Editorial: Michigan can't overlook mental health
Beaumont Health recently announced it will begin construction on a new 150-bed, free-standing psychiatric hospital in early 2019. This is a need in Michigan, where the mentally ill have been woefully underserved since the closure of most state mental hospitals in the 1990s. In addition to increasing capacity, hospital systems should consider other alternatives to care for those struggling with mental illness.
In 1993, community hospitals in Michigan had a collective capacity of 3,041 adult beds and 729 child/adolescent beds. Today, that number has decreased to 2,197 adult beds and 276 youth beds. The number of mentally ill people has not decreased, but the support has significantly.
The populations which had been normally treated by the big state-run mental hospitals were supposed to be replaced by inpatient care at community hospitals, keeping patients closer to their family members, and removing stress on law enforcement who were expected to transport patients around the state. But that plan was poorly implemented.
State and federal funding was supposed to help in the transition, but many elements necessary for effective health treatment fell by the wayside. For one, small community hospitals have a hard time caring for patients who are violent, aggressive or developmentally disabled. Those hospitals are also accustomed to long-term patient care.
Most patients who need more intensive care in Michigan are referred to one of four state psychiatric hospitals which have a grand total of 772 beds and which are operated by the Michigan Department of Health and Human Services. But those few facilities don’t have enough resources to care for the number of mentally ill in our state, given that most days the waiting list tops 200.
This means many patients are forced to wait in hospital emergency rooms, where they receive inadequate care.
To combat this crisis, the state health department convened a group of specialists to discuss Michigan inpatient psychiatric admissions, which published its findings and recommendations earlier this year.
To help alleviate the stress on state-run psychiatric hospitals, the group recommended a digital, real-time database for psychiatric hospital bed use. Creation of a tool like this would help hospital systems optimize their resources and ensure that their available space is in constant use by those most in need.
The number of those in need of care who were turned away is another area for concern. From March 2016 to March 2017, Community Mental Health Service Programs in the MidState Health Network region (21 counties in the Lower Peninsula) reported 31,107 instances of community-based psychiatric inpatient denials, which impacted 1,676 individuals who clearly needed help.
One of the primary causes of these denials is that health care payment plans are not flexible enough to incentivize health care facilities to admit those with complex needs. Medicaid is only responsible for covering physical health-related admissions, so receiving compensation for mental health care is much more difficult.
As a result, hospitals are far more likely to accept mental health patients with private insurance. This causes the poor to be unduly affected by lack of treatment. Law enforcement are also impacted, as they often get called to handle ill individuals who haven't received proper care and medication.
It's positive to see Beaumont step in to help fill this need. But other fixes are essential, including having hospitals better compile data and broadening Medicaid to cover mental illness.