At Capacity!

*This editorial was published in the April 27, 2022 edition of The Detroit News.

There is a silent crisis facing our region, growing like a virus. Left untreated, it will spread, and our community will face higher rates of ER visits and hospitalizations, incarceration, homelessness, suicide, and community violence. And very soon, we will see further declines in success rates and academic growth in those same kids due to increased problems in and around behavioral health.

Before the pandemic, there was a crisis in mental health for youth and adults. According to CDC data among high schools in 2019, 1 of every three students reported persistent feelings of sadness and hopelessness, and 1 in 5 reported seriously considering suicide. The pandemic has accelerated a preexisting problem. Faced with isolation, disruption in routine, loss of loved ones, and continued uncertainty, our children need our help, and we are glad people are starting to listen. 

We are grateful that our legislators finally made our mental health a priority. The Governor's budget shows that it is also her administration's priority. But the priorities they are both focusing on come up short of solving the problem. 

Significant inequities exist among economically disadvantaged populations and shifting resources to the schools will deplete any investments in an already underfunded community mental health solution. 

Adding more behavioral health specialists in schools is no panacea for the crisis our children face. Community mental health (CMH) providers are already providing these services to our children in and out of school. We need to strengthen the systems we already have in place. Not dilute it by forcing community mental health providers to compete against the schools for an already limited workforce. Funding behavioral health specialists in schools will leave children without any support or services when they are not in school, namely over the summer. School specialists also are not equipped to provide the full array of services community mental health providers are already providing.

Community mental health providers offer a full continuum of behavioral health care and substance abuse treatment for severely ill and often low-income populations in underserved communities. They fill the gaps when individuals cannot obtain treatment from private providers and provide a lifeline in getting individuals the mental health care they need to function in their everyday lives. When people can access care, community mental health providers can help them achieve successful outcomes. Yet a shortage of workers able to support this increased need is standing in the way for people to access vital behavioral health services. 

According to a recent article in Bridge Magazine, Michigan has a current shortage of 34,000 direct-care workers, with projections that the shortage could exceed 200,000 by 2026. 

In a recent independent compensation survey of twenty-three behavioral health agencies in SE Michigan (primarily Wayne County) representing nearly half a billion dollars in revenue, all these providers are understaffed, with 90% reporting related service delivery challenges.

Turnover at these organizations has grown very high during the pandemic, and leaders say workers are leaving for higher-paying jobs in schools, private practice, and large hospital systems. Due to the enormous administrative burdens that regulatory agencies place on them, professionals are also leaving our public health system. With a limited workforce pipeline, a high turnover rate, and constrained funding, the problems plaguing our behavioral health system will only get worse. 

Over 600 behavioral health positions are unfilled across the two dozen agencies cited and represent a loss of services to 10,000 to 20,000 severely mentally ill or developmentally and intellectually disabled adults and children in Wayne County alone. Hundreds of thousands of people in Southeast Michigan are left with untreated behavioral health issues that could be addressed if our legislators had the political will to focus on the real problems plaguing our system rather than suggest private payors take it over or loan guarantees would help.

If legislators cannot find any immediate relief by releasing unspent federal funds or providing other relief, then following the election, they will have to deal with the unintended consequences of people not getting the help and support they need. 

Michigan needs to stabilize and strengthen its community mental health system while developing a consistent pipeline. This starts with pay equity to allow providers to compete against the private sector. Then the state needs to remove the administrative burdens that stand in the way of so many people advancing through community mental health. Next, the state must find a way to support students in making the transition to work in community mental health through paid internships so they don't graduate in debt, helping the state keep people out of jails or emergency rooms. Finally, the state has already allowed for the expansion of Certified Community Behavioral Health Clinic (CCBHC), which Senator Stabenow has been a driving force behind. The state must let the expansion continue, which will help deliver the outcomes we desperately need. 

If the legislature fails to act before the election, we will see the need for acute care services increase. The criminal justice system is already consumed with cases that could have been prevented with intervention, and suicide rates and overdoses continue to rise. In Wayne County specifically, health disparities increase, including significant and avoidable early mortality for those with behavioral health conditions. This is a once-in-a-lifetime opportunity to change the system and make behavioral health a priority that will ultimately impact health care, corrections, criminal justice, and public safety for a generation. It's time we make community mental health everyone's priority and not just an election-year promise.