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CRACKING UP: The Impact of Michigan's Deteriorating Mental Health Care System By Robert E. Martin Despite the fact that Michigan's first Constitution set out the responsibility of the State to care for the mentally ill and developmentally disabled back in 1850, today Michigan is in a crisis. All it takes is a look around the corner of the block in any community throughout Michigan to witness the way legislators have all but abandoned this responsibility. Indeed, ever since then Governor John Engler began closing the State Mental Hospitals, this responsibility to care for the mentally ill has become increasingly ignored over the past two decades, to the point where the negative impact is being severely felt throughout the State. Many experts agree that the mental health system in Michigan has been virtually dismantled. A recent article in The Detroit News noted that Michigan was the only state in the country to receive all failing grades in a national evaluation of mental health care by the National Mental Health Association - the oldest and largest group that represents the mentally ill. Michigan has closed 26 mental health institutions since 1981, two-thirds of them since 1990. There are currently only five state-operated hospitals and centers that serve mentally ill adults and children, along with people with developmental disabilities, following the closure this month of the Northville Psychiatric Hospital. These facilities were closed under the premise that community housing could shelter most of the chronically mentally ill patients and that local hospitals had plenty of beds for people in a crisis. But as Saginaw's State Rep. Carl Williams notes, "The first goal of this premise - affordable community housing - has never been reached, and now many hospitals that serve the mentally ill are breaking under the strain." Even during the plush economic times of the 1990s, state budget cuts kept local community mental health service programs under tight caps, with care for the mentally ill basically an afterthought. Now, with the current economic downturn and an estimated 2003-04-state budget deficit of nearly $2 billion, the problems facing the mental health community are growing worse, especially in Saginaw County. The Saginaw County Community Mental Health Authority is trying to balance an estimated $2.1 million deficit stemming from increasing demand for service at the same time the state is reducing revenue funding. The board is slashing $700,000 annually by cutting 30 positions at the Rambo and Phoenix residential group homes and the crisis residential treatment program, all in the City of Saginaw. The obvious result of this is that many, if not most, of the patients are displaced from Institutions and end up in homeless shelters or jails. The Michigan Coalition Against Homelessness has noted repeatedly that there is a crisis in statewide shelter beds, due in large part to untreated mental disorders. Recently, Rep. Carl Williams organized a Town Hall Meeting in Saginaw to address this problem. Drawing together professionals from across the community, the panel agreed that the crux of the problem centers on three areas: 1) The state's dramatically unfair funding formula for mental health care that has shortchanged Saginaw taxpayers and the mentally ill for more than a decade; 2) Adults & minors with mental illnesses sapping up the resources of Michigan's criminal justice system. 3) The need for insurance companies to provide 'parity' in mental health coverage on a par with medical coverage. Currently most insurers will not pay the same to providers for mental illness, as they will other diseases and afflictions, as if this illness is not considered a true illness. Regarding the state funding formula and cutbacks and closures of state facilities there is debate over whether this move has actually saved taxpayers money or cost them more. During the 1970s and 1980s, treatment methods and attitudes evolved, prompting a movement to decrease the number of people housed in state institutions. More community options were made available and Michigan led the nation with the creation of a Mental Health Code that was basically a set of laws and protections that codified issues like the right to confidential treatment. But during the 1990s, much of the state's control of the mental health system and its funding was transferred to the local level, with counties taking a 'managed-care' approach. "The step toward allowing patients to be able to participate in planning their treatment is a positive move," comments Representative Williams, "but in Saginaw County that service is being put in jeopardy by a state funding formula that unfairly harms the adults & children who require mental health care, as well as cutbacks in the amount of state money Saginaw County receives to finance mental health care." "Additional state budget cuts have eliminated funding for the psychiatric residency programs at Wayne State and Michigan State Universities, where nearly half of their total funding was slashed," states Williams. "These residency programs staff community treatment centers across the state, and these cutbacks will affect the field of psychiatric care in Michigan for years to come." FEELING THE IMPACT Given all these cutbacks there are currently just fewer than 1,000 people in Michigan now being treated in the state's psychiatric hospital system - a small fraction of the number institutionalized in the state in recent decades. Because of the lack of available beds, Saginaw County Mental Health officials are turning away at least 120 adults every three months who have diagnosable mental illnesses, but whose conditions are not quite 'serious enough' to meet the criteria for placement in hospital care. These are the people that usually wind up in our county jail. The Saginaw County Jail holds 513 inmates, and on any given day 35 to 50 of the 'prisoners' can be classified as either mentally ill or developmentally disabled. According to Captain Robert Rae of the Saginaw County Sheriff Department's Jail Division & Law Enforcement Unit, it generally costs an average of $45.00 per day or night to house an inmate. "I've never done the math before, but if you take the average of Community Mental Health clients we have housed in the jails each day and multiply the cost figure, it amounts to about a half million dollars per year." Obviously, for State government the closure of the hospitals may have been 'cost effective', but shifting this burden to the local communities is certainly no savings to taxpayers. Plus, do we really want the mentally ill housed with criminals, or left to roam aimlessly upon our streets? Nationally, the U.S Department of Justice estimates that more than 280,000 mentally ill offenders are housed in state and federal prisons or local jails. An additional 547,000 mentally ill patients were on probation. "It seems to me the state is willing to let the criminal justice system become a surrogate for the mental health system," comments Rep. Williams. "And once these people enter the criminal justice system, it doesn't get any better. The Justice Department found that only 61 percent of those identified as mentally ill in state & federal prisons and 41 percent in local jails received any form of mental health service, so the cycle just continues." THE METHOD FOR FUNDING For several years there has been a funding discrepancy between the amounts of money each of the state's 47 Community Mental Health agencies receives from the state. Under the existing formula, for every dollar that Michigan spends on mental health care, Saginaw County gets 63 cents. Midland County gets $1.68 on the dollar for state funding, Bay Arenac receives $1.35 and Genesee County gets 94 cents. Even Kalamazoo County, which has a client population roughly similar to Saginaw County, gets $1.25. "What is especially frustrating about the formula is that it's based on a model that existed decades ago," notes Williams. "It is not based on any sound reasoning pertaining to the number of patients served or the size of the community. The counties who are the biggest winner under this formula - Oakland, Wayne and Washtenaw - don't want to change it because they would lose the most money." The Michigan Dept. of Community Health, which oversees the 47 local agencies, has tried several times to create a new distribution formula based on client demand for services within each community. The directors of the local agencies have always rejected their plans. They agree any funding changes for equity must be done only when new money is available in the system. They argue any changes would cause a crisis in large counties and within the system, but without additional state funding or a change in the funding mechanism, Saginaw County taxpayers are being forced to foot the bill for the provision of caring for the mentally ill & developmentally disabled to an excessive degree, and the costs to local taxpayers is escalating each year. ARE THERE SOLUTIONS FOR THIS INSANITY? Currently Michigan is one of only 16 states without mental health insurance parity legislation, forcing people whom otherwise have health insurance into the public sector when their limited mental health benefits expire. Most experts generally agree that private insurance coverage for mental health services is inadequate. In recent years a large percentage of the state's mental health spending has gone to Medicaid recipients, but only about half of Michigan residents with mental health needs are eligible for Medicaid. Therefore, there is a need for private health insurers to cover mental health services for Michigan's non-Medicaid population. Unfortunately, this is not happening. People who suffer from mental illness continue to be largely ignored because of soaring costs in insurance and prescription drug costs. This is happening, sadly, even though there is numerous scientific evidence that many of what are considered mental disorders are indeed physical disorders that should be covered by insurance companies. In October of last year, Representative Williams co-sponsored legislation in the House of Representatives that would address this parity issue, as did other lawmakers in the Michigan Senate. Unfortunately, those bills did not make it out of committee. "I am optimistic that action will be taken this year because we do have bipartisan support in the Legislature for these parity bills,' notes Williams. House Bills 5123 and 5128 and Senate Bills 101 & 102 would require health insurers in Michigan to ensure that their cost-sharing requirements and benefit and service limitations for inpatient and outpatient mental health services are the same as those for impatient and outpatient medical services. In essence, mental health would be put on a par with other medical conditions, and insurance companies would have to treat mental illnesses in the same manner they treat other illnesses such as cancer. Additionally, Governor Granholm's budget pan for Fiscal Year 2003-04 includes a recommendation for a 1.6% increase for local mental health care services. As a member of the House Appropriations Committee, Williams hopes to see that spending approved. "The parity legislation also is extremely important because this will actually lower the overall cost of treating mental illness," adds Williams. "When mental illnesses are treated early, the amount of care needed is far less than when they become chronic due to a lack of care." |
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