Michael Engel, D.O., president of the Michigan Psychiatric Society (MPS), brought APA’s "Vision for the Mental Health System" to members of the Michigan State Senate in September.

State Senate Majority Leader Ken Sikkema (R) ordered joint hearings of the Senate’s Committee on Health Policy and the Subcommittee on Community Health of the Appropriations Committee after the Detroit News published a front-page series titled "Michigan’s Mentally Ill: Crisis in Care." The series described problems in the state’s mental health system.

Engel served as medical director for two community mental health programs in Michigan and is now in private practice.

He testified before the joint committee, "We are committed to the principles of community care and to the promise of recovery—yet shifting priorities and patchwork funding have set us adrift from our mission."

Engel added, "Our programs have grown and developed from an historical base that no longer fits with modern understanding and practice in psychiatric care."

Many problems grew out of the turn community mental health centers (CMHCs) took toward an emphasis on social services, rather than health care.

He told the committee, "Michigan needs. . . a decisive realignment and commitment to deliver services as a responsible, professional health care organization directed by competent health care professionals. Individuals with medical and clinical training, as well as health care organization and management training, are needed at the helm of every level of our delivery system."

Engel emphasized that point in an interview with Psychiatric News. "We are dealing with a medical illness that must be stabilized before the patient can utilize social services in a meaningful way."

He also noted that a medical approach is particularly important when treating seriously mentally ill people who were released to the community with the closure of state hospitals.

Engel said that according to state law, CMHC medical directors act only in an advisory capacity in terms of clinical decisions. Consequently, the CMHC directors, who are not required to be physicians, can overrule their decisions concerning medical care.

He recommended to the committee the development of a "full and prepared continuum of services in which each individual enters the continuum at the level of service needed (not after failure at a lower level) and moves through, with continuity—without languishing—to an optimum level to recovery."

Engel concluded his testimony by announcing that APA had prepared "A Vision for the Mental Health System," which had been provided to members of the joint committee and staff of the state’s Department of Mental Health and Substance Abuse.

He told Psychiatric News that Sen. Thomas M. George, M.D. (R), had expressed strong support for the comments in the vision statement about mandatory treatment and about the statement as a whole.

CMHC staff from around the state called Engel to commend his statements about the importance of good medicine in providing mental health services.

The September 18 Detroit News reported that some senators on the committee challenged the assumptions on which health care for the mentally ill is based and financed.

George pointed out that many mental patients require intensive, lifelong services. He asked, "Does managed care ever really work in the mental health arena?"

Patrick Barrie, state director of mental health and substance abuse, replied that while managed care provides some savings, "it is difficult to implement."

According to the July 20 Detroit News, "Money has not followed the mentally ill" after the closure of state hospitals began in 1972. In 2001 people with mental illness comprised three-quarters of the clients in the state’s mental health system and received benefits and services totaling $860.2 million. The developmentally disabled, who were 18.4 percent of the population in the system, received benefits and services totaling $862.2 million.

About 25 percent to 40 percent of the financing is "lost to administrative costs [in] a multilayered health care system where strict accounting procedures are sometimes absent."

Sen. Beverly Hammerstrom (R), chair of the joint committee, said that she expected legislation to result from the hearings. ▪