Legislature threatens to pour gas on mental health fire

By Mark Reinstein
Iconic View of the Capitol looking east down he mall from the sixth floor of the Hall of Justice in Lansing on April 10, 2018. (Dale G.Young/Detroit News) 2018.

Mental health has been in the news lately, especially in Detroit, where Police Chief James Craig has decried the volume of his department’s mental illness cases and the city has formed a Mental Health Task Force.

We have an epidemic of people with mental illness imprisoned. Our publicly funded mental health system, run through governmental Community Mental Health (CMH) programs the past several decades, has too much bureaucracy, lacks statewide uniformity, is weak on rights protection, has meager hospital resources, and is not well monitored by the Michigan Department of Health and Human Services (DHHS).

The system is underfunded and overburdened. To provide one local example, Wayne County has just one walk-in crisis program – the COPE facility in Livonia, managed by Hegira Inc. – and that program often deals with a volume of clients far too great for its resources.

The mental health advocacy community desperately wants improvements and is open to major changes, however, we aren’t going to fall for something that won’t work and will only make matters worse.

We are presently forced to deal with an idea from the governor and powerful legislative interests that just about everyone in the mental health arena labels a looming disaster.

The powers-that-be want all Medicaid mental health money transferred from CMH programs to private insurers (Medicaid health plans, or MHPs), some of which are for-profit. That is more than $2 billion, as Medicaid is the dominant payer for CMH services.

After a year-plus of examination, with mental health consumers, families, advocates, and providers overwhelmingly opposing this concept, the Legislature dictated that Michigan will have three pilot programs – and one related demonstration project – to test this idea. These are now targeted to begin late next year.

After the Legislature so ordered in 2017, DHHS repeatedly stated that the pilot MHPs must contract with CMH programs for service to serious mental illness cases, and that it would be illegal if CMH programs weren’t involved in the management and provision of such cases.

Yet the state Senate recently adopted budget language that pilot MHPs would not have to contract with CMH programs and can unilaterally manage all service for serious mental illness. This flies in the face of MHPs having little experience with severe mental disorders.

Thanks to mental health advocacy, the Senate language did not make the final state health budget bill for next year, but it’s a sign of how far some legislators are willing to go for a concept that won’t improve integration of mental and physical care. This can happen only at the provider level, not the point of who gets legislative appropriations. Nor will it improve service access or quality. Indeed, both will worsen.

I have worked on mental health public policy matters for 35 years, and this is the most significant issue that I have encountered.

I have been a critic of the existing system. I’m open to many possible changes, including an entirely state-managed system or a regional one with fewer CMH programs (there are currently 46). I’m open to competition among service managers so that those better performing get rewarded with more business.  I’m open to more public-private partnerships. But the mental health advocacy community is solidly behind one key point: We want your tax dollars managed by public entities, which are not based on profit-making motives and that have a degree of transparency and accountability that the MHPs do not and cannot.

Michigan is heading for a tragedy built on the backs of those with mental illness. Will the people of Michigan let this happen?

Mark Reinstein is president & CEO of the Okemos-based Mental Health Association in Michigan, a statewide advocacy group for people experiencing mental illness.