Sheehan said he found two pleasant surprises in the 27-page report. One was that other states use their public psychiatric hospitals 17 times more than Michigan does.
“This shows you even progressive states have an awful lot of state hospitals as one of their main line forms of mental health care, which is a barbaric form of (treatment),” Sheehan said. “We have transformed to a community-based system pretty effectively.”
A second surprise was that Michigan ranks sixth in the nation for access to care for adults and 28th for children and adolescents, according to the Mental Health in America in 2020 report. Overall, Michigan ranked 17th.
“We’ve taken some pretty bad budget cuts over the years, and I was pleasantly surprised about sixth for adults,” he said. Now, 28th isn’t great for kids, but it still is in the top half, and given the cuts we’ve taken, I am quite impressed.”
But Pallone said the report by Mental Health America includes commercial and Medicare mental health information. “The CMHAM claiming credit for a national ranking on this site is like Toyota claiming credit for Michigan’s ranking in domestic truck sales,” he said.
Sheehan said Michigan still has a problem with access to certain types of community hospital behavioral health beds.
“The mix of the beds and the kind of client we need for them doesn’t match,” said Sheehan. For example, people with moderate to severe behavior problems might have a hard time finding an inpatient bed if hospitals only have beds staffed for depression.
Udow Phillips said there is no question more funding is needed for the public mental health system, but more importantly a new approach is needed in Michigan to serve physical and behavioral health needs of Medicaid population.
“The (community behavioral health clinic) initiative keeps the focus on integration of clinical care and provides an opportunity to continue the alignment of the financial and clinical systems,” Udow Phillips said. “Using the CCBHC model as the focus for expansion of care and innovations in the state should advance the goals both the legislature and the governor have both supported for mental health care in Michigan.”
Sheehan said some state legislators have acknowledged that the way the state pays for mental health services needs to be reformed. He said increasing demand for behavioral and substance abuse services has plagued the system for years.
Sheehan said CMHA is not opposed to redesigning and reforming the mental health system. He said it must be accomplished through a patient-centered approach as opposed to a financially driven management approach to integration.
“There is a gray zone between what the health plans manage for Medicaid and what we manage. That’s a problem,” Sheehan said. “If you’re severe enough, you get the community mental health system. But if you aren’t severe enough, you have a hard time getting into the commercially managed system.”
Sheehan said a growing number of agencies are taking on the mild to moderate cases, even though it is the responsibility of Medicaid HMOs.
“Agencies do this from a risk management and humanitarian impulse, but we are underwriting (care that Medicaid HMOs are responsible for,” Sheehan said. “We do it, but it is not what we are supposed to be doing with the Medicaid dollars that we manage.”