The Harsh Realities of Michigan Mental Health Care
On a recent Sunday afternoon, I opened my laptop with the intention of fixing a few things before the Monday morning chaos was upon me. I see an email with a time stamp of 8:28 am waiting with the subject line “Please help.” It is from a distraught mother whom I have come to know in two years. She tells me that her son thought the radio was talking to him last night. She tells me that things are calm for the moment and that she will watch him closely. Deep in my mind, I still hear echoes of the promise I made to them a few days earlier: “I promise I will do my best to keep you out of the hospital.”
I am a social worker and therapist, and have been working in the mental health field in Metro Detroit for the past decade or so. In social work school, you learn early on that your clients don’t have it easy, and the real challenge often comes in navigating a broken system.
The pandemic has shed light on mental health in a way we’ve never seen before. People with no history of depression or anxiety have found themselves trapped inside and shaken by anxious thoughts. And while some would say we weathered the changes with no problem, for a long time the majority of us just didn’t feel well. We are all human, and most of us can say that we know what it is like not to feel good emotionally or mentally. The pandemic has brought us an explosion of telehealth services, which have been remarkably helpful to countless patients – and I would be remiss if I did not recognize how telehealth has removed many barriers to accessing treatment.
Conversely, the pandemic has cast an even greater shadow on those diagnosed with severe and persistent mental illness (SPMI). These are the types of mental health issues that are likely to always require some level of treatment in order for a person to stay healthy. Some examples would be severe autism, schizophrenia or bipolar disorder. But not all people with these diagnoses would meet SPMI criteria; it is about the seriousness of the particular case of an individual. For those who may require hospitalization when their symptoms are severe enough, the prospect of a hospital stay looms like the grim reaper. It only takes a stay in a psychiatric floor to know you never want to go back.
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But for many patients and their families, the revolving door of the mental hospital is a way of life, and sometimes there is no end in sight. If you’ve ever wondered what it would be like to be in a crisis all the time, these are the people who will know all about it. They worry if their loved one will ever achieve stability for more than a few days or weeks. They hope their insurance companies will continue to cover expensive drugs.
If you have never received emergency psychiatric care before, you might be inclined to assume that a person with MIPS could access treatment in a skilled facility when they need immediate care, but unfortunately this does not. is not the case. Michigan emergency departments were inundated with mental health crises, and patients (many of them children) languished for days in the emergency room awaiting treatment.
An available psychiatric bed offers no sigh of relief. Receiving care in a psychiatric unit means temporarily suspending several of your freedoms. You are told when to eat, when to take medication, when to attend therapy, and when to call loved ones. If a patient is psychotic, they may not have the presence of mind to sign an information waiver for their family members, and then everyone is left in the dark until they are released. ‘he be released. A nonverbal patient with severe autism, suddenly surrounded by adults who cannot understand them, may naturally become more frightened and agitated in this environment, often resulting in the use of drugs to put them to sleep.
As Michigan looks to the future, I hope this vulnerable population can benefit from better access to care, as well as improved policies and guidelines for mental hospitals. We will never allow someone to wait days in the emergency room for medical treatment, and our response to mental health care should be the same.
I tell patients that I will do everything in my power to make a psychiatric admission unnecessary, and most of the time this is achievable, even for those with a long history of previous psychiatric admissions. Pharmacology has come a long way, and evidence-based therapeutic interventions also play a critical role. But sometimes something that a patient is not safe, or other people are not safe, and hospitalization is required. When a patient’s family member contacts me to tell me they need emergency help, they don’t realize I’m on the other end of the phone, holding my breath and praying that the emergency response that I recommend does not cause more damage.
While it is reassuring to know that patients with mental illness are treated much more ethically and compassionately than in decades past, it can be troubling to find that long-term hospitalizations, even for patients with mental illness. from SPMI, can be almost impossible to get covered by Insurance. When a mental hospital fails to properly treat a patient’s symptoms, patients sometimes explore options for residential treatment facilities, many of which cost thousands of dollars out of pocket. However, most patients do not have the income available for this option.
There are times when the unknowns are overwhelming, even for caregivers who have dedicated their lives to healing others. Time has taught me to accept that I answer many questions with “I don’t know”. There is heartbreak and sadness, but there is one thing I can say to any patient that will bring us back to a place of empowerment: “If you don’t give up, I won’t give up.
Rachel Kwiatkoski is a mental health clinician at the Rochester Center for Behavioral Medicine.