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OPINION: Mental health care is desperately needed, difficult to achieve

The Blade - 3/2/2018

March 02--DETROIT -- When I was a child growing up in the 1950s and 60s, all the kids "knew" what happened to crazy people. They were taken to the insane asylum or, less elegantly, the "nuthouse."

Sometimes, adults whispered that adults who didn't seem to be normal might be taken off to "Eloise," a large psychiatric hospital in western Wayne County which once housed thousands of patients.

That doesn't happen anymore.

Read last week's column from Jack Lessenberry

Nearly all state mental health facilities were closed down in a wave of deinstitutionalization beginning in the 1960s. Eloise, which was oddly named for a postmaster's daughter, closed in 1982.

Gov. John Engler closed most of the state's psychiatric hospitals in the 1990s, sending some patients out on the streets. Today, by common consent, Michigan doesn't have nearly enough facilities to take care of psychiatric patients in need of hospitalization.

"Often these days, when you are trying to find a bed for a person all agree requires hospitalization -- you feel like your name is Mary and Joseph and you can't find a bed anywhere," said Tom Watkins. He should know; he just finished four years as president and CEO of the Detroit Wayne Mental Health Authority, and, back in the 1980s, was director of the state mental health department.

The numbers back that up. Eloise alone once housed as many as 10,000 patients. According to Michigan'sDepartment of Health and Human Services, state community hospitals had 3,041 beds for adults and 729 for children and adolescents in 1993.

You might think that after so many mental hospitals were closed, local hospitals would have stepped up, but exactly the opposite happened. Last year, the number had dwindled to 2,197 adult beds and a mere 276 for younger people -- statewide.

The result is that too many patients who need to be hospitalized are repeatedly turned away, so they flood emergency rooms and eventually do something that lands them in prison.

Severely mentally ill prisoners are, in fact, one of the most rapidly growing parts of Michigan's prison population, and are the most expensive, according to State Court Administrator Milton Mack, a former chief probate judge long been concerned with the issue of prisons and the mentally ill.

Now, it is important to note that nobody is arguing in favor of again building enormous psychiatric hospitals to house thousands of patients.

"There were very good reasons to get rid of most of our state hospitals," said Gerald Goffin, who spent a life working for mental health agencies. A now-retired mid-Michigan community health supervisor, Mr. Goffin, who once worked at Eloise, said "these hospitals were outmoded, largely ineffective and often inhumane."

He believes mental illness can be much more effectively treated on a community basis, and most other mental health professionals agree. But there is one problem; they aren't adequately funded.

"The Community Mental Health Act of 1963 created a financial incentive for states to close state-funded mental hospitals, while promising to fund community-based outpatient treatment and community mental health centers to replace the services provided by hospitals," Milton Mack wrote in a major report on decriminalizing mental illness, a cause of his for decades.

However, "the community health centers that were to be the backbone of the promised community treatment system failed to materialize," mostly because the funds were never appropriated.

Combine that with rulings making it harder to intervene when someone has mental health issues, and, Mr. Mack noted, we've created a system where we "use jails and prisons as the de facto mental health system," in Michigan and many other states.

EDITORIAL: An ounce of prevention

Recognizing this, the Michigan Department of Health and Human Services did a seven-month study before producing a report Feb. 13. Among other recommendations, it called for expanding the number of psychiatric beds statewide, and building a new 50-bed psychiatric hospital near the top of Michigan'sLower Peninsula.

When it comes to mental health needs, Northern Michigan is indeed the least well served part of the state. Chris Campbell, a legal aid lawyer based in Traverse City, said "I have a lot of clients who are also clients of the local community mental health organization, or need to be." But over the years, he's seen services shrink.

Closing mental hospitals and letting people live in the community is great, he said -- if we "provide supportive services to make that successful." But we don't, he noted.

"We've honored the first because it's cheaper and ignored the second because that's cheaper, too. Let's face it -- there are no lobbyists for crazy people," Mr. Campbell said.

But while not treating the severely mentally ill may save money in the short run, in the long run, it can be devastating -- especially in a society where everyone has access to high-powered guns.

The Michigan Health and Human Services report made it clear that we could drastically improve mental health care, if we are willing to spend reasonable amounts of money.

Michigan has a legislature, however, that has been unwilling to properly fix the roads and which is instead obsessed with cutting taxes. Better mental health care is clearly needed.

Politically, however, that may not be easy to achieve.

Jack Lessenberry is the head of the journalism faculty at Wayne State University in Detroit and a former national editor of The Blade.

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