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Beds come up short for mental disorders

The Record-Eagle - 4/18/2021

Apr. 18—TRAVERSE CITY — Michigan may have closed many of its state-run asylums during the past several decades, but the doors are still slamming shut on the people suffering from mental illness.

With beds in the state's five psychiatric hospitals numbering less than 800, county jails have become warehouses for those with untreated mental disorders. They are picked up for trespassing, drunk and disorderly conduct or domestic assault, often becoming repeat offenders.

About a quarter of the people entering Michigan jails have a serious mental illness, according to a recent study by the Michigan Joint Task Force on Jail and Pretrial Incarceration. Other studies suggest that up to 70 percent of those in jail have some history of mental illness.

"It's common knowledge that the largest psychiatric hospitals are jails and prisons," said Dr. Lawrence M. Probes, a psychiatrist with the Traverse City Pine Rest Clinic.

The closing of state hospitals across the nation can be traced to the Community Mental Health Act of 1963 signed into law by President John F. Kennedy. The CMHA was to replace mental institutions with federally-funded community-based mental health centers that would provide inpatient and outpatient services for those with mental disorders.

The CMHA did much to address inhumane treatment of people with mental illness in often-overcrowded institutions while also creating a financial incentive for state hospitals to close, as treatment in clinics would be less costly. A total of 1,500 community centers were to be constructed, but the funding never fully materialized. Fewer than 800 of the centers were built.

The centers also did not focus on patients being discharged from the state hospitals, but rather those with less severe illnesses who were sometimes called "the worried well," defined as those who are unnecessarily anxious about their mental or physical health.

Commitment laws were later reformed, making it much more difficult to institutionalize a person. The reforms went a long way in protecting the rights of people with mental illnesses, but more state hospitals closed, including the Traverse City State Hospital, shuttered in 1989 after years of declining use.

The reforms also limited access to in-patient services for those who may need it most, Probes said.

"Criteria for admitting patients have become so strict," Probes said. "It's gotten so tight now that people are being diverted from the places that would give them the treatment they need to jails."

In addition to state hospital beds, Michigan has about 2,280 adult licensed beds and 270 beds for children and adolescents in community hospitals and private psychiatric facilities, according to the Michigan Department of Health and Human Services. The numbers were updated in March.

Just 32 of those beds are located in the 18 northern lower Michigan counties comprising MDHHS Region 7 — 17 at Munson Medical Center and 15 at Alpena General Hospital. There are none for those younger than 18 years.

The numbers leave an unmet need of 69 adult beds and 17 for children and teens in the region, according to the state agency.

Still, there are no plans to add more psychiatric beds in an expansion underway at the Traverse City hospital, said Terri LaCroix-Kelty, Munson's behavioral health director.

The behavioral health unit, known as D-6, opened in early 2018 and replaced the former 14-bed Center 1 unit. The unit has an average daily census of 15 patients, but Munson is looking at the community-wide need for the system, LaCroix-Kelty said.

The hospital is not trying to keep people out, she said, but strict insurance criteria often keeps them from being admitted to the unit. Those criteria say a person must be a danger to themselves or others or be unable to take care of themselves.

"We know they're in crisis," LaCroix-Kelty said. "I would much rather have a crisis center where people could go. We don't like to involuntarily hospitalize people and take their rights away."

It's also best to intervene with a person in behavioral health crisis as early as is possible to help get that person back on the track to wellness, she said.

"We need to get the right care at the right time versus simply going to the highest level of care," LaCroix-Kelty said.

Adding to the problem is a nationwide shortage of psychiatrists, Probes said, with many people languishing for weeks on long waiting lists to see someone. He gets phone calls, texts and emails daily from people seeking help.

"There's a level of desperation in their messages," Probes said.

Michigan has about 12 psychiatrists per 100,000 people, according to a recent study by the University of Michigan School of Public Health Behavior Health Workforce Research Center. Fifteen counties in the state have no psychiatrists, according to Altarum, a health research organization in Ann Arbor.

It used to be that anyone could be seen by a Community Mental Health Authority, Probes said, but that has changed.

"In the last 10-15 years that has been so reworked by our system that now it's very difficult to get into the public mental health system if you don't have a level of very severe mental illness," he said.

In recent years mental health and substance abuse services have become hot-button issues, Probes said. Despite that, there is little funding for solutions such as one proposed for Grand Traverse County, a 24/7 walk-in clinic for those in crisis.

"It just doesn't penetrate the walls of the legislature when it comes to funding," Probes said. "We can always afford the next war, but taking care of mental illness? We have very poorly sorted out national priorities."


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