LANSING, MI — Michigan is in the process of settling a lawsuit filed in 2018 by families who say their children didn't receive the proper care for serious mental health issues.
The goal of the lawsuit is to help kids stay with their families, get the care they need, and grow into adults who can stay and contribute to their communities, said Kyle Williams, director of litigation at Disability Rights Michigan and one of the lead attorneys in the lawsuit.
Gov. Gretchen Whitmer's 2022 executive budget would allocate $91 million of her 2022 to improve behavioral health service supports, part of the settlement.
"I think that appropriating $91 million is an excellent start to trying to have some real change to this system that's going to have a positive impact on those folks that are most vulnerable," Williams said. "And so I would say it's definitely good to appropriate money towards the system to try and improve that system and to try and target it towards home and community-based services," Williams said.
Remember Jay Gross? He's not a part of this lawsuit, but he knows the struggle well.
He's the Michigan father whose video went viral while he was trying to get his son inpatient psychiatric care. We brought him back into the conversation...to see what he had to say about the lawsuit and the money from the state.
"I just I wonder if it's a Band-Aid, I don't know enough about it, but I'm like if it's gotten the families what they need because they were buried in health care costs for the kid going through this, it paid those bills, and some of this money goes in for the right purposes for mental health, that's a good thing...I'm not going to knock it," Gross said.
A Closer Look at Governor Whitmer's Plan
The investments proposed in Whitmer's budget would go to make sure Michigan children who are enrolled in Medicaid or are part of the child welfare system have better access to Behavioral Health Services.
It would also invest $26.5 million to establish 14 certified community behavioral health clinics among other things.
Robert Sheehan is the chief executive officer for the Community Mental Health Association of Michigan. In 2017, he was a part of an initiative launched by the Michigan Department of Health and Human Services. It is known as the Michigan Inpatient Psychiatric Admission Discussion Workgroup. Their goal was to investigate the inpatient psychiatric services and give some recommendations.
"The report was issued in 2018, calling for a number of changes. You know, better staff training, beds scattered throughout the communities, rural as well as urban, better payment sources, a number of alternatives," Sheehan said.
Here are four changes identified in the report that experts we spoke with said were among the most promising:
Crisis Stabilization Units
A crisis stabilization unit is basically, a place where a person can get short-term mental health care and get back on track.
"Sometimes time is a benefit in psychiatric care if I'm in crisis, or if I've used medications that cause me or drugs that cause me to be in Crisis or if the stressors that I'm in, cause that being in a non stressed setting can actually those symptoms can abate," Sheehan said.
The report recommends that the state require prepaid inpatient health plans, organizations responsible for managing Medicaid services related to behavioral health and developmental disabilities, to have crisis stabilization services available 24/7.
Sheehan says there are six "crisis stabilization unit lookalikes" already in the state, but they aren't certified to hold people for more than 23.5 hours. It could take about a year for those six sites to be certified, he said.
Addressing The Psychiatrist Shortage
“There's a lack of psychiatric staffing across the country, there are insufficient adult and child psychiatrists and you have to have a psychiatrist to run an inpatient unit and if you can't find one, and you can't use telemedicine for some of those services so you can't have a psychiatrist in another location calling in or videoing in for a lot of inpatient work," Sheehan said.
There are a few theories as to why there is a shortage, one being the fact that psychiatrists aren't compensated as well as other medical specialists.
One of the report's recommendations is that the state health department could offer student loan repayments as a way to encourage people to get into the field.
The behavioral health workforce research center at the University of Michigan says additional solutions could be:
- Educational training programs
- Leadership training
- Innovative approaches
- Providing other financial incentives
"The psychiatric workforce problem is a bit deeper, you know the pipeline is long, starts with med school, maybe undergrad, and then med school and residency, and keeping people around for longer payment. So you got to start early in that in that pipeline. So that's a couple of years away," Sheehan said.
Map of Hospitals in Michigan with Child/Adolescent Beds
**disclaimer: the below map shows the current hospitals in Michigan that have beds for children/adolescents. This map does not guarantee that there are beds available.**
More Beds In Community Hospitals
The report recommends community hospitals develop the capability to assess mental health patients and begin treatment while they are waiting for inpatient placement.
Harmony Gould is the vice president of hospital and residential services at Pine Rest Christian Mental Health Services. She says we need to make sure we have the right services for people.
"I think the complexity is, this is a really big system and matching people with what they need, especially if it doesn't exist. It really creates all these unintended consequences. So it's the, making sure that in our continuum, we have the right services and certainly the preference is to reach people earlier, so they don't need us, an intervention like going to a hospital or even a crisis stabilization unit, but if they're able to access partial hospitalization or the right, outpatient services, the right group services to meet their need," Gould said.
We learned from Jay Gross's viral video that his son was in the Gratiot Community Hospital in Alma for twelve days waiting for an inpatient bed to open up for him.
What if those twelve days had been spent beginning the treatment process?
"We're pushing - the hospitals are, too - for more beds in community hospitals across the state. One of the ways to do that is to have mental health wards kids wards in med surge hospitals because the days of the freestanding psychiatric bed in every community was gone," Sheehan said.
Create A Registry
The report suggests the state health department created a web-based resource that would look for available beds by gender, age and diagnosis.
"It's actually being developed now it's called a bed registry, yeah it would allow you to lookup. You know, 'I have a 14-year-old female who's got this condition. Are there any beds that can take that 14-year-old female?' As opposed to making nine phone calls. Michigan's working on that so I guess that's the fourth or fifth part of this constellation of solutions," Sheehan said.
The state Department of Health and Human Services says the development of this resource has begun. But there's no word on how long it could take.
"MDHHS is strongly committed to increasing the access to mental health services for children in Michigan," the department said in an email. "It is important that our children grow up healthy – both physically and mentally."
There are many more recommendations in the MIPAD report.
So how does Jay Gross feel about this?
"I think it gives us hope because anything positive to go down this to me is, it's even if it's only half a step or a quarter step. Even a lean forward, we got to keep moving forward," he said.
Williams agrees. But also hopes the state will look at more community-based treatment plans so they can limit inpatient services.
MDHHS has communicated a target date for the development of a plan by the end of this month to the legislature. But these plans will take time to achieve before making them a reality for the public.
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