New plans for Michigan psychiatric facility raise more concerns about care

Psychiatric hospital

Michigan ranked fourth worst in the country in 2016 for number of state psychiatric beds per capita. As a result, patients in mental health crises wait hours or days for psychiatric facilities or beds. (Shutterstock image)

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As the politics of mental health care in Michigan continue to shift, it now looks like a state psychiatric hospital in the Thumb will remain open.

But instead of building a $115 million, 200-bed new hospital in Caro, state officials are recommending renovating the existing hospital or building a downsized 84-bed hospital at a cost of $40 million to $65 million. They also propose shifting 61 beds to other state hospitals and finding community-based care for 55 additional patients with serious mental illness.

But one mental health advocate said the Michigan Department of Health and Human Services recommendations announced last week fail to address the much larger issue -– an ongoing acute shortage of state psychiatric beds and lack of overall care.

“This has become a political football. But this decision just doesn’t do a darn thing for what we need, more intermediate and long-term psychiatric beds,” said Mark Reinstein, president & CEO of the Okemos-based Mental Health Association in Michigan, a nonprofit advocacy group.

“We don’t have nearly enough of those.”

Reinstein noted there continue to be long waits for seriously ill patients to be admitted to state psychiatric hospitals, a gap in care underlined by a 2018 state report that found a 200-person wait list at Michigan’s state-run psychiatric hospitals. Michigan ranked fourth worst in the country in 2016 for number of state psychiatric beds per capita.

As a result, patients in mental health crises wind up in emergency rooms for many hours –- or even days -– as mental health professionals scramble to find an inpatient psychiatric facility that will admit them.

Moreover, some inmates wait months for court-ordered mental health treatment –- further evidence of a broken system despite the apparent change of heart by the administration of Gov. Gretchen Whitmer about the psychiatric hospital in Caro.

Mark Reinstein

Mental health advocate Mark Reinstein said the state’s decision to keep the Caro psychiatric hospital open “doesn’t do a darn thing for what we need.”

In October, Gov. Rick Snyder broke ground on what was to be the new hospital, to replace the aging Caro Psychiatric Hospital, which is about 80 miles north of Detroit.

But in March, Whitmer officials hit the pause button, ordering a review of the project while they cited concerns about staffing shortages at the hospital and the difficulties of some families in visiting the facility.

In April, news reports disclosed that Whitmer officials had months earlier favored shutting the hospital down.

In January, according to Flint television station WJRT, new MDHHS Director Robert Gordon held a meeting to discuss the Caro hospital. The following day, it reported, Andrea Taverna, deputy cabinet secretary for Whitmer, emailed state officials recapping the meeting. 

"Secretary Gordon increasingly believes that closing Caro entirely is the correct path forward," she wrote.

Weeks later, according to the account, Gordon visited the hospital and sent an email to state officials, including Whitmer aides and the budget department.

"We don't want to build another facility there," he wrote.

Whitmer health policy director Meghan Groen then wrote in a Feb. 5 email to Gordon and other officials: “It seemed very evident from our meeting and your visit that building another facility in Caro is not a viable option.”

Gordon now says the decision to keep it open will mean better care.

"We want to be able to strengthen the quality of care in Caro,” he said in a statement.

The legislature would have to approve whatever final plans for Caro that MDHHS recommends.

Asked to comment on Reinstein’s assertion the decision to keep Caro open does nothing to improve overall mental health care in Michigan, Whitmer press secretary Tiffany Brown said the department’s recommendation “will maintain the existing Caro facility near the same number of beds currently filled, expand the availability of care in other parts of the state, and improve the quality of mental health services here in Michigan.”

Lynn Sutfin, spokeswoman for MDHHS said in a statement: “The Caro recommendations are not intended to be a single solution to address the needs of all people with behavioral health needs. These services must exist over a continuum, ranging from outpatient services through intensive community-based care to state psychiatric hospitalization. “

In the meantime, Michigan sits near the bottom of states for its number of state psychiatric beds per capita. According to the Treatment Advocacy Group, a nonprofit mental health advocacy organization, Michigan in 2016 had 7.3 state psychiatric beds per 100,000 people, compared to the U.S. average of 11.7 beds per 100,000 people.

It’s a legacy of the shuttering of mental health hospitals that began in the 1960s and accelerated in the 1990s when then-Gov. John Engler closed most of the state’s remaining 16 psychiatric hospitals and moved patients into local community care.  The state now operates five psychiatric hospitals, all in the Lower Peninsula.

Funding for state psychiatric hospitals has fallen from 9 percent of the state general fund in 1965 to just under 3 percent of the general fund, according to MDHHS.

But at the same time, the 2018 Michigan Department of Health and Human Services report found, Michigan’s community hospital psychiatric capacity has “fallen precipitously,” from 3,041 adult beds in 1993 to 2,197 adult beds in 2017.

“As the number of inpatient psychiatric beds has decreased, health care providers have increasingly struggled to secure inpatient services for individuals who are in psychiatric crisis. Providers must frequently contact multiple facilities with no guarantee that an appropriate bed may be available,” the report stated.

Moreover, there are widespread reports of inmates spending months awaiting court-ordered psychiatric treatment. 

According to MLive, that included 28-year Justin Lee Dawson. Dawson was found incompetent to stand trial for second-degree criminal sexual conduct, but according to his attorney, languished nearly year in jail while awaiting treatment at a state psychiatric hospital.

And as a further consequence of these gaps in mental health care, advocates say, Michigan’s jails and prisons are filled with the mentally ill. According to the Michigan Department of Corrections, nearly a quarter of state prisoners have some form of mental illness. A 2003 report of jails in Wayne, Kent and Clinton counties found that 51 percent of inmates were mentally ill.

Jenny Thomas

Lansing mother Jenny Thomas, above, said her mentally ill daughter is not getting the long-term care she needs: “It’s been incredibly frustrating.”

East Lansing resident Jenny Thomas told Bridge Magazine she’s struggled to navigate the mental health system for three years, as she tries to get care for her 23-year-old daughter. Thomas said her daughter has been diagnosed with a combination of schizophrenia and bipolar disorder that at times can leave her catatonic. She said she preferred not to name her.

Compounding her daughter’s difficulties, Thomas said, she also has been diagnosed with anosognosia, a condition that blocks her ability to recognize that she is mentally ill. That can make her resistant to taking her prescribed medication, which can lead to repeated mental health crises.

Thomas said she’s been hospitalized eight times, in psychiatric facilities from suburban Chicago to Lansing, Owosso and Saginaw. That included one episode where she was sent to two hospitals in Lansing, then to a community treatment facility where she waited days for a placement, then to a private treatment center in Saginaw.

“It’s been incredibly frustrating,” Thomas said.

Thomas said she’s been unable to secure the long-term treatment she believes her daughter needs. Save for one three-week stay in Saginaw, Thomas said, most of her treatment has been about five days to a week.

“These are your revolving-door patients. You just set them up for returning,” Thomas said.

Robert Sheehan, CEO of the Michigan Association of Community Mental Health Boards, said the decision to keep Caro open was probably for the best.

“Something had to be done,” he said.

“Keeping some people there makes a lot of sense. But the fact that you are providing only [approximately] 150 beds total, it really just scratches the surface. Caro is one piece of the pie.”

But Sheehan lack of long-term mental health care and difficulty retaining direct care workers remains important barriers to what’s needed in Michigan.

“There are gaps,” he said.

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Mon, 08/05/2019 - 8:56am

Before we answer the question of how many hospitals or how much to spend, I’d like to see a presentation of what the patient count is as a percentage of the overall population. I’m just shocked when I see numbers such as 23% of Michigan’s population is on Medicaid, or as in this story, 9% of the general fund went to mental health hospitals. Those are huge numbers when compared to a total population of 10 million. Are there really that many that have some form of mental illness, or are we treating a broader range of illnesses than was done in the past. When looked at from a total perspective of state needs, it becomes clearer as to why we can’t “fix the damn roads” or spend more on schools.

And then there is the question of a person not taking medication that would at least alleviate some of the illness. Is it the State’s responsibility to force feed the medication to the patient or do the parent’s have some responsibility to do this. Is it our privacy laws that prohibit parents from participating in caregiving once the patients are no longer children?

Mon, 08/05/2019 - 11:51am

As someone who works with children of abuse and neglect, it is really difficult to get kids severely mentally ill and violent into psychiatric placement. It's a waste of resources to put inpatient facilities in rural areas because staff doctors and nurses rarely want to live in such places. If they do build more inpatient facilities (would it be cheaper to keep the mentally ill in sheltered living situations vs. jails?), they should be near large highways so that families can get there to visit if their loved ones are placed remotely from their home area. When the state hospital beds were closed, the patients were sent to the streets and now we are reaping the blowback from bad decisions. I have volunteered also in a ladies' max security prison and the mentally ill compromise a huge percentage of the patients. One of my previous students has managed to keep out of prison for about 10 years but only because she was confined to a state hospital briefly, got discharged to continuous out-patient care with day care and safe housing. This was in a more enlightened state. Arjay, you are right. The citizens AND our legislators need more information to move in the correct direction. As for getting patients to take their medications, that's such a tough issue. Developing more injectable long-acting medications would help.

Mary K. Freel
Mon, 08/05/2019 - 11:14am

In other words the state needs to build the new hospital in Caro and increase beds all over the state. But that takes money and mentally ill people are not good at lobbying their reps for that so they get lost in the shuffle. What a mess!!

Timothy Sullivan
Mon, 08/05/2019 - 12:37pm

Mr. Reinstein is correct, Michigan has way too few psychiatric beds. Michigan has three psych hospitals (Walter Reuther, Caro and Kalamazoo), the Forensic Center and the children's facility - Hawthorn Center. Caro was selected by the previous Administration due to cost. We owned the land, the utilities were already in place, and so was the staff, making it a whole lot cheaper to build (Snyder was an accountant after all). The 250 beds first planned at Caro were not enough. The planned revision of 84 beds is woefully inadequate and, quite frankly, Kalamazoo and Walter Reuther cannot take up the slack. And since Northville, Ypsi, CVC and so many other facilities have fallen to the wrecking ball, we have to either build new or buy existing hospitals to provide the bed coverage. Intermediate and long-term beds are needed. Whitmer wants them closer to Detroit (presumably), so that places limits on where they can go.

So, a modest proposal from a retired state employee, former chief steward and former (ages ago) employee of the Department of Mental Health.

Building new usually works out best, but it costs to buy the land, lay in the utilities and other infrastructure, and recruit staff. But this is expensive. The cheaper way is to purchase an existing hospital and convert it to mental health uses. In selecting such a hospital, you're much better off taking one the is functioning than one that has been closed for years as the conversion costs from general to psychiatric hospital would be burdened by the additional costs of simply fixing what has deteriorated over the years. The hospital should NOT have attached medical offices like St. Mary's in Livonia. Too many security issues.

Two facilities that could work would be Pontiac General (about 300 beds with a 30 bed psych unit) or McLaren Oakland, the former Pontiac Osteopathic, which has about 350 beds, give or take. Since McLaren wants to build a new hospital in Clarkston, they might be willing chip in some of the costs (and I am not, nor to the best of my knowledge is any family member, employed by McLaren) in exchange for permission to build in Clarkston, though Pontiac General may be the right size for bed counts. Both hospitals should retain a medical unit (like A3-M at Northville) and maybe, a surgical unit. No need then to transfer ill patients to other hospitals, and the mentally inmates in county jails could be sent there. They can become teaching hospitals for the medical schools at U of M, MSU, WSU, WMU or Oakland University. God knows we need more mental health professionals and regular health professionals learning to deal with the mentally ill.

Now this comes at a cost, and it is not cheap.

When I hired into state government in 1974, Mental Health was, by far, the largest department in state government. Now, the Department of Corrections has that title, but houses way too many mentally ill inmates, people who previously wound up at Northville, Ypsi, CVC and the other facilities. And even when Northville and Detroit Psychiatric Institute were open (along with Walter Reuther), the largest concentration of psych beds in Wayne County was the Wayne County Jail when the late Dr. Bruce Wenokur worked there. Properly placing the long-term mentally ill in hospitals instead of prison means shifting money from MDOC to DHHS. More or less a budgetary break even.

Caring those mentally ill who are not incarcerated in a hospital instead of seeing them as the homeless in our streets, will drain the existing Medicaid budget and would require new monies being allocated, unless Congress changes how Medicaid funds mental health services.

There is also the scourge of drug addiction exacerbating or causing some of the problems of the mentally ill. Rhode Island has a plan in motion that has significantly reduced that population with aggressive and intensive treatment. It warrants further consideration.

There will be concerns over money and forcibly treating the mentally ill who, in the depths of their illness, refuse treatment as they do not realize the depths of their illness. How we answer those concerns is probably reflected in our answer to Cain's rhetorical question to God found in Genesis.

Tue, 08/06/2019 - 4:44pm

There is a recently-vacated regional hospital in Marquette, and a proposed deal with a developer just fell through. Granted, this does not address the issue raised by other regarding accessibility to patients' families (other than those in the UP), but it was only vacated in June when patients were moved to the new hospital. Might be worth considering.

Timothy Sullivan
Wed, 08/07/2019 - 1:46pm

LH, They closed Marquette General? Which hospital is still up and running in Marquette?

A psychiatric hospital in the UP is not a bad idea. When I was younger and had a full head of hair, Newberry over in the eastern end of the UP served the UP while Traverse City Psychiatric Hospital handled the upper part of the lower peninsula. A small hospital, or leasing a floor or two for a psych unit in the remaining Marquette area hospital(s) might work.

Fri, 08/09/2019 - 12:40pm

Tim, MGH hasn't been MGH for a few years. It was purchased by Duke Lifepoint and is now known as UP Health Systems (for-profit). They just moved into a brand-new facility in Marquette in June. A local investor's group had looked at purchasing the old hospital, but recently backed out. So this large facility is currently sitting vacant with no plan for re-use at this time.