LANSING, Mich. - More Michigan families are reaching out to community mental health services for help coping with job losses and the related economic fallout. However, the increased demand for services comes at a time when the state is also ramping up its prisoner re-entry program, leaving greater numbers of former prison inmates in need of services, too.

Maxine Thome, executive director, National Association of Social Workers' Michigan chapter, says despite these increasing demands, federal, state and local money is drying up – which, in her view, contradicts the very laws that govern Community Mental Health Services (CMH).

"'The Community Mental Health Services program shall provide a comprehensive array of mental health services appropriate to conditions of individuals, regardless of an individual's ability to pay.' So, the CMHs are really dependent on federal Medicaid money."

Thome points out that not everyone qualifies for Medicaid assistance, and it is unlikely that uninsured or under-insured individuals will get the services they need, so she predicts the burden will be shifted to law enforcement agencies and hospitals. The result, she says, is that tax dollars will be spent for mental health care – one way or the other.

"What we'll see are more people being released from the Michigan re-entry programs who are really in need of services, who are not getting them. You know, I think for some people, it's easier to live in prison than it is to live outside of prison without supportive services."

In a continuing trend, Thome says, this year's state funding for such services is slated to be reduced by $384 million. It can be difficult for people to understand, she adds, that without increasing taxes or revenue, even mandated services cannot be maintained.



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By Reyna Revelle for WISH-TV.
Broadcast version by Joe Ulery for Indiana News Service reporting for the WISH-TV-Free Press Indiana-Public News Service Collaboration

Health care providers recognize the need to ensure accessible, culturally competent mental health support, especially with the growing diversity in central Indiana and the resources available to those in crisis.

Dr. Sally Fleming, a clinical psychologist at Riley's Children's Hospital at IU Health, told News 8, "It is a real issue here in our home state of Indiana. We see it daily. But, it's throughout our state for all ages. It's not just the kids, it's everyone, and the numbers are not decreasing."

IU Health has made strides to expand its suicide prevention programs. Its health care providers have been training staff on the best practices for supporting others from diverse backgrounds. They have worked to reach underserved groups and destigmatize conversations around mental health.

Fleming said, "Suicide rates are higher. Suicidal ideation.. these things are higher in our population of more diverse ethnic groups, and we have to be aware of that as clinicians and ask the right questions."

The clinical psychologist says the stress of coming to a new country combined with disparities in socioeconomic status are complex factors that can profoundly affect mental health and suicide risk. Prioritizing mental well-being is taught through support groups, education, and action.

"One program I'm involved in is the Collaborative Assessment Management of Suicidality. It is suicide-specific and held at Riley hospital. This is primarily for our teenagers who have experienced suicidal ideation and attempts."

The U.S. Centers for Disease Control and Prevention reports suicide is the second-leading cause of death for Hoosiers from the ages of 14 to 39. It also says, in the past year, 5% of Hoosier adults and 11.1% of young adults from the ages of 18 to 25 have experienced suicidal thoughts.

Jason Craig, director of the Indiana Suicide Prevention Network, said, "Suicide affects anybody and everybody. There is no discrimination to suicide or thoughts of suicide. Bringing awareness to things like the 988 line; they have interpreters available significant for all walks of life."

A recent study shows that the majority of adults believe that suicide can be prevented, and 96% of adults in the U.S. would act if someone close to them were thinking about suicide.

"You can be that shining light of hope for somebody by asking how you are doing and being sincere with that ask," Craig said.


Reyna Revelle wrote this article for WISH-TV.


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Gaps in mental health care are a common research topic right now and for Minnesota youth in rural areas, a new report showed their families face big obstacles in navigating the care system if their child displays symptoms.

In its analysis, the Center for Rural Policy and Development said long travel distances and a lack of information make it hard for parents in these settings to put a concrete plan together.

Marnie Werner, vice president of research and operations at the center, said other factors are at play.

"There's a desire for anonymity," Werner pointed out. "People don't necessarily want all their neighbors to know that their kids are seeing a therapist. And in rural areas, especially, there are just getting to be fewer and fewer people in the mental health field."

Because of a fragmented system, the authors say in a crisis, parents -- especially in rural areas -- often end up taking their child to the emergency room, which can create a host of other problems. As long-term solutions take shape, parents are encouraged to educate themselves about early warning signs and the basics of mental health. And if their child reaches a crisis point, the 988 Suicide and Crisis Lifeline is a resource to lean on.

Werner noted there is also an evolving approach to integrate mental health care with primary care.

"Having a therapist in the regular clinic," Werner explained. "Mental health has often been siloed off to the specialty clinic. And so, with behavioral health integration, the doctor can bring the therapist in to meet you and your child while you're there at your appointment."

The authors said it is not a perfect solution but school-linked mental health services are increasingly becoming more dynamic, which can make it easier to seek assessments and schedule treatment on campus.

Meanwhile, the American Heart Association is raising awareness about establishing healthy routines like physical activity, which help improve mental health while preventing such conditions as anxiety and depression.

A U.S. Department of Justice investigation has found Kentucky is failing to provide access to community-based mental health services for people who need them, and instead relies too heavily on psychiatric hospitals.

The report says the state is potentially in violation of the Americans with Disabilities Act, or ADA.

Licensed Psychologist Sheila Shuster, who is part of the Advocacy Action Network, said years of budget cuts have reduced or eliminated the city's crisis centers - such as the Living Room, which opened its doors in 2018 and was shut down within a year due to lack of funding.

"Three to four hundred people a month coming in and using the services, and getting referrals," said Shuster. "And then boom, it's gone. So, that was May of 2019, and we don't have anything like it back in place."

The University of Louisville Hospital provides emergency psychiatric treatment to more than 2,200 adults with serious mental illness each year.

In a separate investigation last year, the Justice Department concluded the city and the Louisville Metro Police Department violated the ADA by subjecting people with mental illness to an unnecessary police response.

While the new report raises awareness about the needs of people living with mental illness, Shuster said it doesn't capture the full picture.

She cited recent changes the city has made, such its 911 call diversion program for mental health-related incidents, as well as families' view of the role of hospitalization.

"By and large, what I hear from the family members is not that their loved ones are being kept too long in the hospital, but that they're not being kept long enough," said Shuster, "which I think is what is leading to the revolving door."

Marcie Timmerman, executive director at Mental Health America of Kentucky, said the focus should be on early intervention and treatment, so folks don't end up being involved with the police.

"We would love to have more providers available," said Timmerman. "I'm not sure that pinpointing our psychiatric hospitals is really helpful."

She added that a mobile crisis response system, and Medicaid-funded housing and support programs, could help reduce the number of people who continue to cycle through hospitalization and the criminal legal system.





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