Opinion | Time to close Michigan’s access gap to mental health services

Only half of Michiganders on Medicaid who need mental health support receive care; those on private health insurance don’t fare much better. (Shutterstock image)

Hundreds of thousands of Medicaid-enrolled Michiganders need mental health support, but only about half receive help. We can do better for family members and neighbors in need. 

That’s why we, the leaders of six leading mental and behavioral health organizations in our state, are calling on state legislators and our governor to allocate the needed resources to fill funding gaps amid rising rates of behavioral health-related conditions locally and across the United States.

Society’s inattention to mental and behavioral health needs is the result of misinformation and misunderstanding. Stigma and the inability to pursue treatment continues to hold back the effectiveness of Michigan’s behavioral health structure. 

A new study commissioned and funded by the Michigan Health Endowment Fund confirms behavioral health care in Michigan needs more attention. The report recommends the following to improve care in our state:

  • Increase retention of behavioral health providers in Michigan;
  • Fully leverage all members of the health care team for better coordinated response to behavioral conditions;
  • Promote effective use of trained lay providers such as peer support specialists, parent support partners, youth peers and recovery coaches;
  • Use telemedicine to extend the reach of the behavioral health workforce;
  • Expand school-based behavioral health care; 
  • Integrate primary care and behavioral health care delivery at the service delivery level. 

We strongly support these findings and call for collaborative action, by public and private leaders to raise awareness of these recommendations and remove barriers leading to workforce shortages, prohibiting real utilization of proven approaches such as tele-behavioral health, school-based mental health services, peer support enhancement and increased para-professional, or lay-person assistance. These challenges are not new, but they remain largely unaddressed. 

As this study points out, there are serious unmet mental-health needs in urban, suburban and rural communities across our state, with large mental health service “deserts” spanning rural parts of Michigan. This is especially prominent in northern Michigan and the Upper Peninsula, where few mental health providers are located and where people with limited transportation face travel challenges to even attempt to access specialty care.

As this study indicates, the gap in access to needed mental health care is large across all groups of Michiganders: those with commercial insurance, Medicaid coverage and the uninsured. 

If all of Michigan could achieve the rates of care seen in the best access areas of our state, we could serve 57,000 more people with mental health needs and 27,000 more people with substance use disorders. This is a goal that is possible and within reach – if our state prioritizes the needed funding and addresses barriers. 

To the study’s recommendations, we would add two more. 

There is also a need to increase public and private dollars for mental health and drug addiction. This past spring, the Community Mental Health Association of Michigan released an analysis finding a $150 million gap between the cost of care and funding provided to Michigan’s public mental health system. The financing gap is not limited to publicly-funded care. 

Fifty-three percent of those with mental health needs and 39 percent of those with substance use disorder needs, with insurance coverage, cannot afford the cost of treatment or have enough health insurance coverage to fully recover. A system that is too expensive for the population who needs it most is a disservice to our people. 

Similar increases seen in the mental health benefits of commercial/private insurance plans must be provided by employers wishing to ensure a sound and stable Michigan workforce long term. 

Michigan should also adopt a law similar to laws on the books in more than 40 other states, specifying how our state government is to monitor, report on, and enforce federal behavioral health parity (equality) law. Without it, many privately insured Michiganders will continue experiencing discrimination in their behavioral health care services, compared to the care they receive from other medical conditions.  

Together, we can and must increase access to behavioral health services for Michiganders and support populations with the highest need. That’s why we are calling on the leadership of Gov. Gretchen Whitmer, the Michigan Department of Health and Human Services, the state legislature, and commercial health insurance companies to address these challenges with us as allies.

This commentary is jointly written by Mark Reinstein, CEO of the Mental Health Association in Michigan; Kevin Fischer, CEO of NAMI-Michigan; Jane Shank, CEO of the Association of Children's Mental Health; Greg Toutant, CEO of Great Lakes Recovery; Sam Price, CEO of Ten16 Recovery Network; and Robert Sheehan, CEO of Community Mental Health Association of Michigan.​

Bridge welcomes guest columns from a diverse range of people on issues relating to Michigan and its future. The views and assertions of these writers do not necessarily reflect those of Bridge or The Center for Michigan.

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Comments

Matt
Mon, 09/09/2019 - 7:41am

Since we're presented with yet another story of society's unmet needs, maybe we should consider a new tax system so we can fund solutions to all problems. How about if we just have a 100% tax and the state just provide a food clothing and shelter stipend to each person (notice this isn't limited to residents or citizens). But will this even be enough? Unfortunately ... probably not.

Jennifer
Mon, 09/09/2019 - 12:12pm

This idea pushes us further towards a socialist nation, if not a dictatorship. This is America. Home of the brave and land of the free. The problem lies within private and state insurance. Greed is the monster here. For instance, my husband and I have private insurance. Our insurance covers a small portion of the medication for my depression, anxiety and PTSD. They do not cover therapy and only cover 50% if one of us were to need hospitalization for mental health. We make far too much for state insurance. State insurance covers nearly 100% of mental healthcare. Make no mistake though. Receiving mental healthcare with state insurance is no easy task. It takes months to get into see someone for therapy. If you can find a provider that takes state insurance. Whereas if you want to be medicated it's as simple as a visit to your family doctor. For example, our 3 children are from my first marriage and the adoption process has not run its entire course so they receive MIChild. In the process of my divorce and an ex husband who didn't want to be in the kids' lives consistently, the children needed counseling. I fought for 3 , almost 4 months, trying to get them seen using their medical benefits. The hoops a parent has to jump through to get their child seen is unbelievable. The first time I was told they would not see the boys for whatever excuse the county mental health division came up with. I did not allow their decision to deter me from continuing to seek help for my boys. I tried again but with a recommendation from their doctor in hand. Both boys have ADHD and the county mental health division was more than happy to take them on for therapy now that the boys needed medication. The key point is... as long as mental health professionals can dole out meds to numb society then there's a chance for people to receive therapy. Meds are needed in many circumstances but in my experience with depression, anxiety and PTSD myself... therapy goes a lot further than medication. My son went from being on meds for ADHD and a mood stabilizer (which is extremely bad for your body) to no mood stabilizer and a reduction in ADHD medication. Two years of weekly counseling was enough to help him learn to deal with issues that happened and situations that would arise later on. Numb isn't fixing anything. It's a bandaid for a gaping wound.

Bernadette
Mon, 09/09/2019 - 12:51pm

This problem is an outcome to a great degree on the total deconstruction of the mental health system by Republican John Engler in the 1990's. His actions led to the collapse of the system, release of thousands of mentally ill persons on the streets who were then jailed (talk to any police officer). Add on top of that the defunding of schools, the extreme regional poverty, the tax cuts to corporations, and the gerrymandering of our districts so there was illegal republican control for the last ten years and this is what you get.

I am sorry you are such an unhappy person Matt and you live in such a small little world. There are many ways to solve this problem, and some of these suggestions are good, but as a republican you keep singing the same old song about taxes. What role do you see government playing? What do you do with the poor and the vulnerable who have not had the opportunities you have had?

Bones
Tue, 09/10/2019 - 12:13pm

The poor and vulnerable? Why, we have prisons and union workhouses for them... /s

But in all honesty, this is one of the fundamental problems with the libertarian world view. "We can't have a basic safety net, much less the dreaded socialism, because humans are inherently greedy and selfish. That's why we should make the poor reliant on the charity of the aforementioned greedy and selfish..."

Gina Fournier
Mon, 09/09/2019 - 9:55am

There is racism, sexism, poverty and corruption, but there is no psychiatry, which is a religion. People need support, yes, but beware of bogus dangerous mental health care, which makes money for big organizations and doctors, but too often mistreats patients. For me, this discussion is too simple and masks real danger. I see the term "behavioral health," not "mental health" or "psychiatry used," which may be a positive move, but great confusion and division remains. Even U.S. Sen. Debbie Stabenow does not seem to know there is no science to back the labels of mental health care or the use of Big Pharma drugs. There is no "chemical imbalance" in some people making them mentally ill compared to others.
This big lie has been repeated in the media for decades. Professional and patient voices that speak about these dangers are marginalized. Critical involuntary patient voices like mine are silenced. ginafournierauthor.com/ Coloring with the Catholics:
My Story of Criminal Mental Abuse and Higher Ed Gaslighting in Larry Nassar’s Michigan.
I was murdered by "behavioral medicine." The status quo should not receive additional support.

Jennifer
Mon, 09/09/2019 - 12:47pm

I was not impressed with the "behavioral " label either(I hope I understood your comment correctly). Mental health involves so much more than behavioral issues. Many of the mental health issues are not self-made. They are inherited or brought on by trauma. It's no different than being in a car accident or falling and breaking a bone and being treated for injuries. It should be covered by insurance with the amount we pay in premiums every month.

Gina Fournier
Mon, 09/09/2019 - 9:58am

There is racism, sexism, poverty and corruption, but there is no psychiatry, which is a religion. People need support, yes, but beware of bogus dangerous mental health care, which makes money for big organizations and doctors, but too often mistreats patients. For me, this discussion is too simple and masks real danger. I see the term "behavioral health," not "mental health" or "psychiatry used," which may be a positive move, but great confusion and division remains. Even U.S. Sen. Debbie Stabenow does not seem to know there is no science to back the labels of mental health care or the use of Big Pharma drugs. There is no "chemical imbalance" in some people making them mentally ill compared to others.
This big lie has been repeated in the media for decades. Professional and patient voices that speak about these dangers are marginalized. Critical involuntary patient voices like mine are silenced.
ginafournierauthor.com/

Coloring with the Catholics:
My Story of Criminal Mental Abuse and Higher Ed Gaslighting in Larry Nassar’s Michigan.

I was murdered by "behavioral medicine." The status quo should not receive additional support.

Anne
Mon, 09/09/2019 - 11:54am

Mental health is such a new science that we are just sort of figuring out that maybe we should treat mental illness, instead of just laughing at the mentally ill or locking them all up. The gun lobby is quick to insist that we have a mental health problem, not a gun problem, but then sort of changes the subject when anyone suggests that maybe we need to spend money on mental health care services. When I needed treatment for a fairly severe bout of depression years ago, my insurance slapped me with large co-pays and then capped the number of visits to my therapist they would pay for. Apparently, I was supposed to ‘snap out of it’ after the money ran out.
Until we properly fund and treat mental illness, we will continue to have the police, the emergency room, and the morgue as the first line of treatment. Pay now, or pay later.

Marlene Augst
Mon, 09/09/2019 - 1:01pm

HOW did this become the taxpayers responsibility too?

Bones
Tue, 09/10/2019 - 12:16pm

Perhaps because it's in the interest of society at large to have a populace that is both mentally and physically healthy?

John
Thu, 09/12/2019 - 9:38am

Let me guess. If you benefit from taxpayer funded services then you consider it a good use of taxpayer money. If you don't need the service then its a terrible waste of tax payer money and you resent having to pay for it? Amiright?

John S.
Tue, 09/10/2019 - 11:42am

The question as always becomes, Where's the money for all of these things? It must be very disappointing to mental health professionals to know that society and public officials will not be putting a higher priority on mental health. The professionals are basically told to do the best with what they'll be getting. There's a state legislature and governor that can't even reach agreement on where to get money to fix the roads. Pathetic!

More GOP BS
Wed, 09/11/2019 - 7:34am

After about a decade of complete GOP control and destruction of our beloved state, the GOP has the audacity to complain that the recently elected governor is to blame for everything, while the GOP STILL controls both the house and the senate. Yes, YOU Sue Allor are full of BS.
Here is her outrageous op ed blaming the current governor:
http://www.iosconews.com/oscoda_press/opinion/article_41543904-d3d7-11e9...
Well, Sue and your incompetent GOP cohorts, where is the BUDGET?
Northern Michigan WAKE UP, Trump and the GOP is doing NOTHING for you or the rest of us. It's no wonder that suicide is so prevalent, especially in northern Michigan and the UP. You keep voting for the part of HOPELESSNESS.

Linda Berch
Tue, 09/17/2019 - 12:07am

It is too complicated and expensive to get care. Online therapists may be a good solution for some. Many like the results. It is much cheaper too with greater privacy.