EXPERT WITNESS: Mental health care in Michigan

By Michael G. Brock

M-live recently ran an article that headlined: Survey of Michigan Physicians Finds Residents Are Drastically Underserved in Access to Mental Health Care.1 The author states that roughly two thirds of Michigan doctors in the larger metropolitan areas and three-fourths of those in Muskegon, Petoskey and St. Joseph believed that services for mental health and substance abuse were inadequate.

This is certainly no surprise to those of us in the mental health field. Over the time I have been a licensed practioner I have seen outpatient insurance benefits go from unlimited and adequately paid, to 20 visits, not so well paid, to those visits being dolled out a few at a time and having to stay on the phone for 20 minutes to get them. Reimbursement rates actually declined as inflation increased.

And it's not just outpatient services that have been cut. Someone who was seriously depressed used to be able to stay in a hospital up to 45 days if need be, and there was no limit on the number of admissions. Substance abuse inpatient stays were typically 28 days, which is probably enough time for someone to get started in recovery if the person is motivated. Today, you're lucky if you are able to get approved by your insurance company for 7-10 days of inpatient for either mental health or substance abuse, or to receive adequate treatment for either unless you have the money to pay cash.

And lives are lost because of it. A few years ago I sent one of my clients to two different hospitals for two back to back ten day stays. After the second one he committed suicide. I refuse to believe that the mental health professionals and hospital administrators who put him back on the street could not see how disturbed he was. They were afraid they were going to have to eat the cost of extending his stay. They paid his wife $500,000 for their "mistake."

Were there abuses under the old guidelines? Certainly. But alcoholics and drug addicts are not the only ones who don't take adequate care of their health, and Major Affective Disorders are as fate appointed as cancer or congenital heart disease. Probably the main reason insurance companies stopped paying for mental health and substance abuse services were:

1. Mental health and substance abuse problems are still very stigmatized;

2. therefore, these people were/are not deserving of the treatment afforded to truly "sick" people; and,

3. paying for this treatment cuts into the insurance company's profit margin.

This is on the private side, for people with "good" insurance. If you're paying for your own non-group plan you are probably lucky if it pays most of your hospital expenses. The cost of insuring most outpatient services is usually greater than the cost of paying out of pocket. If you had a pre-existing condition (prior to Obamacare) you could pretty much forget being insured, except by Blue Cross, which was required to take everyone under their State charter. With the Blues you could get poor coverage for a lot of money as long as you could pay the premiums.

According to this article, Michigan ranks 42 out of 50 states when it comes to the number of inpatient beds per capital, though 25% of the population has had a mental health diagnosis at some time. It further states that, "...as Michigan closed 12 of its 16 State mental hospitals between 1987 and 2003, rates of incarceration for the mentally ill are reported to have increased significantly and in some reports, quadrupled." At 34K per prisoner per year2, that is a very expensive way for the taxpayers to fund caring for the mentally ill, and probably not the most humane or efficient way to allocate the State's resources.

The writer of this article bemoans the fact that under Obamacare, those who are currently uninsured will have insurance, but nowhere to get the mental health services they need. But the reason these facilities do not exist is because there is no money in it. According to the bureau of labor statistics3, a starting salary for a counselor at a community mental health facility is 25K, and the median salary is only 40K. Is it any surprise that no one wants to go into the field? What we pay people reflects how much we value them. Steven Cohen makes billions, though his company has been found guilty of trading on insider information, but the average teacher makes just 52K.4

The fact that we do not want to pay a living wage to even people with professional training, and the fact that full time employees at fast food restaurants need food stamps to survive, are not an indication that State has become too socialistic. Rather, it is a testament to just how great the division is between the haves and the have-nots. Fox "news" and its foreign owner (who made his money how? Oh yeah, dishing dirt on public figures) have won the propaganda war and convinced the average American that "liaise faire" capitalism is in everyone's best interests, and they may succeed in derailing Obamacare.

In truth, this patchwork of private and public healthcare is no substitute for the socialized medicine that is the norm in every country that has any concern for providing the minimal needs of its citizens, but given how much money there is in healthcare and pharmaceuticals, that was never going to happen in this country. So we will have a system that is proportionately unfair to the young, with the demographic bulge of the baby boomers moving into retirement. Still, it may reverse the trend of decreasing mental health services provided by both the public and private sector, and result in saved lives and reduced suffering if it survives the propaganda wars.

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1 http://www.mlive.com/opinion/index.ssf/2013/12/marianne_udow-phillips_michiga.html.

2 Michigan State University Library http://staff.lib.msu.edu/harris23/crimjust/correct.htm.

3 Occupational Employment and Wages, May 2012 http://www.bls.gov/oes/current/oes211014.htm.

4 BLS Occupational Outlook Handbook http://www.bls.gov/ooh/education-training-and-library/middle-school-teachers.htm.

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Michael G. Brock, MA, LLP, LMSW, is a forensic mental health professional in private practice at Counseling and Evaluation Services in Wyandotte, Michigan. He has worked in the mental health field since 1974, and has been in full-time private practice since 1985. The majority of his practice in recent years relates to driver license restoration and substance abuse evaluation. He may be contacted at Michael G. Brock, Counseling and Evaluation Services, 2514 Biddle, Wyandotte, 48192; (313) 802-0863, fax/phone (734) 692-1082; e-mail, michaelgbrock@ comcast.net; website, michaelgbrock.com.

Published: Wed, Dec 18, 2013