FIG2 Michele Reid, M.D., was
ebullient when asked about the prospects for reform of Michigan's mental
Members of the Michigan Mental Health Commission pose with Gov. Jennifer
Granholm (center), who holds their report recommending extensive reforms of
the state's troubled mental health system.
Courtesy of the Michigan Mental Health Commission
"October 25 was one of those perfect days I'll remember
forever," she said. On that day members of the Michigan Mental Health
Commission submitted their report and recommendations to Gov. Jennifer
"The governor greeted each of us by name, thanked us for our work,
and instructed Janet Olszewski, director of Michigan's Department of Community
Health, to come up within 90 days with a list of recommendations that could be
implemented immediately and a timeline for other actions."
Reid, who is medical director of the Detroit-Wayne County Community Mental
Health Agency, was a member of the commission. Other psychiatrists on the
commission were Thomas Carli, M.D., and Rajiv Tandon, M.D.
Michele Reid, M.D., a member of the Michigan commission, called October
25 "a perfect day."
Granholm appointed the 33-member commission on December 15, 2003, with the
charge "to recommend sweeping changes in both the delivery of services
and effectiveness of Michigan's mental health network."
At the group's opening session, Granholm said that the system is"
During the next 10 months, hundreds of people testified at public hearings
and submitted comments to the commission's Web site. The views of
psychiatrists were represented by the three members on the commission and by
other members of the Michigan Psychiatric Society (MPS) who participated in
work groups about specific issues or testified before the commission.
Tandon said, "I found the proceedings arduous, intellectually
stimulating, and incredibly informative." He was a professor of
psychiatry at the University of Michigan at the time of his appointment.
During the work of the commission, Tandon became chief of psychiatry for
Florida's Department of Children and Families and commuted to Michigan for
The experience with the commission proved "incredibly valuable"
to what he is doing now, he said.
Reid said that MPS Executive Director Kathleen Gross kept the members
well-supplied with background information from APA. APA's "A Vision for
the Mental Health System" was a key source document cited by the
Carli said, "The psychiatrists played an important role in bringing
the medical perspective to the deliberations of the commission."
Carli is a clinical associate professor of psychiatry at the University of
Michigan and director of medical and disease management at the University of
Michigan Health System.
The commission came up with hundreds of recommendations that support the
achievement of seven goals (see
Both Carli and Reid mentioned a recommendation for strengthening the role
of the state's medical director for mental health as being particularly
important to psychiatry.
The recommendation is to "strengthen the role of the current Michigan
Department of Community Health Medical director so that s/he becomes the
leader in the development of evidence-based practices in the mental health
system." The recommendation describes specific actions to implement
Reid mentioned the commission's emphasis on consumerism as being"
"Consumer and family members should be involved in the design and
delivery of services," she said. "It's the only way to
She also cited the importance of recommendations about suicide prevention
and reducing stigma.
Carli said that psychiatrists reminded the commission that treatment of
mental illness often necessitates managing a chronic illness. "We
discussed whether or not that concept conflicts with a focus on the recovery
model and decided that the two are not incompatible," he added.
The report analyzes the impact of the "Medicaidization" of
mental health services. Prior to 1999, the state legislature funded community
mental health services through one line item that did not depend on a
patient's eligibility for Medicaid benefits. Since then, community mental
health dollars have been split into Medicaid and non-Medicaid lines, with a
federal prohibition against using any of the former to benefit a non-Medicaid
Medicaid does not cover many people with serious mental illness or
emotional disturbance because eligibility requires meeting a restrictive
definition of disability and restrictive income requirements, according to the
The result is fewer resources for screening, early intervention, or
treatment of persons whose conditions are of moderate or mild severity and who
are not Medicaid-eligible.
Some of those people will deteriorate, resulting in additional direct or
indirect costs to the state.
The report also presents data that show that the amount the state is
spending on mental health from its general fund is declining, when adjusted
Commission members noted that Michigan had once been a national leader in
the development of Assertive Community Treatment programming, person-centered
planning policies and family-center practice, creating clubhouse programs, and
offering wraparound service delivery.
"The erosion of state funding and other policy support in the past
decade, however, has contributed to serious gaps in both availability and
quality of essential services...."
The commission recommended "funding streams dedicated to public
mental health services and treatment."
The commission also noted that public testimony showed that people do not
want to see services taken out of their local settings.
Carli said that there was considerable discussion about balancing the
assets and deficits of regional administration and delivery of community
mental health services with those of administration and delivery at the county
The aim is to capture the financial savings of regional administration
while maintaining local delivery.
The problem is complicated by the fact that there is significant variation
in funding and administrative costs among counties.
The report concluded with a statement that echoes findings of the
President's New Freedom Commission on Mental Health in 2003.
"The unintended result of several factors and policies that were well
meaning but not always far-sighted has been a state/community mental health
system that is uncoordinated and fragmented, with few real quality controls
and dispersed accountability."
About the work of the commission, Carli said, "The outcome was good,
but the process was tough." The commission was large and included"
every possible constituency," which led to difficulties in coming
up with a genuine redesign of the system. "The recommendations represent
a lot of good incremental steps," he said.
Tandon said, "It was an honest, open, and inclusive process and we
were able to pull everything together at the end to come up with a strong
Reid and Carli both commented that Granholm has a strong commitment to
improving the state's mental health system.
The two psychiatrists will be working with other advocates in a coalition
to monitor progress on the recommendations.
A press release on and the final report of the Michigan Mental
Health Commission are posted online at<www.michigan.gov/gov/0,1607,7-168--104835--,00.html>.▪