Commentary: Building on Michigan’s Proven Public Mental Health System


There is currently a set of Michigan Senate Bills, SB 597 and 598, which, if passed, would transfer management of the state’s Medicaid mental health system to private health insurance companies.

This move would destroy Michigan’s nationally recognized public mental health system – its Community Mental Health System or CMH, its provider network, and its publicly managed care operations – and harm the 320,000 Michigan residents served by that system.

Rather than continuing down this path, Michigan must take concrete steps that will advance Michigan’s high performing public mental system – building on its strengths – all of which are within our grasp.

Rather, these Senate bills will do real damage. These bills:

  • Move the Michigan system from a publicly managed system with low overhead (6%) to a privately managed system with high overhead (15%). This would mean a loss of $ 300 million per year for the service delivery system.
  • Dramatically reduce funding for public community mental health agencies in every community, thereby destroying this cutting edge clinical system and long-standing partnerships between CMHs and schools, courts, law enforcement, homeless shelters. shelter and hospitals
  • Do not integrate mental health care and physical health care, as the promoters claim, but simply transfer taxpayer money to private insurance companies. True integration of health care occurs where the client / patient receives care.
  • Put the state’s public mental health system in the hands of private health insurance companies that have no experience serving people with severe and complex mental health needs. In fact, for the portion of the state’s Medicaid mental health benefit that these insurance companies administer, registrants have reported that they are unable to find psychotherapists and psychiatrists to serve them.
  • Ignore the views expressed by those who would be directly affected by these changes – those served by the public mental health system and their families. These views, captured in the Article 298 Final report go against the direction indicated in these bills.
  • Eliminate the strong local control and governance of the current system, linked to locally elected officials accountable to members of the local community.

Instead, we should rely on Michigan’s high performing public mental health system. The long-standing high performance of this system is described in a report by the Center for Healthcare Integration and Innovation, “A Tradition of Excellence and Innovation”.

Michigan’s Public Mental Health System:

  • Regularly meets or exceeds performance standards established by the State and recognized at the national level.
  • Lead the nation in converting a system dominated by public hospitals to a community system (allowing 32 Michiganders be served for what it costs to serve a person in the public hospital).
  • Pioneered, in partnership with the MDHHS, almost every mental health innovation, evidence-based and promising practice that has taken place in Michigan.
  • Has over two decades of experience designing and managing a high performing state-run system that oversees the care of all community mental health care and does so with very low overhead (spending 94 % of every dollar for services).
  • Controls costs, resulting in billions of dollars in savings for taxpayers compared to Medicaid cost increases seen in other states.
  • Is a leader in the integration of mental and physical health care (with over 600 integrated care efforts led by this public system).

Rather than shifting state mental health dollars to private health insurance companies, Michigan must take concrete steps that will truly advance the state’s public mental health system.

  • Improve access to comprehensive mental health services for all Michigan residents by increasing the number of Michigan Certified Community Behavioral Health Centers, Behavioral Health Homes, and Opioid Treatment Homes – programs that capture increased federal dollars for such improved access.
  • Improve access to hospital psychiatric care and residential alternatives to hospitalization by implementing the recommendations of the Michigan Psychiatric Admissions Discussion group, an interdisciplinary group of experts from across the state
  • Address the mental health workforce shortage by paying competitive salaries and creating a career path for direct support professionals in mental health; expand loan repayment programs to attract psychiatrists and other clinicians to underserved Michigan communities; and overhauling the administrative requirements that keep clinicians away from serving Michiganders.
  • Foster true integration of health care by encouraging the growth and expansion of existing partnerships between Michigan’s public system and primary care providers.

Rather than following the path outlined in these Senate bills, Michigan can build on its strengths to advance this system and make high-quality care accessible to all.


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