NASW-MI Signs Onto Letter Opposing Profitization of CMH

An Open Letter to Legislators on State Services for Mental illness, Emotional Disturbance, Substance Use Disorder & Intellectual or Developmental Disability

April 2016

We, the undersigned, are pleased that the language of Boilerplate Section 298, in the Governor’s Executive Budget for MDHHS, will not be a part of the budget deliberations.  We are also pleased to be working with Lieutenant Governor Calley on alternatives to address some of the issues with the current system. We do not think this effort necessarily has to result in replacement Boilerplate by May; the executive branch is free to foster analysis and discussion in the absence of any Boilerplate.

We are not inherently opposed to possible changes in the management and delivery of state-funded mental and other health care services. It is important, however, to delineate some of our concerns with Section 298 as presented to the Legislature.

First, integrating funding at the macro funding level does not necessarily mean the effective integration of behavioral health and physical health care at the service delivery level to persons who might benefit. Merely privatizing and combining funding at the macro level is more likely to endanger the vulnerable populations we represent and serve.

Second, most of the supports and services persons need and receive from the current public mental health system are not medical care. The important goals of the State’s 1915 (b) Waiver, which serves most persons with developmental disabilities and those with mental illness, are Independence, Community Participation, Recovery, and Productivity. Health care entities who manage acute health care are not familiar with, and do not possess expertise in, these areas.

Third, from our State’s constitution to the Mental Health Code, Michigan has spelled out obligations and intent to protect and serve this State’s most vulnerable citizens. The result of Section 298 would have been to potentially abrogate that promise. Putting private, including for-profit, entities, some perhaps based outside this State, in charge of such critical day-to-day supports and services to those with mental illness, substance use disorder, and developmental disabilities could ultimately represent this State’s turning its back on this long-standing solemn obligation.

Fourth, we find the haste to make such a drastic change to be surprising, given that this State has embarked on four pilots to test integration, MI Health Link. The results and evaluation from these pilots should be available in 18-24 months. Not waiting for these results seems questionable, even though we find most persons with developmental disabilities or a mental illness are actually taking an affirmative action to opt-out of these very same “Health Plans.” Despite automatic enrollment and incentives to stay in the pilot, a strong majority of the aforementioned populations are indicating they want to maintain their current arrangements with their physician, and not have that physician or the health care entities involved with the rest of their (non-medical) life.

Finally, there are a number of logical efforts that should and have been implemented at the local level that can make a difference. Clinic options, some of which are underway, hold considerable promise for helping persons address chronic or secondary conditions. Those particularly at risk, or with a history indicating the need for integration of supports, would be far better served by an accountable care organization at the local level. The new Certified Community Behavioral Health Clinics, for which our State has received a planning grant, would be another far better option for actually dealing with those who would benefit from integration of their mental health and physical health care services. We wonder why there is a rush to move forward with an unproven model, at a level that may not accomplish our goals, instead of using some of the new and developing information to improve our “public” system.

Thank you for your assistance and thoughtful consideration of our views.

The Arc Michigan, Sherri Boyd & Dohn Hoyle

Association for Children’s Mental Health, Jane Shank

Epilepsy Foundation of Michigan, Arlene Gorelick

HIV/AIDS Alliance of Michigan, Jimena Loveluck

Mental Health Association in Michigan, Linda Burghardt

Michigan Association for Children with Emotional Disorders, Susan McParland

Michigan Association of Community Mental Health Boards, Bob Sheehan

Michigan Council for Maternal & Child Health, Amy Zaagman

Michigan Disability Rights Coalition, Norm DeLisle

Michigan League for Public Policy, Karen Holcomb-Merrill

Michigan Partners in Crisis, Mark Reinstein

Michigan Protection & Advocacy Service, Elmer Cerano

Michigan Psychiatric Society, Jane Sherzer

MICHUCAN, Marjorie Mitchell

National Alliance on Mental Illness–Michigan, Kevin Fischer

National Association of Social Workers–Michigan, Allan Wachendorfer