Michigan bill intended to shorten ER waits for youth in mental health crisis

  • In Michigan, children with mental health problems can spend days — even weeks — in emergency rooms before receiving treatment
  • A bill would allow hospitals to expand who can evaluate patients in crisis situations to speed up treatment decisions
  • Critics say rapid evaluations aren’t the problem, it’s the lack of psychiatric beds and staff

Michigan’s worn-out mental health system faces problems that are daunting and complicated, but a new bill in the state house aims to speed up the decision on whether a patient should be hospitalized during a crisis, its sponsor said.

The measure follows years when, particularly during the COVID pandemic, Michigan children and adolescents in mental health crises spent days or weeks in emergency rooms awaiting evaluation or treatment due to the lack of openings in specialty facilities or mental health units to treat them.

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“It’s not a law that will solve all the problems in Michigan’s mental health services, but it is a step in the right direction,” Rep. Graham Filler said of the measure, which would apply to both minors and adults during the crisis.

On Thursday the invoice, sponsored by filler, R-Greenbush Township, received its first hearing before the House Health Policy Committee. it would require a community mental health (CHM) worker to examine a patient in crisis within three hours of being notified by a hospital that the patient needs to be assessed.

If a CMH employee is not available in three hours, a “clinically qualified” hospital The staff member could make the assessment and in turn decide whether the minor needs to be hospitalized or treated in another facility.

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Thursday’s hearing included testimony from Nicole Knight, a registered nurse and mother of a teenage boy with mental health problems. Knight described endless waits in emergency rooms when her son was in crisis – once for 43 days.

It only increased the anxiety of a boy “who isn’t used to being placed in a 10 by 10 room. That leads to restraint and sedation and further trauma that only deepens the trauma he’s already experienced,” she told the committee.

“If a person seeks help in the ER, they should be given priority,” said Knight, who started a Facebook page. Michigan Parents for Mental Health Reform.

She testified that this “helps reduce stigma and it saves lives too.”

Michigan has long suffered from a shortage of psychiatric staff and inpatient beds for people in serious crises. Bridge Michigan documented these problems in 2021 in a series chronicling what a hospital president “a tidal wave of sadness‘ in young patients.

In the series, hospital leaders described how emergency rooms came to serve as stopping-off points for the most troubled young patients; Places where they could be monitored but not receive the treatment they need for their underlying condition.

“When a person is in a psychiatric crisis, the last thing they want is to wait hours in an emergency room,” Marianne Huff, president and CEO of Michigan’s Mental Health Association, told the committee Thursday.

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And that’s the crux of the matter, said Filler, the sponsor of the bill.

“Keeping a patient waiting for hours or days can be extremely damaging,” he said. “People with mental illnesses need immediate care just as much as those with other injuries or illnesses.”

but Alan Bolter, Associate Director of Community Mental Health Association of Michigan, who represents the state’s municipal mental health agency, said the bill does not address the biggest hurdle to immediate assessment and care.

As it stands now, Michigan’s Mental Health Code requires each of Michigan’s municipal mental health agencies is said to have 24-hour screening staff available to respond to a crisis.

Under a contract agreement with the Michigan Department of Health and Human Services, these workers must respond to an ER crisis within three hours at least 95 percent of the time, Bolter told the committee.

They exceed that standard, he testified, and responded within three hours more than 97 to 98 percent of the time.

The real problem, Bolter said — in a point also raised by officials in their survey — is the lack of mental health staff, which in turn leads to under-inpatient beds for both adults and children.

Additionally, he said, the bill would allow hospitals to bypass community mental health workers — who he says are best placed to assess a patient’s mental health needs — by allowing qualified hospital staff to see patients in their absence see. Even if they happen, local, tax-financed, community health agencies would cover some of the cost of inpatient care.

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(Under the bill, hospital staff authorized to assess patients without CMH work would need to have at least a master’s degree in a profession specific to behavioral health to conduct assessments.)

BExcluding community mental health workers in the assessment process would also increase the possibility that patients would be hospitalized when they would be better cared for in an outpatient setting, he said.

“We’ve all heard stories … from people in emergency rooms for 10 days, 15 days, 20 days, 30 days,” Bolter said. “All of this is extremely tragic; however this In our view, laws do not solve this problem.”

State Rep. Lori Stone, D-Warren, also focused on the shortage of psychiatric staff across the state.

“My understanding is that significant patient delay … is largely due to the lack of mental health providers given the (low) reimbursement rates paid by health insurers,” she said.

Filler, the sponsor, agreed that the bill does not solve these larger, more complicated insurance reimbursement and staffing issues.

“Technically, this isn’t a bill for access to care, Rep,” he replied to Stone. “This is a rapid assessment bill.”

Representatives did not vote on the bill Thursday. It remained in the committee, which has not yet scheduled any further hearings.

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