Michigan must beef up mental health services for kids under court settlement

• Michigan has settled a federal lawsuit that accused the state of  ‘staggering failures’ in mental health services
• A judge still has to approve the settlement 
• Some improvements are underway, but with Medicaid funding in peril and continuing workforce shortages, it’s unclear how quickly the state can make additional changes

Michigan children with mental health needs might soon get more help from the state under settlement terms in a federal lawsuit accusing the state of “staggering failures” that caused “tragic and incalculable damage.” 

The class-action suit, filed by a group of families in 2018, focuses on Michiganders younger than 21 whose “intensive home and community-based services” for mental health issues are covered by Medicaid — a primary payer for those services, whether the child is in foster care, with family, or on their own.

The lawsuit painted stark pictures of children with severe mental challenges that — without little to no treatment — forced them into a cycle of emergency rooms and institutionalizations. Sometimes the children lashed out violently. 

The state failed to ensure the young people “with behavioral, emotional or psychiatric disorders receive medically necessary services required by law,” according to the families.

The settlement of the suit, now known as D.D. et al v. Michigan Department of Health & Human Services and Elizabeth Hertel, calls for sweeping changes in the way the state delivers care. 

Among them, the state has agreed to:

• Expand its array of services to be covered by Medicaid, including home-based and “wraparound” services and respite care
• Develop more outreach, including a website, to inform the public of these services
• Expand the workforce 
• Collect data to better understand its own delivery system and identify needs and gaps in services as well as long waiting periods or denials of service and share that data with the public
• Establish an advisory board, made up of providers, families and children, to advise the state on its progress toward these goals

State leaders cannot comment on pending litigation, Lynn Sutfin, a spokesperson for the state health and human services department, said. 

Still, she noted that the state already has made several changes to the way it delivers mental health services. That includes establishing a Clinical Support and Service Navigation team to address gaps in the system. It also launched a screening tool to determine eligibility for specialty behavioral health services, funded local efforts to support mobile teams for children in crisis and created student loan repayment and internship stipends for people training to be mental health providers. 

Additionally, it established programs — Parent Support Partners and Youth Peer Support Services, Respite, Intensive Crisis Stabilization Services and Intensive Home-based Services — to support families and children facing mental health challenges. 

But with Medicaid funding now uncertain, it’s also uncertain how quickly improvements outlined in the settlement will happen_. US District Judge Thomas L. Ludington is expected to rule on the agreement at a hearing Aug. 27. 

Meanwhile, the state already is struggling to meet its commitments from an earlier settlement that addressed mental health needs in certain youth, while it also tries to build capacity in the face of severe staffing shortages in mental health care, as Bridge has documented.

“There’s a huge commitment from the state,” said Laura Marshall, a plaintiff in the latest case and one of three co-founders for the support and advocacy group Advocates for Mental Health of MI Youth. But, the Cedar Springs mother acknowledged, “it also comes with a huge price tag.”

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For years, Marshall and other parents have pleaded for better mental health services for kids, telling lawmakers about their children’s violent breakdowns, long waits for care and a revolving door between mental health and the criminal justice system.

Although the system has failed her son, Marshall said, she’s encouraged by more recent changes.

During a crisis last fall, she called a 24-hour line for mental health help for her son. A team of three people arrived — a surprise to the mother who said she’d called after-hours crisis lines many times over the years, only to be told the family would have to wait for help until office hours.

The team that evening helped de-escalate the crisis, albeit temporarily, she said.

“In the past, it has been ‘sorry-about-your-luck’ and ‘call us in the morning,’” she said.

An earlier suit, related

Michigan already is doing a major overhaul of its child welfare system, after settling a 2006 lawsuit that was focused on foster youth. Plaintiffs alleged that the young people were “routinely denied” services, even a “minimally adequate mental health system,” according to a court filing by New York-based Children’s Rights.

The advocacy organization sued Michigan in 2006, charging that its child welfare system pulled children from homes only to allow them to languish in a bureaucracy, bouncing from foster home to foster home, where many were abused and neglected again, and even died in care. A settlement in 2008 forced improvements in the way children are placed in foster care and dramatically bolstered staff and reduced caseload levels.

To be clear, that earlier lawsuit took a broad swing at the entire child welfare system; in contrast, the D.D. suit now being settled is focused on mental health services.

As part of those improvements that began after Children’s Rights sued, the state has improved the way it extends services to families, including mental health treatment, more quickly to boost a child's chances of remaining at home, decreasing the chance of family separation, said Janet Reynolds Snyder, president and CEO of the Michigan Federation for Children and Families, a long-time advocacy organization that represents private, nonprofit providers.

One of the biggest changes was the creation of Certified Community Behavioral Health Centers, a bureaucratic mouthful that essentially means a network of centers that provide services to residents in crisis — regardless of age, address or, critically, their ability to pay, said Laura Huot, president & CEO of the Guidance Center, which provides mental health services to children in southeast Michigan.

The state ensures the centers are reimbursed for care, Huot said — a crucial guarantee that allows centers to immediately treat children without worrying first about billing and red tape, she said.

“That has been a game-changer,” she said.

“It’s hard to argue that kids aren’t better off today,” agreed Sean de Four, a long-time social worker and president & CEO of MiSide, a behavioral health clinic.

Medicaid uncertainty, worker shortages

While the complainants and courtrooms are different in the cases, both class-action lawsuits will require the state to continue massive, costly changes to the way it focuses services for children covered by Medicaid — a major financing source of services.

Just how much potential Medicaid cuts will hinder improvements is unclear. Another hurdle is continued workforce shortages, said Bob Sheehan, executive director of the Community Mental Health Association of Michigan.

“We’re impressed with the department's embrace” of the settlement provisions, “but we really do need to resolve the workforce issue,” he said.

That, and the uncertainty over Medicaid funding, “are real impediments.”

David Honigman, one of several attorneys for the plaintiffs, acknowledged those challenges of the settlement that’s up for approval in August. Bottom line, he said, the settlement forces the state to establish more oversight in its system.

“These aren’t easy problems to solve,” he said of funding and staffing shortages. But, he added, the state must find a way or it will face more court challenges.

“It’s not a choice,” he said.