to sponsoring state Rep. Mark Tisdel, R-Rochester Hills.

The legislation, he said, would expand the practice and allow people to get treatment before a “disaster” unfolds during a crisis.

“It’s a way of getting people into care quickly and getting them into the system, even involuntarily, but also maintaining their due process rights,” Tisdel told Bridge Michigan.

an empty waiting room with colorful decor. — Outpatient facilities, like this clinic operated by Pine Rest Christian Mental Health Services, offer ongoing support to patients outside of an emergency. (Courtesy of Pine Rest)

Lawmakers that voted against the bill package said the reforms were well intended, but lacking.

In noting her opposition, Rep. Stephanie A. Young, D-Detroit, issued a statement calling for treatment plans to require more involvement from guardians. She said she was uncertain if Community Mental Health “should have the sole responsibility to determine assisted outpatient treatment” and that “individual and family preferences should be considered for inpatient orders.”

Advocates who have long called for extensive policy and funding changes to the state’s mental health system say current practices fail to protect patients. The three bills have the support of organizations like the Mental Health Association in Michigan and the Michigan Health and Hospital Association.

Democratic leadership, too, has signaled the legislation could pass out of both chambers following MDHHS input.

“We’re wholly supportive of the package and just working through to make sure we can get them done this year,” said state Sen. Kevin Hertel, D-St.Clair Shores. “I’m hopeful we’ll see some action here before the summer.”

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