Added on August 12, 2019  Marsha Chartrand

New plans for Michigan psychiatric facility raise more concerns about care

by Ted Roelofs (Bridge)

As the politics of mental health care in Michigan continue to shift, it now looks like a state psychiatric hospital in the Thumb will remain open.

But instead of building a $115 million, 200-bed new hospital in Caro, state officials are recommending renovating the existing hospital or building a downsized 84-bed hospital at a cost of $40 to $65 million. They also propose shifting 61 beds to other state hospitals and finding community-based care for 55 additional patients with serious mental illness.

But one mental health advocate said the Michigan Department of Health and Human Services recommendations announced last week fail to address the much larger issue -– an ongoing acute shortage of state psychiatric beds and lack of overall care.

“This has become a political football. But this decision just doesn’t do a darn thing for what we need -– more intermediate and long-term psychiatric beds,” said Mark Reinstein, president & CEO of the Okemos-based Mental Health Association in Michigan, a nonprofit advocacy group.

“We don’t have nearly enough of those.”

Reinstein noted there continue to be long waits for seriously ill patients to be admitted to state psychiatric hospitals, a gap in care underlined by a 2018 state report that found a 200-person wait list at Michigan’s state-run psychiatric hospitals. Michigan ranked fourth worst in the country in 2016 for number of state psychiatric beds per capita.

As a result, patients in mental health crises wind up in emergency rooms for many hours –- or even days -– as mental health professionals scramble to find an inpatient psychiatric facility that will admit them.

Moreover, some inmates wait months for court-ordered mental health treatment –- further evidence of a broken system despite the apparent change of heart by the administration of Gov. Gretchen Whitmer about the psychiatric hospital in Caro.

In October, Gov. Rick Snyder broke ground on what was to be the new hospital, to replace the aging Caro Psychiatric Hospital, which is about 80 miles north of Detroit.

But in March, Whitmer officials hit the pause button, ordering a review of the project while they cited concerns about staffing shortages at the hospital and the difficulties of some families in visiting the facility.

In April, news reports disclosed that Whitmer officials had months earlier favored shutting the hospital down.

In January, according to Flint television station WJRT, new MDHHS Director Robert Gordon held a meeting to discuss the Caro hospital. The following day, it reported, Andrea Taverna, deputy cabinet secretary for Whitmer, emailed state officials recapping the meeting. 

“Secretary Gordon increasingly believes that closing Caro entirely is the correct path forward,” she wrote.

Weeks later, according to the account, Gordon visited the hospital and sent an email to state officials, including Whitmer aides and the budget department.

“We don’t want to build another facility there,” he wrote.

Whitmer health policy director Meghan Groen then wrote in a Feb. 5 email to Gordon and other officials: “It seemed very evident from our meeting and your visit that building another facility in Caro is not a viable option.”

Gordon now says the decision to keep it open will mean better care.

“We want to be able to strengthen the quality of care in Caro,” he said in a statement.

The legislature would have to approve whatever final plans for Caro that MDHHS recommends.

Asked to comment on Reinstein’s assertion the decision to keep Caro open does nothing to improve overall mental health care in Michigan, Whitmer press secretary Tiffany Brown said the department’s recommendation “will maintain the existing Caro facility near the same number of beds currently filled, expand the availability of care in other parts of the state, and improve the quality of mental health services here in Michigan.”

Lynn Sutfin, spokeswoman for MDHHS said in a statement: “The Caro recommendations are not intended to be a single solution to address the needs of all people with behavioral health needs. These services must exist over a continuum, ranging from outpatient services through intensive community-based care to state psychiatric hospitalization. “

In the meantime, Michigan sits near the bottom of states for its number of state psychiatric beds per capita. According to the Treatment Advocacy Group, a nonprofit mental health advocacy organization, Michigan in 2016 had 7.3 state psychiatric beds per 100,000 people, compared to the U.S. average of 11.7 beds per 100,000 people.

It’s a legacy of the shuttering of mental health hospitals that began in the 1960s and accelerated in the 1990s when then-Gov. John Engler closed most of the state’s remaining 16 psychiatric hospitals and moved patients into local community care. The state now operates five psychiatric hospitals, all in the Lower Peninsula.

Funding for state psychiatric hospitals has fallen from 9 percent of the state general fund in 1965 to just under 3 percent of the general fund, according to MDHHS.

But at the same time, the 2018 Michigan Department of Health and Human Services report found, Michigan’s community hospital psychiatric capacity has “fallen precipitously,” from 3,041 adult beds in 1993 to 2,197 adult beds in 2017.

“As the number of inpatient psychiatric beds has decreased, health care providers have increasingly struggled to secure inpatient services for individuals who are in psychiatric crisis. Providers must frequently contact multiple facilities with no guarantee that an appropriate bed may be available,” the report stated.

Moreover, there are widespread reports of inmates spending months awaiting court-ordered psychiatric treatment. 

According to MLive, that included 28-year Justin Lee Dawson. Dawson was found incompetent to stand trial for second-degree criminal sexual conduct, but according to his attorney, languished nearly year in jail while awaiting treatment at a state psychiatric hospital.

And as a further consequence of these gaps in mental health care, advocates say, Michigan’s jails and prisons are filled with the mentally ill. According to the Michigan Department of Corrections, nearly a quarter of state prisoners have some form of mental illness. A 2003 report of jails in Wayne, Kent and Clinton counties found that 51 percent of inmates were mentally ill.

East Lansing resident Jenny Thomas told Bridge Magazine she’s struggled to navigate the mental health system for three years, as she tries to get care for her 23-year-old daughter. Thomas said her daughter has been diagnosed with a combination of schizophrenia and bipolar disorder that at times can leave her catatonic. She said she preferred not to name her.

Compounding her daughter’s difficulties, Thomas said, she also has been diagnosed with anosognosia, a condition that blocks her ability to recognize that she is mentally ill. That can make her resistant to taking her prescribed medication, which can lead to repeated mental health crises.

Thomas said she’s been hospitalized eight times, in psychiatric facilities from suburban Chicago to Lansing, Owosso and Saginaw. That included one episode where she was sent to two hospitals in Lansing, then to a community treatment facility where she waited days for a placement, then to a private treatment center in Saginaw.

“It’s been incredibly frustrating,” Thomas said.

Thomas said she’s been unable to secure the long-term treatment she believes her daughter needs. Save for one three-week stay in Saginaw, Thomas said, most of her treatment has been about five days to a week.

“These are your revolving-door patients. You just set them up for returning,” Thomas said.

Robert Sheehan, CEO of the Michigan Association of Community Mental Health Boards, said the decision to keep Caro open was probably for the best.

“Something had to be done,” he said.

“Keeping some people there makes a lot of sense. But the fact that you are providing only [approximately] 150 beds total, it really just scratches the surface. Caro is one piece of the pie.”

But Sheehan lack of long-term mental health care and difficulty retaining direct care workers remains important barriers to what’s needed in Michigan.

“There are gaps,” he said.