A Crack in the System

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Parents of children with mental illnesses have compared it to a lottery system. If you're lucky you get in, if not, emergency rooms, child welfare and juvenile justice are your only options.

"Where are these children supposed to go?" Tiffany Bryan, a mother of three said.

Bryan's oldest child struggles with mental health issues and while the family has insurance, she has struggled to get him help.

"My son has had meltdowns, my son has become violent, he's extremely aggressive," Bryan said of the 11-year-old. Five years down the road she worries he'll hurt others or himself. Bryan loves her son, but says the nightmare of Newtown hit home.

"I'm afraid if he doesn't have the right supports and the right services and medications that go with that, things could escalate," she said. "We could end up dead before anything is really happening."

Her family is one of many, trapped by Michigan's lack of mental health parity.

The state is one of only seven without laws requiring employers to cover mental health needs, the same way they would cover medical or surgical benefits. That leaves many people with private plans under-insured and turning to the public system for care.

"We have a huge gap that's being created in this state, that home and community-based care is not available unless you have Medicaid, or are eligible for community mental health," Malissa Pearson, Executive Director of the Association for Children's Mental Health said.

Pearson says those caught in the middle would be able to get help with dollars set aside in the state's general fund, but that money has been eroded.

Since 2009, the state has cut non-Medicaid mental health funding by more than $89 million. Non-Medicaid mental health funding is projected to increase this year and again in 2014, but will still fall short of 2009 levels.

Pearson calls it a blow on two fronts. As Michigan trimmed community mental health funding, she says it also funneled more patients there, by rapidly closing the state's public psychiatric hospitals.

The change was well-intentioned, but according to Pearson, poorly planned.

"We deinstitutionalized, yet when we put people back into homes and communities, we failed to provide good comprehensive community based services, she said.

The state had one of the most aggressive deinstitutionalizations in the nation, closing three quarters of its 16 psychiatric hospitals by 2003. It now has just three public psychiatric hospitals for adults and one for children.

According to the national non-profit Treatment Advocacy Center, Michigan is among the worst in the national at caring for the severely mentally ill. A center report shows Michigan with the fourth-lowest number of public psychiatric beds per capita in the country, with about six for every 100,000 people.

The shift from hospitals to community-care is bringing an increasing number of patients to local jails or state prisons. The facilities are not equipped to care for the needs of the mentally ill, but some are reporting a third or more of inmates with mental illnesses.

"We're maxed, we are using every hour that is available to deal with inmates who have mental health issues," Ingham County Jail Director, Major Sam Davis said.

Davis says if those needs were addressed early, it's possible his jail wouldn't be so full.

But unless you're suicidal, homicidal or commit a crime, Pearson says public mental health services are hard to come by.

"They are turned away by mental health, our mental health code says our community mental health centers serve the most significantly impaired individuals," she said. "Due to funding cuts, the criteria to be eligible for community mental health care has gotten higher and higher."

"That often does happen, that the most severe cases are the ones who get treated," Michigan Community Health Director Jim Haveman said.

Haveman heads up those programs statewide.

"I don't like gaps in service, I want to be part of solving what people are critical of out there," he said. "What I think we can't do in this state is say we're underfunding things all the time."

Compared to other states, Havemen says Michigan's per capita mental health spending is in the top third. He admits there are problems, but says we're rebuilding after hard times.

"The support that we've had to expand services, even getting new money in the budget, we should be proud of where we're at," Havemen added.

Governor Rick Snyder made a monetary commitment to mental health in his 2014 budget, but Havemen says Snyder's call for Medicaid expansion is an even bigger win.

It will provide mental health services to 320,000 people who don't have insurance. The Affordable Care Act is bringing other changes.

"We're entering a new era where mental health will have parity and substance abuse will have parity with other illnesses, that's a huge step forward," Haveman said.

Children are a focus in the governor's new budget. It sets aside $5 million for what the administration is calling mental health innovations, which will fund three areas impacting kids. First, comprehensive home-based mental health care to reduce child hospitalizations, more services for children with complex behavior issues and mental health training for law enforcement and other public and private groups.

Money is also being marked for programs to pull those with mental illness out of jails and into treatment programs. Corrections staff say the $1.6 million investment there will be life-changing and a good move for taxpayers.

"You know we are a short term facility," Davis explained. "They're here for a short time and then they're back out into the community, that continuation of care is something that's really critical for their success."

Another focus will be standardizing care, making sure the same options are available everywhere in the state.

"It's time for us to say okay, we have to do something different," Pearson said.

Havemen believes we're on our way.

"This governor is taking a commitment to mental health care real serious and that's why he's putting new money into it," he said.

For families like Bryan's, it can't come soon enough.

"Right now he's little, he's short and tiny for her age," she said. "Give him five years he's going to be bigger than me."

Without treatment, she worries he'll hurt others or himself.

For additional information on seeking mental health in Michigan visit the state's website.