I was recently involved in a protracted discussion on Facebook about mental health awareness. The discussion centered on the fact that one person in three will be personally affected by mental health issues in their lifetime.
When I worked for the Michigan Department of Public Mental Health, about twenty-five years ago, it was estimated that one person in four was affected by some form of mental affliction. It is an unfortunate sign of the times that as the number of people who may need some form of treatment, has increased significantly, as services for the mentally challenged have become virtually nonexistent.
Back in the day, when someone was having a personal crisis, typically the police were called. If the problems could not be resolved, after the peace officers arrived and no one was physically injured, the person in crisis might be taken to Detroit Receiving Hospital, Eloise, Northville Regional Psychiatric Hospital, or Clinton Valley Center and receive treatment without cost to the consumers of services or their families. In the mid seventies, through the late eighties, Michigan had one of the best mental health service delivery systems in the country. It was also one of the most expensive. Folks like me were paid handsomely to care for the mentally challenged. Although the mental health code required that an individuals’ course of treatment be completed “in the shortest practicable time”, once the chronically mentally ill or developmentally challenged were placed in a facility, many would be interned for the remainder of their lives.
ELOISE PSYCHIATRIC HOSPITAL image provided courtesy of wikipedia.org
State operated hospitals like Eloise became havens for the mental and developmentally challenged. At one point, Eloise housed over 7,000 consumers. Families would literally drop off consumers at the door of the facility. At one point, Eloise housed over 7,000 consumers. In the early seventies, there was a public outcry, regarding the safety and well-being of consumers in overcrowded institutions, all over the country. In the mid seventies, an effort was made to begin housing consumers in the least restrictive environments. Here in Michigan, homes were constructed and apartment buildings were renovated to accommodate consumers. The program that the Michigan Department of Public Mental Health created became world renown for its innovated approach to the care of consumers of mental health services.
I was part of the movement of consumers from institutional to residential care. At the beginning of my career, I worked at the Coldwater Regional Center as a social worker/case manager. I managed group homes, nursing homes and a dormitory on the campus of CRC, that housed residents that required medical monitoring. The CRC facility was well run and the consumers were well cared for. During my time there, I personally witnessed direct care workers, all of whom were classified civil servants for the state of Michigan, treat the consumers with care and compassion. In some cases, the direct care staff treated the consumers better than their own children!
When I moved back to metropolitan Detroit, I worked at the Macomb Oakland Regional Center. I was the chairperson of interdisciplinary teams, that included a physician, a psychiatrist, a registered nurse, a dietician, and occupational and speech therapist. The interdisciplinary team monitored the care of each consumer that lived in community based housing. I also provided case management services for group homes and facilities known as Alternative Intermediate Service facilities. The AIS facilities were in newer homes or small apartment buildings that were supposed to be transitional housing for developmentally challenged consumers.
Having come from an institutional setting, I was confronted by a prevailing sentiment that facilities, like the one I had worked at in southwestern Michigan, were evil places where consumers were “fenced in like animals”. I objected to that characterization, made by one of my co-workers, one night when a group of co-workers had gone to a lounge after work. The director of case management services jumped to the defense of the attractive female co-worker who made the scurrilous indictment of institutions, and informed me that my attitude was detrimental to the goals of the MORC Program!
I learned rather quickly that I was dealing with a group of DMH employees that had a cult like devotion to the goals of de-institutionalization. Fortunately for me, the skill set that I brought to Macomb/Oakland helped me develop a reputation of being a “fixer”. Throughout my time at MORC, I was assigned homes that other case managers had failed to properly manage. I would go in and fix problems. Once the problems were resolved, I would be sent to another home in to clean up someone else’s mess.
The problem that I encounter more often than not was the fact that the cart was leading the horse. Many of the providers of services, were former state employees or hard-core business people who were more concerned with the financial bottom line than the care of the consumers. I became a guerilla social worker. I would align myself with the home manager and the direct care staff, parents and guardians to ensure that the consumers received good care. I went to great lengths to avoid open confrontations with providers because I readily discovered that my bosses would go to great lengths to preserve their relationships with providers, at the expense of case managers and ultimately the consumers. I was just a big grunt that civil service had ‘encouraged’ the agency to hire – but that’s another blog! My managers and co-workers would do nothing that might get them excluded from the lavish soirees that some of the providers would have from time to time. My invitation always got ‘lost int the mail’ but my consumers were happy and well cared for.
In the late eighties, an associate of mine, that worked inside of state government, informed me that The Michigan Department of Public Mental Health , which was the second largest state agency, was being dismantled. After 5 years of racially contrived abuse, sliding off of poorly managed Oakland county roads in the winter, and having to witness in silence atrocities that exceeded anything I had been exposed to while working in the ‘bad ole institution’, I had had enough. I dusted off my resume’ and became a desk jockey in the Department of Education for the Disability Determination Service.
While working a MORC, I quickly grew tired of cronyism and the politics that go hand in hand with millions of dollars to service providers, in Metropolitan Detroit. When I was employed at Coldwater Regional Center, I had to deal with politically charged situations that arose between Community Mental Health Agencies and the Department but it was childs play in comparison to the political machinations of religious organizations, ambitious state employees and the greedy.
The Road To Hell Is Paved With Good Intentions. Act 258 of the Mental Health Code of 1974 was an ambitious document that detailed how consumers should be treated by providers of mental health services. The Act essentially opened the door for the development of group homes and specialized facilities for consumers of mental health services. Act 258 inadvertently led to the demise of those services, that were once touted as the best in the nation!
As the de-institutionalization machine moved forward, the idea was to eliminate the middlemen-classified civil servants and facilities that required a significant portion of the annual state budget-and give that money directly to community mental health agencies. By the early nineties, the 800 pound gorilla formerly known as the Department of Public Mental health was no more. The shift from a state funded service delivery system to a system funded by private insurers was supposed to provide better more efficient services to consumer. The theory once implemented proved to be a disaster for consumers of mental health service. Today, if you have no insurance or have no ability to obtain insurance, you are essentially, as we say in the hood, “ass out”.
These days, when the police are called, here in Detroit that mentally challenged person is taken to jail or if no one else has been injured, they are taken to Detroit Receiving Hospital, kept for evaluation, for a short period of time and released back into the community. Jail or temporary internment in the psych ward at Detroit Receiving have come to replace treatment in a state operated mental health facility, for the uninsured. Low income consumers that have Medicaid have access to treatment through Neighborhood Service Organizations and private agencies. I have found however, that consumers have a tendency to change providers frequently and have little or no continuity of services because of the intricacies of Medicaid/Medicare.
The mental health service delivery system in the state of Michigan, as it was envisioned almost 40 years ago is nonexistent today. Consumers, sit in hopeless despair in their homes, wander the streets or end up in jail, when the are unable to cope with their issues. As a former agent for a provider of those services, I am angry about the events that led to the dismantling of those services. The baby got thrown out with the bath water!