Families should not have to plead for psychiatric help
“We need some help. We don’t know where to turn. … We’re not going to lose this kid.”
Those were the words from father Jay Gross, who recently posted a video of his firsthand experience trying to help his son, after spending nearly two weeks in a hospital emergency room. The video went viral. The message that started in his car has taken families and professionals across the state and U.S. by the storm.
Certainly, his struggle and frustrations were all too real, but the issue extends beyond his experience. There are solutions.
The Gross family were victims of an ever-growing problem in Michigan — there are not enough psychiatric beds, and where there are beds — the needs of the potential patient are beyond what hospitals can handle. Health care providers are increasingly struggling to provide adequate inpatient services — short term, intensive treatments — for those in psychiatric crisis. Stacking onto these issues, hospitals are also frequently under-resourced, especially during the coronavirus pandemic, and they do not always have psychiatric staff available onsite to help keep people safe.
To understand the issue further, we must examine history. People with serious mental health needs have increasingly been transitioned from hospitals into community-based settings. However, over the last several decades, the number of community-based psychiatric beds has not grown in number or in their ability to meet the more complex needs of current inpatient clients. In fact, the lack of access to appropriately staffed psychiatric beds has pressured hospitals to hold those with mental health crisis in their emergency rooms for extended periods of time. This was the case for the Gross family.
People who point out gaps in the mental health system forget the public behavioral healthcare heroes, and Michigan’s public Community Mental Health System working around the clock to ensure Michigan residents are supported. This has been particularly true recently, as the public mental health system has been forced to pivot during the pandemic to serve even more vulnerable citizens across the state.
The Michigan Department of Health and Human Services has partnered with the Michigan Inpatient Psychiatric Admissions Discussion to help address this issue. In 2018, they released a workgroup report including several recommendations — two of which are being implemented.
Public Act 402 of 2020 creates crisis stabilization units. These units are designed to better treat and assess individuals who are experiencing a mental health crisis versus keeping them in an emergency department for several days, which can quickly turn into weeks. Crisis stabilization units would be appropriately staffed to better handle behavioral crisis services while a permanent placement can be found for the person in need.
The second implementation is Public Act 285 of 2020. It requires MDHHS to establish psychiatric residential treatment facilities for Medicaid patients under the age of
21. These new facilities would serve as a stepping-stone for children who require intense services while meeting their treatment needs.
Between July 1 and December 31, 2017, 2,289 individuals had at least one hospital denial logged into the Michigan Psychiatric Inpatient Denial Database. One out of five of these individuals who were denied were children among ages 5 to 17 years old. The average rate of denials per event (a single episode where an attempt was made to place the individual) was 10.2 — meaning professionals had made calls to find placement at least 10 times. “At capacity” was by far the most frequent reason cited — 71.5% of the time, according to the Mid-state Health Network Psychiatric Inpatient Denial Data Collection Pilot.
The heroes are families like the Gross’ and clinicians in the public Community Mental Health system who develop and implement community-based supports and services. They are the heroes working around the clock to place endless calls to build community-based services and supports, including residential and inpatient care.
Laying to bed long-term issues such as inpatient psychiatric hospitals denying access to families in need must be revived. Hopefully, the attention this unfortunate and tragic ordeal received will shed light on the scope of the problem, to ultimately reduce inpatient denials and for the State to investigate and resolve patterns of inpatient admission difficulties, which should lead to better access for individuals experiencing acute psychiatric distress. Families should not have to cry out in crisis to get the resources they need.