In Search of a Psychiatric Bed?

Mar 22, 2018 by

Tom Watkins –

It is true. I am quoted in the article below as saying by noted Detroit-area columnist, Jack Lessenberry, “Finding a psychiatric bed for someone with a serious mental illness is often like your name is Mary and Joseph. It’s December 24th.”

Sometimes, the truth hurts. Mental health care is desperately needed, but difficult to achieve.

Squeals have been heard from Lansing and local hospitals as well as others responsible for fixing this problem about my pointing this out. But is scarcely a secret among those working in the system or those attempting to get a loved one appropriate mental health care.

Being quiet on the topic will not make it go away. To pretend it is not an issue has not worked — the problem has persisted for decades. If silence was the answer, the problem would have been solved by now.

There have been various rationales and excuses for this inability to find adequate hospital beds for some of society’s most vulnerable people. They go something like this: “You need to understand the historical perspective (I do)”, or claims of “massive budget increases/decreases”, “inadequate reimbursement”, “professional staff shortages” or claims that “these people” are “too sick and aggressive” to be in our local hospitals.

Hospitals claim they are losing money caring for the chronic and seriously mentally ill and if forced to do so without adequate reimbursement, they will close their psych units. This will only exacerbate the problem.

The goal is not to cast blame but to create a greater sense of urgency to assure this long-standing and festering problem is resolved before an avoidable tragedy jolts us into action.

The Michigan Department of Health and Human Services (MDHHS) created a task force late last year, Michigan Inpatient Psychiatric Admissions Discussion (MIPAD), and recently completed its work to find solutions to these long-standing problems. They acknowledge that many of the fixes will require time, resources, or power that is currently lacking.

I’m heartened to learn the MDHHS has identified 19 of the task force recommendations for short-term action in 2018 and will partner with the House C.A.R.E.S. Task Force on improving access to inpatient psychiatric services. More good news -the Michigan Health Endowment Fund has also provided grant funding to help support the implementation of the MIPAD initiatives.

There is a 3-year timeframe set to address the four dozen or so recommendations. Honestly, this is no relief for family members seeking adequate care for their loved ones NOW! It does appear bureaucratic, kicking the can down the road – AGAIN – into another administration’s term in office.

We can endlessly debate whether the issue is a need for more psychiatric beds or greater accountability to assure that those in need of hospitalization receive it. Finger-pointing does not solve the crisis for the community mental health worker, hospital social workers, and loved one trying desperately to get help for their son, daughter, mother, father, brother, sister, friend, or neighbor.

And no, the answer is not re-opening – in masse – the state hospital system, closed during Governor John Engler’s reign. A few strategically placed longer-term beds in the Southeastern Michigan region, however, would help.

Show Me the Integration

The buzzword around Lansing these days is “integrated care.” Yet, the state allows – whether by default or design – a local hospital to deny persons with serious mental illness access to available psychiatric beds. Two questions:

1)  Why?

2)  How are we integrating care by denying service to those most in need?

Hospital social workers have told me their job is to “move these people out” or less politely, “to get THOSE PEOPLE the hell out of the emergency room”. They describe their jobs like the words to that old movie theme for Rawhide: “Keep movin’, movin’, movin’ … (though they’re disapprovin’), keep them doggies movin’, Rawhide.”

Don’t try to understand ’em, just rope and throw and brand ’em … “Move ’em on, head ’em up. Head ’em up, move ’em on up, Rawhide!”

The fact is some of our most vulnerable citizens – those most in need of short and longer-term hospitalization to address their serious mental illness – are daily being turned away across the state. This is not simple advocacy rhetoric: the data exists to clearly demonstrate the problem.

This is a crisis and a scandal of the first order. Why doesn’t this concern us all on multiple levels?

None of the rationales or excuses deny the fact that persons in need of service are being turned away. In moments of honesty, hospital staff will confirm there are “do not admit lists” for those chronic and repetitive persons with a serious mental illness that are “non-compliant or aggressive.”

Does it come as any surprise that in some cases, these behaviors are part of the illnesses that staff are professionally duty-bound (and paid by taxpayers) to treat?

There seems to be no adequate effort to hold people accountable for appropriate service to those with the most severe mental health needs in our state.

The Truth

One major provider with over 40 years of watching the merry-go-round and excuse-machine puts it bluntly:

“Every day we face the same thing: hospitals looking for the least suicidal, least aggressive and most receptive patient to fill their open beds. At the end of the day, nearly every day, we end up with the illest persons waiting for the longest for appropriate care. Imagine a cardiologist having this kind of freedom to choose which myocardial infarction he or she would like to treat! It’s like waking up in Bill Murray’s time loop of Groundhog Day.”

Kevin Fischer, the CEO of NAMI-MI, the voice for persons with mental illness ( who lost his son, Dominic, to suicide while battling a serious mental illness says, “We have to move past the finger pointing and do not only what we know needs to be done but do what we know is the right thing to do. When the state hospitals were closed in the 90’s, the idea was the non-profit and for-profit hospitals would help fill the gap in partnership with community health. What we have seen is that’s not happening, I’m being told because it’s not profitable. There is a solution, the state and the hospitals just need to work it out.”

(I have written about his powerful advocacy here in this article, Values-Driven Advocate Under Capitol Dome

Joseph P. Sedlock, CEO for Mid-State Network, understands and has been a true leader in attempting to forge change to meet this human and civil right need of persons with mental illness stresses:

“The bottom line is that there are adults and children in acute psychiatric distress – an emergency – that should be immediately admitted to the appropriate level of care, in this case, psychiatric inpatient care. It is unacceptable for any other illness that people experiencing an emergency would be housed in inappropriate settings, sometimes for days, weeks and in a few cases a month or more. People experiencing psychiatric emergencies require immediate, safe and effective treatments in inpatient settings and deserve no less. I support the MIPAD recommendations as a participant in the process. While these recommendations are being addressed, we cannot lose sight of the fact that, meanwhile, we still have people experiencing a mental health emergency that is being denied admission to psychiatric inpatient care and is being boarded in emergency rooms, clinics and other places not appropriate to their condition. We wouldn’t tolerate it for cardiac conditions or stokes, and we shouldn’t tolerate it for mental health emergencies either.”

Mark Reinstein, Ph.D., President & CEO of the Mental Health Association of Michigan ( has been a loud and persistent advocate on behalf of persons with mental illness emphasized:

“Some people with mental illness will clinically need psychiatric hospitalization at one or more points in their lives. Relying on private psychiatric hospitals and psych units in community hospitals has proven problematic because those hospitals, which have reduced the number of psych beds, don’t always feel equipped for difficult cases, sometimes refuse to take perceived difficult cases, and provide only short stays (averaging less than a week). This is not enough to stabilize many people. Meanwhile, we’ve closed most state-run psychiatric hospitals and are one of the five worst per capita states for state-operated hospital beds, per the Treatment Advocacy Center (Virginia). Further, our remaining state hospitals are filled with forensic patients and have long waiting lists. No one is suggesting we re-open 15 state psychiatric hospitals, but we definitely need more state-operated (longer-term) beds than what we have right now. We also need better standards (and lessened insurance pressure) for increased length of stay in community hospitals. And public mental health system contracts with those hospitals should better address acceptance of more consumers referred by the system.”

Elmer Cerano, the CEO of Michigan Protection & Advocacy Service ( a longtime advocate protecting the dignity and rights of persons with disability put an explanation point on the issue saying, “Appropriate mental health care, be it inpatient or community based must be:

  • Promptly available when the individual wants or needs the mental health care.
  • Provided in the least restrictive environment appropriate to the individual’s needs.
  • Accessible.
  • Affordable.

It must not be restricted by artificial political or manufactured budget barriers. Sadly, too often, this not the reality for persons with serious mental illness in Michigan.”

Yes, there are once again plans in the works to address this problem and I have pledged to help in any way I can to help make the plans work.

Trust Me

The state closed multiple state psychiatric hospitals in mass in the early 90’s promising better care, closer to home, delivered by local hospitals for inpatient needs and local community mental health services when the care and support can and should be delivered in ones’ own community. The community system has met, to a large extent, its side of the bargain. But the need for local, inpatient, hospital care has yet to be met.

Now the state wants to transfer $2.6 billion tax dollars – primarily federal Medicaid funds – to the private, profit-making insurance companies, to provide care.

With only a ‘promise’ that this policy will work out just fine. “Trust me, I’m from the government and I am here to help you” falls on deaf ears in the advocacy community.

Mental health Advocates Rise Up

Believe me, “trust me” is not an acceptable response for consumers, family members and advocacy groups across the state.

Sheriffs and local police are frustrated and angry after repeatedly picking up a person who is a danger to himself or others (because of their mental illness), taking them to the emergency room— only to see them back on the streets openly psychotic and no better for the experience— and the merry-go-round begins anew. Lack of adequate and appropriate psychiatric beds for these individuals is a gaping hole in our system of care. Our jails and prisons have become the de facto psychiatrist hospitals of the 21st century.

Policymakers need to address this crisis as though it is their loved one with a serious mental illness.

A continued spotlight must be focused on the promises made in the MIPAD initiatives report developed with the input of stakeholders.

Truthfully, what is being allowed to transpire today is unacceptable.

State government, step up! A greater sense of urgency is needed.

Tom Watkins has worked in the public mental health system for over four decades. Serving as a therapist, program coordinator, director of a local CMH agency, deputy director of administration, acting state hospital director, chief deputy and director of the former Michigan Department of Mental Health. The past four years he served as President and CEO, leading the transition from the former Wayne County Community Mental Health Agency to the Detroit Wayne Mental Health Authority (DWMHA). He can be emailed at:, or followed on twitter at:@tdwatkins88


Source: In Search of a Psychiatric Bed?

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