Michigan bill intended to shorten ER waits for youth in mental health crisis

• In Michigan, kids in mental health distress can linger for days — even weeks — in ER’s before getting care 
• A bill would allow hospitals to broaden who can evaluate patients in crisis in an effort to speed treatment decisions 
• Critics say quick evaluations are not the problem, it’s the lack of psychiatric beds and personnel

Michigan’s threadbare mental health system faces problems that are daunting and complicated, but a new bill in the state House is intended to speed up the decision on whether a patient in crisis should be hospitalized, its sponsor said. 

The measure follows years in which, particularly during the COVID pandemic, Michigan children and teens in mental health crisis spent days or weeks in emergency rooms awaiting evaluation or treatment because there were no openings at specialty facilities or psychiatric units to treat them.  

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“It's not … a bill that will fix all the issues in Michigan’s mental health services, but it is a step in the right direction,” State Rep. Graham Filler said of the measure, which would apply to both minors and adults who are in crisis. 

On Thursday, the bill, sponsored by Filler, R-Greenbush Township, received its first hearing before the House Health Policy Committee. It would require a community mental health (CHM) worker to evaluate a patient in crisis within three hours of being notified by a hospital that the patient needs evaluation.  

If a CMH worker isn't available in three hours, a “clinically qualified” hospital employee could do the assessment and, in turn, decide whether the minor needs inpatient care at the hospital or another facility. 

Thursday’s hearing included testimony from Nicole Knight, a registered nurse and the mother of a teen with mental-health issues. Knight described endless waits in emergency rooms when her son was in crisis — once for 43 days. 

It only added to the anxiety of a boy “who is not used to being housed in a 10-by-10 room. That leads to restraint and sedation and further trauma that just deepens the trauma he already experienced,” she told the committee. 

“If a person seeks care in the emergency room, it should be treated with priority,” said Knight, who founded a Facebook page, Michigan Parents for Mental Health Reform. 

Doing so, she testified, “helps to decrease the stigma and it also saves lives.”

Michigan has long suffered from a shortage of mental health personnel and inpatient beds for people in severe crisis. Bridge Michigan documented those problems in 2021 in a series chronicling what one hospital president called “a tidal wave of sadness” among young patients. 

In the series, hospital leaders described how emergency departments came to serve as holding stations for the most troubled young patients; places where they could be monitored, but not receive the treatment they needed for their underlying illness.  

“When a person's in the throes of a psychiatric crisis, the last thing they want is to be waiting for hours and hours in an emergency room,” Marianne Huff, president and CEO of the Mental Health Association in Michigan, told the committee Thursday.

And that’s the heart of the issue, said Filler, the bill sponsor.  

“Having a patient wait for hours or days can be extremely detrimental,” he said. “People with mental illness need immediate care the same way that people with other injuries or illnesses do.”

But Alan Bolter, associate director of the Community Mental Health Association of Michigan, which represents the state’s community mental health agencies, said the bill does not address the major hurdle to prompt evaluation and care. 

As it now stands, Michigan’s Mental Health Code requires each of Michigan’s community mental health agencies to have screening staff available around-the-clock to respond to a crisis. 

Under a contract agreement with the Michigan Department of Health and Human Services, these staff members must respond to an ER crisis within three hours at least 95 percent of the time, Bolter told the committee.

They exceed that standard, he testified, responding within three hours more than 97 to 98 percent of the time.

The real problem, Bolter said — in a point also raised by representatives in their questioning — is the lack of mental health staff, which in turn, leads to too few inpatient beds for both adults and children.

Additionally, he said, the bill would allow hospitals to sidestep community mental health workers — who he said are best positioned to assess a patient’s mental health needs — by allowing qualified hospital personnel to see patients in their absence. Even when they happens, he said, local, tax-funded, community health agencies would pick up some of the cost for inpatient care.

(Under the bill, hospital staff permitted to evaluate patients in the absence of a CMH work would need at least a master’s level degree in a behavioral health specific profession to perform assessments.)

Bypassing community mental health workers in the evaluation process would also raise the possibility of patients being hospitalized when they would be better served in an outpatient setting, he said.

“We've all heard stories…of individuals in emergency departments for 10 days, 15 days, 20 days, 30 days,” Bolter said. “All of this is extremely tragic; however, this legislation does not, from our perspective, solve that problem.”

State Rep. Lori Stone, D-Warren, also focused on the lack of psychiatric staff across the state. 

“My understanding is that a significant amount of patient delay … is largely due to the lack of providers in the mental health space because of the (low) rates of reimbursement” they are paid by health insurers, she said.

Filler, the sponsor, agreed that the bill doesn’t solve those larger, more complicated issues of insurance reimbursement and staffing.

“Technically, this is not an access-to-care bill, Representative,” he replied to Stone. “This is a … quickness-of-evaluation bill.”

Representatives did not vote on the bill Thursday. It remained in committee, which has not yet scheduled further hearings.