Revision to ‘Kevin’s Law’ means quicker treatment for the mentally ill

Betsy Johnson

Betsy Johnson of the Virginia-based Treatment Advocacy Center: “It’s not a cure-all for the problems of a broken mental health system.”

On any given day in Michigan, they can be found wandering the streets, or in shelters, jails and prison. There are an estimated 300,000 adults with serious mental illness in Michigan.

Advocates say a measure signed into state law in November should make it easier to secure court-ordered mental-health treatment for those who may be too sick to recognize they need help. It allows families or guardians to seek court-ordered treatment for the mentally ill before they reach a crisis stage where they have to be hospitalized or do something dangerous to themselves or others.

But at the same time, caution critics, the revision alone won’t fix a state mental-health system still riddled by gaps in access and treatment.

“It’s not a cure-all for the problems of a broken mental health system,” said Betsy Johnson, legislative and policy director for the Treatment Advocacy Center, a Virginia-based nonprofit advocacy group for improved treatment of severe mental illness.

“It’s really only intended for a relatively small population of individuals with serious mental illness, who lack insight into their illness. But for that select group of people, it could be the difference between life and death.”

Milton Mack

State Court Administrator Milton Mack: “I am optimistic (the new law) will help a lot.”

Plugging a small, but critical, hole

“I am optimistic it will help a lot. I think it has the potential to have a major impact,” said Milton Mack, former chief judge of Wayne County Probate Court in Detroit, named in 2015 as administrator of the state court system.

Mack was a key advocate for the measure, aimed at patching flaws in “Kevin’s Law,” a package of bills signed into law in 2005 that was to allow judges to order outpatient treatment for unstable individuals with severe mental illness like schizophrenia or bipolar disorder.

The bill was named for Kevin Heisinger, a University of Michigan graduate student beaten to death in the bathroom of a Kalamazoo bus station in August 2000 by Brian Williams, an untreated paranoid schizophrenic. William had for years cycled through mental health institutions and the criminal justice system.

But according to Mack, Kevin’s Law accounted for less than a hundred court orders for treatment a year in Michigan.

“It was insignificant in its impact. It was rarely used,” he said.

By most accounts, Kevin’s Law failed because it was complex and confusing – both to judges and advocates for the mentally ill. 2014 survey of Michigan probate courts by the Mental Health Association in Michigan, a nonprofit advocacy group, found that with the exception of a few probate courts in Michigan, most judges used Kevin’s Law less than three times a year.

The new measure revises Michigan’s mental health code and simplifies the process of seeking court-ordered outpatient treatment for an individual. It allows outside parties – including the individual’s family – to petition for treatment while an individual is in a psychiatric hospital.

Critically, the revisions also allow a court to order treatment if an individual’s judgment is so impaired by mental illness he or she is unable to understand the need for treatment, thus creating a substantial risk of future harm. Courts previously had to be convinced by an individual’s behavior he was an imminent danger to himself or others. At its heart, the new measure is designed to help unstable individuals before they reach the crisis point.

So, for instance, if parents learn that their adult son has gone off his medications, they can start the petition process and not have to wait until the son does something violent or dangerous to get help for him. Getting help for someone with mental illness earlier in the process will also cut down on inpatient hospitalization, which is both more expensive and more difficult to execute because of the shortage of beds for the mentally ill in Michigan.  

Treatment Advocacy Center’s Johnson said the measure – while no panacea – is a significant step forward for Michigan.

Deinstitutionalization dilemma

At the same time, however, experts say Michigan’s mental health care system continues to fail far too many of the mentally ill.

Through the 1950s and 1960s, most unstable individuals in the United States with severe mental illness were housed in state-run psychiatric hospitals, as they were deemed incapable of living with the general population. But that began to change, as medications improved and advocates for patients’ rights argued they would be better served in less restrictive conditions within the community at large.

Michigan was more aggressive than most states in making the shift – at a cost.

By 2003, Michigan had closed three-fourths of its psychiatric hospitals and by 2016 had the fifth fewest number of state psychiatric beds per capita in the nation, with 7.3 beds per 100,000 people. Advocates recommend 40 beds per 100,000.

The move to local treatment also coincided with a spike in incarceration and homelessness among the mentally ill, especially those who are both severely mentally ill and resistant to treatment:

In 2010, a University of Michigan analysis of the state prison population concluded that 20 percent of males and 25 percent of females had severe psychiatric symptoms – but that 65 percent of those with mental health symptoms did not receive psychiatric services. The study was based on detailed mental health assessments of 618 randomly selected inmates.

According to the National Alliance on Mental Illness (NAMI), a Virginia-based nonprofit advocacy organization, an average of 26 percent of those in homeless shelters across the nation have some form of serious mental illness. In 2007, the National Center for Mental Health and Juvenile Justice , a New York-based nonprofit advocacy organization, reported that 70 percent  of juveniles in the criminal justice system have some form of mental illness, while 20 percent have severe mental health disorders.

Overall, NAMI estimates, 4.2 percent of American adults experience serious mental illness in a given year – which would amount to about 300,000 in Michigan.

One expert said the shift to community-based treatment for the severely mentally ill worked out for many. But for others, it was a broken promise.

“It’s easier to say we’ll serve everyone in the community, but much harder to do,” said Mark Reinstein, president and CEO of  the Mental Health Association in Michigan, an Okemos-based nonprofit advocacy group. Reinstein was in the working group that helped craft revisions to Kevin’s Law.

“We relied too heavily on psychiatric hospitals and residential programs and now we have relegated so many to the juvenile justice system, jails and prisons, or they are homeless. We need to do much better.”

And left unresolved, Reinstein noted, is a controversial proposal by Gov. Rick Snyder to transfer mental health funds from local public mental health agencies to private, for-profit Medicaid HMOs. After considerable pushback from families and mental health stakeholders, that plan remains on hold until next year. A group convened to the study the issue is to report to the Legislature in February.

One family’s story

Like many parents with a severely mentally ill son or daughter, Washtenaw County resident Patricia Doyle often felt like a helpless spectator in the life of her son. A past president of the NAMI advocacy group branch in Washington County, she asked that he not be named.

Diagnosed with schizoaffective disorder 15 years ago, her son has careened between stretches of stability and mental deterioration that left him isolated, confused and, at times, homeless or in jail. Those interludes coincided with his decision to quit taking medication designed to keep him stable.

“He would end up on the streets. He would wander away. Honestly, there were times when we didn’t know if he was dead or alive,” Doye said.

A few years ago, Doyle got a call from Utah. Her son was in jail, locked up for grabbing food off the shelf in a party store.

“People don’t understand, when you get a call and your son is in jail,” Doyle said. “You are relieved, because at least you know he is alive. We had to go out and get him.”

Thirteen years ago, Doyle said she got her son admitted to Rose Hill Center in Oakland County for a year of in-patient treatment. She and her husband, James, dug into their retirement savings to pay for it since there was no state funding to cover it.

“It was very expensive,” she said.

But his life remained on a roller coaster as, all told, he was hospitalized 11 times over a decade. Doyle went to probate court three times to persuade the court to order treatment for her son. But it seemed to Doyle her son’s behavior had to reach a crisis point before the court was willing to act.

Off his medication, Doyle said, it was like her son transformed into to another person. He heard voices. He might fixate on a single Bible verse or obsess about Hitler. He got in the face of strangers on the street.

But for the past three years, his life has been on a positive trajectory.

Her son, now 42, lives in his own subsidized Washtenaw County apartment and works 20 hours a week, cleaning and doing maintenance in office buildings. A 2013 probate court treatment order helped him connect to a state program called Assertive Community Treatment, under which a social worker initially saw him five times a week to ensure he was taking his medication. He now reports twice a month to receive an injection of medication that keeps his illness under control.

“He is a part of a church community. He is politically active. You would not know this is the same person,” Doyle said of her son.

Doyle said she was somewhat aware of Kevin’s Law over the years as she sought treatment for her son, but never invoked it. From Doyle’s perspective, if revisions to Kevin’s Law make it easier for others to get treatment, she’s all for it.

“I know there are many families trying to get treatment (for relatives) and they run into so many obstacles. It’s going to be a godsend for them.”

Reinstein of the Mental Health Association in Michigan said it will be critical in the months ahead to educate judges, mental health workers and parents alike about changes in the law.

“This didn’t happen the first time around,” Reinstein said, referring to the original version.

“This is not going to be a magic solution to all the problems of community care. Will the state Department of Health and Human Services put on effective training? That didn’t happen the first time around.”

It should be different the second.

Snyder spokesperson Laura Biehl said DHHS regional training sessions are planned for 2017 for courts, Community Mental Health agencies, treatment facilities and law enforcement on revisions to Kevin’s Law.

Lt. Gov. Brian Calley, who pushed for the revisions, told Bridge in a statement that the law should “help connect Michiganders with the help they need sooner, giving people a better chance of living self-determined independent lives.”

About The Author

Ted Roelofs

Ted Roelofs is a Bridge contributor based in Grand Rapids. He can be reached here.

Comment Form

Add new comment

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Minimal HTML

  • Web page addresses and e-mail addresses turn into links automatically.
  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Lines and paragraphs break automatically.

Comments

William C Plumpe
Tue, 01/10/2017 - 8:35am

I can remember back in the mid 70's when I graduated from U of M and worked as a counselor in a drug and suicide crisis center.Laws to commit individuals with obvious mental problems were much simpler andmore straightforward. It was relatively easy for police to get a court order to temporarily commitsomeone to inpatient psychiatric care for observation. Easier too for families to get a court orderso that a family member with serious mental problems could at least be seen and evaluated by a competent doctor.There also were more mental health care options with extensive State subsidized in patientpsychiatric care much more readily available.But very liberal mental health care attitudes as well as ever decreasing budgets in the last 40 yearshave changed all that and I am not sure it was always for the best.Police who are confronted with an individual with obvious mental problems really haveno option other than to jail the individual for the legally allowed time to keep them off the streetsif they pose a danger to themselves or others and even that is difficult.Have we become too liberal in regards to mental health issues?Police are not trained to be mental health counselors and should not be expectedto take on additional responsibilities because of well meaning but ill advised budget cuts.disguised as initiatives that "free" the mentally ill to "be themselves".That is not a good idea at all when those individuals are clearly a threat to themselves and others.People who are "hearing voices" on a regular basis are not healthy and well adjusted andneed to be steered to psychiatric care not "liberated" and thrown out on the streetswhere they are expected to fend for themselves. Too much freedom is not a good thing either.What is needed is an option for police to get a court order as in the past to temporarily commitsomeone who in the opinion of a mental health professional has a serious mental health problemthat makes them a danger to themselves and/or society.But then we run into the second problem that the kind of mental health treatment facilities available in the mid 1970's including extensive in patient psychiatric care facilitiesprovided by the government are no longer available or are provided on a for profit basis.So the solution is two fold. First we must increase the availability of in patient mental health careso that those with really serious problems can at least be evaluated for their level of threat andgiven appropriate treatment after evaluation. Then second we must make it easier for policeto identify individuals with serious problems so that they can at minimum make contactwith a mental health professional at an in patient psychiatric facility for evaluation.These people are now wandering the streets and filling homeless shelters.It seems we have abandoned the most vulnerable in the quest for the bottom lineand that is not only improper and inappropriate but heartless and cruel as well.

Tue, 01/10/2017 - 12:38pm

Loved your thoughts, William, but disagree with the liberal policies angle. Those theories that attempt to normalize mental illness are definitely out there, with people like William Glasser and Thomas Szasz at the forefront. However, actual treatment of mental illness on any widespread basis has overwhelmingly been about alleviating suffering. If I'm one of those professionals who don't believe in mental illness (I'm not) and someone comes to me who can't work, can't get along with their family or maintain friendships, and can't practice basic hygiene, then whatever my thoughts about the diagnostic system or the pathologizing of certain ways of being, I'm going to try to help alleviate that person's suffering. I'm not claiming you haven't seen these hippy-ish policies in action, I'm sure you have, but I don't think they are responsible for the overall decline in mental health treatment. I think the financial issues you mentioned and massive ignorance among policy makers are responsible.

William C Plumpe
Tue, 01/10/2017 - 3:13pm

I too believe that cuts are largely responsible but I think the "self-actualization", "do your own thing" attitude prevalent in psychiatry in the late 70's and early 80's created an atmosphere where justifying budget cuts was much easier because liberals wanted to "humanize" psychiatry and respond to definite abuses in State in patient psychiatric care facilities that had turned into warehouses for the insane. I just think we've gone too far in the other direction and now have thousands of individuals who need psychiatric care who are "free" to live on the streets as they wish and are therefore not so much of a direct financial burden to the government and are less likely to show up in a budget line item. To me that is misplaced priorities and a very sad state of affairs. We need to be less"politically correct" and more reasonable and practical. People who hear voices on a regular basis are not healthy and are not able to function well in society especially if they don't take their meds. Maybe we have to force them to do that again and consider institutionalizing the most acute cases to at least get them off the street.

Gloria
Tue, 01/10/2017 - 8:52pm

It will only work when courts and Community Mental Hell let it work....they still are recommending against using it, especially when it comes to the smi....Community Mental Hell in St.Clair County is a joke, and the one probate judge here doesn't even understand how to use the law.....

Mack
Fri, 01/13/2017 - 11:05am

You're absolutely right, Gloria. For Kevin's Law to be effective the Court, CMH, and hospitals have to work together. If they don't, more legislation doesn't matter.

William C Plumpe
Sat, 01/14/2017 - 7:23am

Well then maybe legislation should compel them to act.

Anonymous
Sun, 03/05/2017 - 9:27pm

Obviously not...I talk to parents repeatedly that are turned away, turned down, and they are all told they don't know what Kevin's Law is - or how to use it. We want change - it needs to start with Community Mental Hell and poor judges like Judge Tomlinson - who did not even uphold his own court order in my sons case...2 years later and I have spoken to five mothers faced with the same thing I was faced with - trying to save their children's lives....and they are getting NO HELP - and CMHell tells them they do not even know about Kevin's law or how to use it...so this was all just a nice press release and nothing more?????? Who is doing anything about this as our children die?????

Carrie
Sun, 01/15/2017 - 3:08am

I hear you both...I was a teen when in 1996 the governor decided to close the mental health hospitals and I witnessed them closing as my mom had to go back into the hospital, Clinton Valley Center for example, and had to clise and secure medical records. Since then I've worked in outpatient mental health facilities to my current job working in a year round homeless shelter as a service navigator. We house around 62 homeless adults and help them to get connected to community supports and back on their feet to their own home. I can't believe how many come my way with severe mental health issues, it's sad. Trying to get them support is sometimes hard but I am grateful for our community supports that help us through some difficult times. We couldn't help (to our best) our homeless community without the support of CMH and its providers, the local sheriff, Community Housing Network and other community support programs/organizations. To end homelessness for the mentally and non-mentally ill you need ALL the support of ALL community organizations, government agencies (local and statewide) and community support. After all these years I hope and pray that we are in the motion of an upswing of helping ALL involved (patients, clients, guest, family members etc ) of living life to its best potential.