Mental Health Care: Easier to Knock It Down than Build it Up?

Nov 22, 2018 by

By Tom Watkins –

I pulled over to watch as the wrecking ball knocked the building apart. On a cold, blustery November pre-winter day, while riding down Seven Mile Road in Northville Township, out of the corner of my eye I saw the framed hulk of the former Northville Regional Psychiatric Hospital against a bold grey sky.

As I watched, the crane slowly pulled the skin away from the crumbling, hulking edifice that had once warehoused up to 1,500 hundred people with a serious mental illness on any given day.

Back in the 80s’s I had keys to that hospital and would often make unannounced visits at all hours of the day and night while serving as the Deputy, then Chief Deputy and, finally, Director of the former state of Michigan Mental Health Department from 1983-90.

Northville Regional Psychiatric Hospital – as it was called then – was a wicked place, full of challenges, often underfunded and short-staffed. Many good and decent staff there attempted to care for some of the most vulnerable people among us: Persons with serious and chronic mental illness.

Many psychiatric hospitals were shuttered; unceremoniously closed in the early days of then Michigan Governor Engler’s first term in the 1990’s.  The policy of closing antiquated – and in many cases ineffective – state hospitals was not wrong. However, follow-through on promises to fill in behind their closings with community-based hospital care and alternative community programs were not kept during successive Engler (and others) administrations.

The promise of adequately funding community psychiatric beds in local hospitals for the truly needed never materialized.  The ones that did develop psychiatric beds realized it was more profitable to serve the “walking worried” than underfunded Medicaid patients with serious mental illnesses.  Providing 24 hour-a-day care to persons with serious brain disorders is expensive.  However, community mental health system services were never fully funded or developed.

Today, we have more people with serious mental illnesses wandering our streets. Many are homeless and locked up in jails and prisons, rather than receiving the care they need and deserve in a civilized society.  I wondered if the wrecking ball that was tearing down the old Northville Psychiatric Hospital was symbolic of a system of mental health care that has decayed in Michigan.

Earlier this year, I wrote that finding a psychiatric bed for someone with a serious mental illness might feel like, “…your names are Mary and Joseph – it’s December 24th.”

Lack of Funding, Oversight and Accountability

Jack Lessenberry, former head of Wayne State University’s journalism program, captured the problem succinctly when he wrote, “You might think that after so many mental hospitals were closed, local hospitals would have stepped up.  But, exactly the opposite happened.  Last year, the number had dwindled to 2,197 adult beds and a mere 276 for younger people — statewide.”

The result is that too many patients who need to be hospitalized are repeatedly turned away, so they flood emergency rooms and eventually do something that lands them in prison.   According to State Court Administrator Milton Mack, a former chief probate judge long concerned with the issue of prisons and the mentally ill, severely mentally ill prisoners are, in fact, one of the most rapidly growing parts of Michigan’s prison population… and the most expensive to maintain.

Jack also hit the nail on the head when he noted, “Now, it is important to note that nobody is arguing in favor of again building enormous psychiatric hospitals to house thousands of patients.”

We do know that quality mental health care is desperately needed, has been neglected in this state for decades, is underfunded and lacks oversight and accountability.  So we closed the antiquated, often barbaric state institutions with promises of better community based alternatives…then failed to fund them.

Profitizing Mental Health  

In 2016, Governor Rick Snyder attempted to “fix the mental health system”—in the dark of the night and with no input from the very people impacted by his decisions—by proposing a shift of $2.6 billion from public mental health funds to private insurance companies.  This political move was vigorously fought by advocates of the mental health community, family members and parents along with the Michigan Association of Community Mental Health Boards.

Both the family members of persons with serious mental illnesses and advocates remain very concerned about the state privatizing—and profitizing—the public mental health system. They cautioned Governor Snyder and now Governor-elect Whitmer against moving toward what they see as “profitizing” the system of care for their family members.

Privatizing and profitizing the public mental health system is not a panacea for fixing the dysfunctional, disjointed, unaccountable system of care that evolved in Michigan. We need only to examine our own history to come to this conclusion.

Opportunity for a Fresh Start

The incoming Governor has an opportunity to listen to parents, advocates and the consumers of mental health services to structure a system of care that will meet their needs.  Mental health issues skip no zip code and impact one in four people in our communities.

We need to approach the opportunity to integrate physical and mental health care as if we just discovered this place called Michigan and have 300,000 people with disabilities that need care and support.  Just think about $2.6 billion washing up on our shores each year to serve these individuals.  How would we redesign a system around our shared values to help meet their needs?

Making profit from Misery is NOT the Way to go

Clearly, we cannot continue to behave as though nothing has changed in health care when everything is changing around us.  With a new administration comes fresh opportunity IF the Republicans in control of the legislature—and current Governor Snyder—put people before politics and don’t try to send billions of our tax dollars to private insurance companies in the lame duck session.

As I pointed out in an article during the heart of the debate to transfer public funds to private insurance companies, those pursuing this shift in public funds are placing “profits” ahead of “service.”  Such a plan is opposed by the citizens who rely on the care and pay the taxes to support people in need.

Should our elected leaders decide to the begin the process to “profitize” the public mental health system? Will the decision to move in this direction, even on a “pilot” basis, be good public policy and serve the taxpayers and persons in need of mental health service?  Advocates, parents and consumers who depend on these services think not.  They want to maintain the public oversight and control over the public mental health.

 The former Northville Regional Psychiatric Hospital

A wrecking ball is knocking down what was once the largest state psychiatric hospital in Michigan.  It was originally built as a beacon of hope for those with a mental illness. Now is the time to pause and ask, “What services are we going to build in its place?”

Let’s move forward and get past old politics and turf protection so that we can truly place our collective focus on the citizens of Michigan: Our family members and neighbors in need of quality mental health services.  Doing so would truly be a new beginning.

Tom Watkins

Tom Watkins has an eclectic career in both the public and private sectors. He served the citizens of Michigan as state superintendent of schools and director of the department of mental health. He has held leadership positions in higher education, business and behavioral health. Watkins has a interest and passion in all things China and has written hundreds of article on the value of this most important bilateral relationship in the world today.

Source: Mental Health Care: Easier to Knock It Down than Build it Up? | Dome Magazine

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1 Comment

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    Joanne Graves

    This is a very moving article. I was an employee of Northville for 23 years. We cared about our patients. Sad when we closed. Also had an Alzheimer’s unit. Whay happened to them? I loved our old people. It was a challenge, but we all loved them.

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