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Pandemic spurs surge of mental health needs across Michigan, creating 'perfect storm'

Karen Bouffard
The Detroit News

Agencies across Michigan are seeing a surge of demand for mental health and substance-use services amid the pandemic, often from people in the midst of full-blown mental health crises, experts say.

There are a small number of counties that have mobile mental health teams that can respond in crisis situations, and Wayne and Oakland counties have walk-in mental health clinics open 24/7 to deal with emergencies.

But immediate attention for mental health or substance abuse issues can be harder to come by for many Michigan residents, depending on the severity of their condition, their insurance status and where they live. 

Diana Appleton, left, a mental health counselor with Hegira Health, speaks with patient Joshua Hill outside of his mobile home, in Canton, August 4, 2020.

"Across all spectrums — whether it’s people who live with persistent mental illness, mild-to-moderate, or the general population that’s never been diagnosed with a mental health disorder — it’s all experiencing a significant uptick," said Kevin Fischer, executive director of the National Alliance on Mental Illness in Michigan, who added it's too soon to have hard data on the surge that is apparent to mental health providers.  

"Calls for services at our crisis lines (at) some of our local affiliates here in Michigan and at our national crisis line in Virginia (are) up over 80%.And those are the people who are raising their hands — who are not reverting to substances like alcohol or drugs or suffering in silence."

The combination of isolation, fear of getting sick, job loss and uncertainty are unprecedented, said Robert Sheehan, CEO of the Michigan Community Mental Health Association. 

"We just know anecdotally from our members that demand is up, especially for substance abuse treatment, crisis needs and just overall angst or depression and anxiety related to the overall threat of COVID and the isolation and loss of jobs," Sheehan said.

"I hate to overuse the term ‘perfect storm’, but that’s what we have," he added. "Any one of these things would be enough to raise anxiety and depression levels in our society, but they’re all collapsing at once."

Prior to the pandemic, about 62% of the 1.76 million Michiganians experiencing a mental illness were receiving treatment, according to a statewide study on access to behavioral health services published by the Michigan Health Endowment Fund in July 2019. That left 38%, more than 666,000 people, with unmet mental health needs.

About 20% of the 638,000 Michiganians experiencing a substance use disorder were receiving treatment, leaving more than half a million people with no help for their illness, the study found. 

A lack of psychiatrists, social workers and other mental health workers is a major barrier to mental health and substance use treatment in Michigan, Sheehan said. Some counties in Michigan have only one psychiatrist, and many have no child psychiatrist at all. 

A seven-bed unit where patients can stay for 28-hour observation at COPE (Community Outreach for Psychiatric Services), a mental health crisis clinic run by Hegira Health, August 5, 2020.

Barriers to services

The most severely mentally ill are generally covered by Medicaid, the state-federal health program mostly for low-income residents, and are served by 46 Community Mental Health agencies across Michigan.

But treatment for mental health or substance use issues can be more difficult to obtain for individuals with moderate or mild cases, experts say. 

Many people have high-deductible health insurance plans that require thousands of dollars in out-of-pocket payments before coverage kicks in, said Marianne Huff, CEO of the Mental Health Association in Michigan, a group that focuses on policies and legislation related to behavioral health. 

"I know people with these horrible deductibles of say $8,000. How do they pay for health care when they have a huge deductible?" she said.  

Community Mental Health agencies are required by law to provide services to everyone, regardless of their insurance status, Huff noted. But the extent to which they actually do that varies from county to county. 

Workers at COPE (Community Outreach for Psychiatric Services), a mental health crisis clinic run by Hegira Health, staff the facility's dispatch center, August 5, 2020.

The Community Mental Health Association's Sheehan said the public mental health agencies have limited funding to treat people who are uninsured or under-insured. About $200 million was cut from the state mental health budget when Michigan's Medicaid program was expanded under the Affordable Care Act in 2014, he said. 

About a dozen Community Mental Health agencies dropped out of the mental health program when the budget was cut because they couldn't agree to serve everyone who walked in their doors, he said. 

"The hope was that everybody would get on Healthy Michigan. But that’s not what happened. Everyone did not get on Healthy Michigan nor did they pick up their own insurance," Sheehan said.

About 95% of the state's Community Mental Health budget is paid by Medicaid, he said. 

"The state cut the non-Medicaid part of the budget by 60%, so the ability to serve non-Medicaid folks really dropped," Sheehan said.  

"If you’re very severe, you’re on Medicaid, you’re going to be served," he added. "But if you have any mental health condition that’s not hyper-severe, and you’re not on Medicaid, the chance of getting served by the CMH is very slim — because of that large General Fund (budget) cut."

Each Community Mental Health agency has its own approach to fulfilling its public mandates, said Michigan Department of Health and Human Services spokesman Bob Wheaton.

"To the best of my knowledge, all CMHs have the capacity to triage case needs 24/7 through access lines," Wheaton said. 

"But we can’t provide more specifics, as there are regional differences in how they execute those responsibilities and how they staff them with various relationships locally."

Wheaton wasn't able to say how many have resources like 24/7 walk-in clinics or mobile mental health crisis teams. But Wil Morris, executive director of the Sanilac County Community Mental Health Authority in Michigan's Thumb region, said a walk-in clinic wouldn't be practical with his county's huge geographic expanse and thin population.

Diana Appleton, right, a mental health counselor with Hegira Health, speaks with patient Joshua Hill outside of his mobile home, in Canton, August 4, 2020.

Sanilac's CMH is fully staffed during the day and has a clinician on duty during the night to help people in crisis. Clinicians take turns covering the night shift and provide a full range of services both by phone and face-to-face, Morris said. 

"It takes almost an hour to get from one edge of the county to the other, so having somebody in the county seat isn't going to help somebody in the southeast corner of the county in a crisis," Morris said.

"It would take a significant amount of our resources available for services if we were to have a person sitting here 24 hours a day, seven days a week, for the 12 after-hour crises we get a month." 

In Livonia, there's been a steady stream of traffic at Community Outreach for Psychiatric Emergencies, a walk-in clinic for people in mental health crisis that's open all of the time. 

It's operated by Hegira Health, a private nonprofit behavioral health organization that serves about 20,000 Wayne County residents. Hegira holds behavioral health services contracts with the Detroit Wayne Integrated Health Network, the Community Mental Health Agency for the area, and participates with most major insurers, said Jaime White, Hegira's director clinical development and crisis services.

The COPE clinic has a psychiatrist on-site day and night, and is staffed by nurses, therapists and social workers. It also has seven beds to keep clients for short-term observation.

"We are able to treat people’s mental health crises there and get them into a higher level of care, whether that be hospitalization or a crisis residential home," White said. "In the best-case scenario, we’re able to get them a hot meal, a hot shower, get them an immediate psychiatric evaluation, start them on treatment and then hopefully discharge them back into the community."  

Oakland County has a similar walk-in clinic called Common Ground. Located on the county's government campus off Telegraph in Pontiac, the facility is open 24/7 for crisis intervention, with access to a psychiatrist if needed, said Adam Hamilton, manager of provider network at Oakland Community Health Network. 

Diana Appleton, a mental health counselor with Hegira Health, during a home health visit, in Canton, August 4, 2020.

Crisis teams on move

One day in early August, Diana Appleton, a master's level licensed mental health counselor, arrived at a church in Canton Township to meet with a client.

Joshua Hill, 26, had recently sought emergency mental health services in the midst of a crisis, and Appleton and a colleague were there to follow up and ensure he connected with outpatient support. 

Appleton traveled to Canton from the COPE clinic with Pearline Ballard, a trained peer support specialist who has experienced mental illness herself and has a bachelor's degree in social work.

"My role is to break the ice, to make (the client) feel more comfortable," Ballard said. "It makes them feel better that you're not judging or looking at them different — that I've been in their shoes.

"If you don't have the trust, you can't open up."

Pearline Ballard, a peer support specialist with Hegira Health during a home health visit, in Canton, August 4, 2020.

Appleton and Ballard are among dozens of mobile mental health crisis teams dispatched 24/7 from a call center at the COPE clinic in Livonia. When called by a hospital emergency department or urgent care clinic, they go immediately to assess the patient, recommend a course of treatment and follow up with patients when they're released to the community. 

"We're with the person up to 28 days, and it may go longer if necessary," Appleton said. 

Appleton and Ballard circled the church in their car before spotting Hill standing outside an aging recreational vehicle at the rear of the parking lot. Hill had been living in the RV, moving it from one parking lot to another throughout the area. 

The visit was to learn about Hill's situation and come up with a treatment plan. 

As per procedures during the pandemic, they immediately took Hill's temperature, and found he had a fever of 101.4 degrees. Fifteen minutes later, it was higher — 101.7 degrees. Undeterred, they took down his cell number to follow-up with him by phone. Appleton and Ballard also gave Hill their cellphone numbers. 

"We'll connect with him," said Appleton, who succeeded in meeting with him two days later. 

Mobile mental health teams are operating across southeast Michigan, though they vary in the populations they serve and their hours of operation. The teams that operate out of COPE in Wayne County serve only adults and must be summoned by a medical facility.  

A comprehensive mental health agency called New Oakland Family Centers has mobile teams that assist children and young adults in Wayne and Oakland counties, as well as Macomb County adults. 

New Oakland's mobile teams serve young people under 21 in Oakland County, and children 18 and younger in Wayne. Children and families receiving services from New Oakland can reach out directly for assistance from one of the agency's mobile crisis teams. 

Joshua Hill outside of his mobile home, in Canton, August 4, 2020.

New Oakland's teams in Macomb County provide services to adults but must be contacted by a hospital emergency department.  

Hill was referred to the mobile team by clinicians at COPE after he was brought there by his mother in the midst of a mental health crisis. In a phone call with The News, he said he's not sure if they can help him, but he's willing to try.

Hill works as a forklift operator in a warehouse but still struggles financially. He wants to be reunited with his fiancée, from whom he is separated, and with his children, who are in foster care.

"My state of mind was, definitely, was in a state of mind of confusion. I did not want to be there," he said of his visit to COPE. "They gave me an evaluation, sat me down with a psychiatrist, talked to me about what I was going through — they helped me."

Northville Township Manager and Public Safety Director Todd Mutchler

Teams interact with police

Hegira's mobile teams also respond to calls from law enforcement through partnerships with the police departments in Northville Township and the cities of Plymouth and Inkster. 

"Based on my 30-plus years in law enforcement, I would say absolutely it prevents crime," said Todd Mutchler, township manager and public safety director in Northville Township, about the mobile mental health teams. 

"When you look at the history of Michigan closing up its mental health hospitals, those folks just went out to society, so it just became a problem for law enforcement to deal with. Unfortunately, it’s taken some difficult experiences for society to see what happened — I think it became a huge problem.

"This is that resource that was missing. It's fail-safe for (people in mental health crisis) and at least a starting point to get them services that are better than to go sit in jail on some misdemeanor charge." 

Peer support specialist Patrick Edwards works out of the mobile crisis team center at COPE (Community Outreach for Psychiatric Services), a mental health crisis clinic run by Hegira Health, staff the facility's dispatch center, August 5, 2020.

White, the crisis services director at Hegira, said she is part of a team assembled by the Detroit Wayne Integrated Health Network that has been training officers from departments across Wayne County on how to better respond to calls involving mentally ill people. 

The role of police is essential to protect mental health team members, said Fischer, NAMI-Michigan's executive director. But the police also need the support of mental health professionals who know how to deescalate tense situations. 

"Just like domestic violence call, you never know what you’re walking into when you get a mental health call — if I’m schizophrenic, you don’t know what the voices in my head are telling me to do at that moment," he said. 

"Sometimes, they have to go in and clear the scene before they can bring the social worker in. But we recognize that if a person is in the midst of a mental health crisis, sometimes just the arrival of law enforcement can escalate the situation — that’s where we need more mobile crisis services available.

"We’re blessed that we have the Hegira’s and the New Oakland Family Centers, but many communities have nothing."

Twitter: @kbouffardDN