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Dwindling budgets, erratic society negatively impacting mental health

Southfield Sun - 4/3/2018

METRO DETROIT - The Michigan mental health system is perceived as being in disarray, with massively fluctuating state and local budgets impacting the work of minimum wage workers.

Community leaders, advocates and one legislator discussed that and more March 1 during "Mental Health Peace of Mind" - a community collaboration public forum involving both Macomb and Oakland counties. It took place at the Macomb Intermediate School District building in Clinton Township.

The Alliance for the Mentally Ill of Oakland County put on the forum, aimed at introducing issues and objectives; discussing how reform takes place on the entire mental health system; and getting the perspective of citizens who want the system to change but don't know how to facilitate it.

Fred Cummins, president of the Alliance, discussed various tropes that impact the mental health system, whether directly or indirectly.

He discussed legislators putting more focus on areas like road repairs, or focusing on mass shootings and the gun debate rather than mental illness as part of the equation. He said people who show symptoms of extreme mental health issues need to receive care. That includes having mental health advocates in schools. He said, "The system beats them down."

"Figure out what the budget is, figure out what it covers and pay for it. ? We need to revitalize an attitude of people first," Cummins said. "It's not money first. It's a cultural thing, and we've lost that."

When you look at the data, like Macomb County Community Mental Health Deputy Director Jim Losey does, the numbers are staggering.

During the fiscal years of 2016 and 2017, the Michigan Department of Health and Human Services engaged in a financial restructuring of Medicaid appropriations to prepaid inpatient health plans. It was coined as a "Medicaid Rebase."

That resulted in a loss of $37 million in Medicaid funding to Macomb County, including a $5.1 million loss from 2015 to 2017, and a projected $3.3 million loss in 2018. The county has requested an additional $5 million to support its Internal Service Fund, as well as an additional $7.5 million, but a $35.4 million reduction still looms.

According to the Community Mental Health Association of Michigan, the state's fiscal year 2019 executive budget proposal focuses, from most money to least, on Medicaid mental health services, the Healthy Michigan behavioral health plan and autism services.

To put it bluntly, the comparison between the 2015 fiscal year budget and the projected 2018 fiscal year budget is an approximate $40 million decrease in Medicaid funding.

"It's very scary to think about it," Losey said.

MCCMH Executive Director John Kinch said society is in a state of present disarray, adding that mental health services should focus on children with the most serious emotional disturbances; those with serious substance abuse issues; and the intellectually disabled. He urged attendees to not give up.

"Do not lose sight of why we're here," Kinch said.

One of those who have seen the changes throughout three decades of mental health care is Bruce Dunton, director of Crossroads Club House in Warren. There are 47 club houses in Michigan.

The club house is an evidence-based Medicaid psychosocial rehabilitation program, where men and women come to have a sense of purpose. A work-ordered day philosophy involves 30 tasks each, with members spending the rest of their days building relationships in what is described as a second family.

Dunton, who has been in the mental health field for about 30 years, said those who participate are less likely to go back to jail, and more likely to stay in gainful employment. The club house criteria is that residents must be at least 18 years old, have a mental illness diagnosis and have active Medicaid.

One of the major paradigm shifts, he noted, is how back in the early 1980s, those with mental illness went to the hospital for minor episodes of psychiatric symptoms. Now, with the plethora of services available, patients can find help in their communities by way of experts.

"It reduces a lot of the major symptoms people have when they're struggling in their recovery," Dunton said. "What we know for a fact is that people who participate in a clubhouse have significantly less inpatient hospitalizations; significantly less medication changes; they have significantly less, what we call decompensation of symptoms; they have a huge of network of friends."

State Rep. Jeff Yaroch, R-Richmond, was in attendance. He said Macomb County is getting a "raw deal" in budgetary means.

"It's not the lack of appropriations," said Yaroch, who has a relative with mental illness. "It's just that everyone doesn't have the same life experience."

Judy McReavey, a treasurer for the Alliance, has an older son with mental illness. She said the employees who look after her son are "the least paid and the most important."

"They should be paid a living wage," McReavey said.

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