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State funding has fallen short for mental health for years

HOUGHTON — In a recent press release, Gov. Gretchen Whitmer said, “I, Gretchen Whitmer, governor of Michigan, do hereby proclaim May 2021 as Mental Health Awareness Month in Michigan.”

In her 12-point proclamation, the governor went on to say that “all individuals can experience times of difficulty and stress in their lives and should feel comfortable in seeking help and support to manage these times.”

She also stated that the various challenges brought forth by the COVID-19 pandemic, including isolation, loss of income, fear, and bereavement, have significantly contributed to declining levels of mental health in children, teens, and adults in our state. In most state documents, there is noticeable language that uses behavioral health and mental health interchangeably.

According to the Michigan Department of Health and Human Services, and Open Counseling’s Michigan Mental Health Services Guide, anyone in Michigan who has Medicaid, or who qualifies for Medicaid, is eligible for public mental health services as long as those services are medically necessary. Services are considered medically necessary when a person has a mental health condition that impacts their well-being and when that condition will not improve without treatment. Medicaid covers counseling for mild or moderate mental health conditions as well as intensive services for severe mental illness.

The MDHHS site also states that Public Law 102-321 establishes the Federal Block Grant for Mental Health Services. This federally funding program is administered by the Center for Mental Health Services, a division of the Substance Abuse and Mental Health Services Administration. Each year, the Michigan Department of Health and Human Services applies for an award under this program and currently receives an annual grant of approximately $13 million. Of this amount, approximately $4 million is allocated for mental health services for children with serious emotional disturbance and their families.

The federal statute establishing this program requires the funds to be expended through the state’s public mental health system. Through individual block grant contracts with community mental health services programs, these resources are focused on development and maintenance of community based services. For children, the block grant is used primarily to support services that help to build the system of care for children with SED and their families.

The Michigan Health Endowment Fund contracted with Altarum to study access to behavioral health care in Michigan. The final report documents methods and results of analyses to characterize current access to mental health and substance use disorder treatment in the state, describes barriers to care, and identifies potential strategies for increasing access. Altarum’s report was published in July, 2019, and revealed that more than 650,000 Michigan residents with a mental illness, and more than 500,000 with a substance use disorder, are not receiving treatment. That is, 38% of residents with any mental illness and 80% of those with a substance use disorder.

The report also found that the populations with the highest share of individuals going untreated for a mental illness include: the uninsured (65%) and Medicaid enrollees (49%), while populations with the highest share of people going untreated for a substance use disorder include the privately insured (87%) and Medicare Advantage enrollees (79%). The report does not stand alone.

In April, 2019, the Community Mental Health Association of Michigan (CMHAM) also released analysis, “Systemic Underfunding of Michigan’s Public Mental Health System,” which studied the longstanding underfunding of Michigan’s public mental healthcare system. This study found that over the past several years, leading up to 2019, a number of financing decisions by the state of Michigan had systematically eroded the ability of Michigan’s public mental health system to meet the needs of Michigan residents who have come to rely upon the system. while similarly eroding the fiscal stability of this public system.

Since 1997, Michigan has been the only state in the nation to have a publicly managed care system for all four major behavioral health populations regardless of income levels (adults with mental illness, children and adolescents with emotional disturbances, persons with intellectual/developmental disabilities and those with substance use disorders), which reach:

– About 300,000 people with mental healthcare needs

– 50,000 people employed by the public mental healthcare system

– 2 million people statewide who are impacted by one of the 300,000 people served (family, friends, neighbors and co-workers).

Washtenaw County’s website states that in addition to new service demands, the state has not complied with the federal requirement for state support for the development of risk reserves – a key component in the design of any managed care system, especially one that is built to serve the most vulnerable residents and maintain community safety nets.

“Lawmakers and community members may argue the public system has been functioning well despite funding gaps,” states the website, “but CMHAM warns that the current underfunded system is not sustainable long-term.”

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