Mental Health Archives

Pathways to reform in Michigan: Diversion, deflection, and reentry programs

A recent report from the U.S. Department of Justice revealed alarming rates of mental health disorders among jail inmates–on average, 44 percent of inmates had a mental health diagnosis. Despite this prevalence, jails lack adequate resources to meet inmates’ mental health needs, potentially worsened by discriminatory practices, implicit bias, overcrowding, and hostile environments. And these challenges disproportionately affect racial and ethnic minorities. Further, jails are major public safety expenditures. Michigan, for example, spent an average of $35,809 per inmate in 2015.

In the piece, CHRT outlines three justice reform approaches adopted by the Washtenaw County Sheriff’s Office, with funding from the county’s Public Safety and Mental Health Preservation Millage, that have emerged as promising solutions to reduce overcrowded jails, address systemic bias, reduce recidivism, and save taxpayer dollars:

Diversion programs, which divert those with criminal justice involvement into community supports,
Deflection programs, which deflect those at risk of criminal justice involvement into community supports, and
Reentry programs, which get individuals in jail the help they need to successfully return to the community.

Read the brief

Recruiting and retaining behavioral health workers in rural America: Our report and action guide

Lack of behavioral health workers in rural america

In the U.S., there are not enough behavioral health workers to meet the demand for mental health and substance use services, particularly in rural areas.

Over the past year, the Center for Health and Research Transformation (CHRT) has worked closely with the University of Michigan’s Behavioral Health Workforce Research Center (BHWRC) to explore the approaches states have taken to address this concern through recruitment and retention initiatives.

Throughout 2019, CHRT Health Policy Director Nancy Baum and Lead Healthcare Analyst Jaque King interviewed experts from 47 states to learn which types of behavioral health workers they needed most, to explore the factors that exacerbate shortages, and to discuss state efforts to address this demand for mental health and substance use services.

Through a qualitative analysis of the interview transcripts, Baum and King have isolated an array of approaches including loan repayment programs, pipeline programs, Visa waivers, public-private partnerships, tax credits, tiered certification initiatives, scope of practice expansions, telehealth investments, and more.

The key findings include:

State experts lack data about which behavioral health providers are in greatest need, and about which programs are most effective in terms of recruitment and retention of behavioral health workers.
Most experts believe that raising behavioral health workers’ salaries and improving Medicaid reimbursement for behavioral health services will positively impact workforce sufficiency. Experts also suggested that greater investment in pipeline programs and loan repayment programs, as well as increasing state’s residency slots, may have substantial impact on reducing the gaps in rural recruitment and retention of behavioral health workers.
Innovative approaches to recruitment and retention include: increasing the use of public private partnerships to fund tailored loan repayment, scholarships, conferences, and pipeline/pathway programs; investigation of changing certification requirements to encourage earlier entry into practice; and improvements to rural work/life balance to reduce burnout.

READ THE REPORT

Michigan at a crossroads: CHRT highlights key health policy issues for the incoming gubernatorial administration

The Michigan government has jurisdiction over a wide array of health policy issues. From the regulation of insurance products, to oversight of the state’s Medicaid program, to investing in local public health efforts, Michigan policymakers craft policies and budgets that impact the health of millions of Michiganders.

This brief provides an overview of four key and timely health policy topics:

Medicaid and the Healthy Michigan Plan;
the individual health insurance market and the federal Health Insurance Marketplace;
the opioid epidemic; and
the integration of services to address the social determinants of health.

With the expansion of Medicaid and the launch of the Affordable Care Act’s individual Health Insurance Marketplace, the numbers of uninsured Michiganders have been considerably reduced since 2013. Yet Michigan policy makers will still face numerous policy issues and decisions related to health care coverage, health disparities, and access to care in the years to come. Our state will continue to struggle with complex health issues such as substance use and access to mental health services.

Michigan policy leaders, local public health agencies, and the private sector are engaged in many innovative initiatives to address these issues and improve the health of communities. In particular, the state has committed to programs that are intended to improve health equity and focus on the social determinants of health.

All of this work is being conducted at a time of great political change and considerable turmoil at the federal level. The new governor and the 100th Legislature will be faced with both tremendous responsibility and opportunity to shape the health policy landscape for years to come.

READ THE BRIEF

Bipartisan Budget Act adds $3B for substance abuse, mental health, more

A handshake between a red hand and a blue hand, indicating the bipartisanism of the Bipartisan Budget Act.

The Bipartisan Budget Act was signed into law on February 9, 2018. While the main purpose of the legislation is to temporarily fund the federal government through March 23, 2018, it also includes an agreement to raise the caps on domestic and military spending for the next two years.

The legislation includes many health care policies, as well. The health care policies in the Bipartisan Budget Act include:

New funding for the National Institutes of Health (NIH) and for substance abuse and mental health programs related to the opioid epidemic.
Extenders and reauthorizations for the Children’s Health Insurance Program (CHIP); Community Health Centers; the Maternal, Infant and Early Childhood Home Visiting Program; Medicare Extenders; a Medicare Therapy Caps Repeal; the National Health Service Corps; and the Teaching Health Center Graduate Medical Education Program.
Policy changes relating to the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act; the “Doughnut Hole” Closure; the Independent Payment Advisory Board (IPAB); Medicaid Disproportionate Share Hospital (DSH) Cuts; and Medicare Home Health Reforms.
Key offsets for Medicare Parts B & D Premiums, Physician Fee Schedules, and the Prevention and Public Health Fund (PPHF).

To learn the details of the health care policies included in the Bipartisan Budget Act, read the full brief.

READ THE BRIEF

Access to mental health care in Michigan

One in five Michigan residents report having been diagnosed with depression at some point in their lives. Mental health disorders cause more disability among Americans than any other illness group.

Using data from the Cover Michigan Survey and the Michigan Primary Care Physician Survey, both fielded in calendar year 2012, this brief explores issues related to the prevalence of mental health disease, specifically depression and anxiety, and the capacity of the Michigan health care system to serve people with these conditions.

Overall, it is clear that there is high need for mental health services in Michigan and the capacity to serve those in need is not adequate to the task. Without addressing increased capacity for care, the increased mental health coverage provided to many under the Affordable Care Act will do little to help those most in need.

Key findings include:

Depression and anxiety are prevalent in Michigan and higher than the U.S. average. Twenty percent of Michiganders reported ever being diagnosed with depression, compared to 18 percent of Americans. Prevalence is greater when diagnoses of depression and/or anxiety are combined
- Depression and/or anxiety were reported in Michigan at particularly high rates among those with Medicaid (59 percent) and the uninsured (33 percent).
People with depression and/or anxiety had greater difficulty completing everyday activities, including work, than did Michiganders with other or no chronic conditions.
- Respondents with depression and/or anxiety reported twice as many limited activity days compared to those who reported having other chronic conditions. Respondents with depression and/or anxiety reported an average of five days in which poor health limited their activity.
The health care system in Michigan is inadequate to serve adults and children with mental health needs.
- Fifty-seven percent of primary care physicians reported that availability of mental health services in their community was inadequate for adults and 68 percent reported it was inadequate for children.
  - Adult mental health services in the St. Joseph, Muskegon, and Petoskey regions had the highest inadequacy ratings (89, 82 and 77 percent, respectively).
  - Child mental health services received the poorest ratings in the Muskegon and Petoskey regions (100 and 94 percent respectively).
  - Even in regions where primary care physicians reported the best access (Pontiac and Royal Oak), more than a third noted that access was inadequate.
- The availability of psychiatric beds in Michigan is extremely low compared to other states—Michigan was ranked 42nd among the 50 states and the District of Columbia in availability of inpatient psychiatric beds.

READ THE BRIEF

Suggested Citation: Smiley, Mary; Young, Danielle; Udow- Phillips, Marianne; Riba, Melissa; Traylor, Joshua. Access to Mental Health Care in Michigan. Cover Michigan Survey 2013. December 2013. Center for Healthcare Research & Transformation. Ann Arbor, MI.

Publications