Similar to the trend that occurred throughout the whole of the United States, in Michigan the move to shy away from the institutionalization of mentally disabled individuals began to emerge in the 1960’s. Though the limit on who could be admitted into mental institutions at a federal level was in effect in 1963 under the Mental Retardation Facilities and Community Health Centers Construction Act, the setup of the system of community mental health systems in Michigan was not codified at a state level until 1974. Under Public Act 258, which was incorporated into the Michigan Mental Health Code in 1974, a new design of community mental health boards (CMHB’s) was established throughout the state (now referred to as community mental health service programs, or CMHSP’s). This helped to usher in a new era of care for individuals in Michigan with mental disorders. Not only were state-run institutions gradually losing their significance as the primary method of treatment, but also local governments were taking a much bigger role in the scope of mental health treatment.
Currently, there are only five state-operated psychiatric hospitals in Michigan. Many of the major hospitals put to use during the hay-day of the institutionalization movement, such as the Traverse City State Hospital, have since close their doors. Directly prior to the deinstitutionalization push, there were approximately 17,000 patients checked into psychiatric hospitals in Michigan. By 1997, only 1,100 patients remained in these facilities. All of this came in the wake of the community-based treatment philosophy, which serves as the current method of care. Though this movement has been applauded as a way to ensure more humane and proper treatments for individuals with mental disorders, the means by which the transition occurred in Michigan had a substantial impact on the community mental health system as a whole.
Between 1987 and 2003, twelve psychiatric hospitals in Michigan were shut down. The rapid push to relocate the patients of these hospitals to community mental health agencies was seen as economically efficient, just, and more effective in providing treatment at a person-by-person level. However, due to the high influx of patients who were quickly removed from the closed facilities and put in the care of the community agencies, many of these local programs were unprepared to deal with the vast amount of care and attention that was needed. The 46 community mental health agencies that serve all 83 counties in the state have struggled immensely to keep up with the demand for care. This is due in large part to a lack of funding from the state. As the institutions were quickly closing around Michigan, guarantees were made to the community agencies that funding would be made available to assist in the flood of new patients. The promised funding was never realized, and in more recent years funding has been slashed for local agencies.
The Oakland County Community Mental Health Authority serves as a prime example for budgetary constraints most CMH agencies deal with. After the implementation of the expansion of Medicaid in Michigan, nearly $20 million was cut from OCCMHA’s general fund by the state, as a part of the $75 million cut for mental health funding at a state level in FY 2014. This was in response to more individuals qualifying for coverage under the new Healthy Michigan insurance program. The rationale behind this move was that individuals who were previously treated from the general fund could now qualify for Medicaid coverage. However, due to federal restrictions regarding the use of Healthy Michigan, there is still an $8 million shortfall in the general fund for those who still need to take advantage of it. Because of this loss of funding, OCCMHA has set up a waitlist for treatment of individuals who do not qualify for Healthy Michigan. It is unknown now what kind of impact a waitlist will have on those seeking care, but according to Jerry Wolffe, a writer-in-residence and advocate-at-large for the nonprofit Macomb-Oakland Regional Center, the outcome could be very negative. “If we don’t take care of them now, we will have to deal with them later when they are desperately ill,” Wolffe warns. If patients who are not prioritized as highly as others for care, it is not out of the realm of possibility that there will be an adverse result.
What may be the side effects of the underfunded community mental health agencies? Unfortunately, a negative trend is already being observed. According to a 2010 study by the University of Michigan, 20% of state prisoners suffered from a severe mental disorder. In the same study it was observed that 65% of these prisoners received no mental health treatment in the past 12 months. On top of this, nearly a third of the 100,000 homeless in Michigan have mental disorders. Many times, these individuals also go without proper treatment. With services continuously being cut to the community mental health agencies, especially in urban areas with higher concentrations of homeless, this number may continue to rise.
Though deinstitutionalization had the right goal of providing more ethical and humane treatment to individuals with mental disorders, the effects of this movement have come with some negative repercussions that directly impact the quality of life of the most vulnerable part of our population. Community mental health agencies have been assigned a task of providing proper care to patients with mental disorders while relying on a very limited amount of resources crucial to provide such care. As is to be expected in a situation like this, not as many people as desired are served with the treatment they need. Because of this, individuals with mental disorders have been admitted at a higher rate into jails and prisons, while also the homeless population with mental disorders has increased. Until more resources and funding can be provided to the community mental health agencies that act as the primary modes of care and treatment for mental health, these unfortunate trends may continue.
http://www.michigan.gov/mdch/0,4612,7-132-2941_4868_4896-14451--,00.html http://www.michiganinbrief.org/edition06/text/issues/issue-46.htm http://www.rootsweb.ancestry.com/~asylums/northern_mi/.