Michigan clearly needs better mental-health care

When I was a child growing up in the 1950s and ’60s, all the kids “knew” what happened to crazy people. They were taken to the insane asylum or, less elegantly, “nuthouse.” Sometimes, adults whispered that adults who didn’t seem to be normal might be taken off to “Eloise,” a large psychiatric hospital in western Wayne County that once housed thousands of patients.

That doesn’t happen anymore.

Nearly all state mental-health facilities in Michigan were closed in a wave of de-institutionalization beginning in the 1960s. Eloise, which was oddly named for a postmaster’s daughter, closed in 1982.

Gov. John Engler closed most of the state’s psychiatric hospitals in the 1990s, sending some patients out on the streets. Today, by common consent, Michigan doesn’t have nearly enough facilities to take care of psychiatric patients in need of hospitalization. “Often these days, when you are trying to find a bed for a person all agree requires hospitalization — you feel like your name is Mary and Joseph and you can’t find a bed anywhere,” said Tom Watkins. He should know; he just finished four years as president and CEO of the Detroit Wayne Mental Health Authority.

The numbers back that up. Eloise alone once housed as many as 10,000 patients. According to Michigan’s Department of Health and Human Services, state community hospitals had 3,041 beds for adults and 729 for children and adolescents in 1993.

You might think that after so many mental hospitals were closed, local hospitals would have stepped up, but exactly the opposite happened. Last year, the number had dwindled to 2,197 adult beds and a mere 276 for younger people.

The result is that too many patients who need to be hospitalized are repeatedly turned away, so they flood emergency rooms and eventually do something that lands them in prison. Severely mentally ill prisoners are, in fact, one of the most rapidly growing parts of Michigan’s prison population, and are the most expensive, according to state court administrator Milton Mack, a former chief probate judge long concerned with the issue of prisons and the mentally ill.

Now, it is important to note that nobody is arguing in favour of again building enormous psychiatric hospitals to house thousands of patients. “There were very good reasons to get rid of most of our state hospitals,” said Gerald Goffin, a now-retired community health supervisor.

“The Community Mental Health Act of 1963 created a financial incentive for states to close state-funded mental hospitals, while promising to fund community-based outpatient treatment and community mental health centres,” to take their place, Milton Mack wrote in a major report on decriminalizing mental illness, a cause of his for decades.

However, “the community health centres that were to be the backbone of the promised community treatment system failed to materialize,” mostly because the funds were never appropriated.

Instead, America now “uses jails and prisons as the de facto mental-health system,” Mack said.

Recognizing this, the Michigan Department of Health and Human Services did a sevenmonth study before producing a report Feb. 13. Among other recommendations, it called for expanding the number of psychiatric beds statewide, and building a new 50-bed psychiatric hospital near the top of Michigan’s Lower Peninsula.

While not treating the severely mentally ill may save money in the short run, it eventually may be devastating — especially in a society where everyone has access to high-powered guns.

The Michigan Health and Human Services report made it clear that we could drastically improve mental-health care, if we are willing to spend reasonable amounts of money.

But Michigan’s legislature is instead obsessed with cutting taxes. Better mental-health care is clearly needed.

Politically, however, that may not be easy to achieve.