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Michigan set to make strides in mental health, addiction services

State selected for innovative mental health reforms, while governor works to tackle drug epidemic

By: Nick Mordowanec, Tiffany Esshaki | C&G Newspapers | Published November 4, 2015

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METRO DETROIT — Michigan is making vast strides to combat mental and behavioral health deficiencies.

The Substance Abuse and Mental Health Services Administration recently announced that Michigan has been selected to participate in a year-long planning process for a demonstration program that is designed to alter the delivery of mental health and addiction services.

U.S. Sen. Debbie Stabenow, D-Michigan, is responsible for the Excellence in Mental Health Act that debuted in the early part of this decade. That perpetuated a series of events that have helped strengthen mental health and addiction care and offer better care for children, adults and families.

“Michigan and the other states selected by SAMHSA for planning grants will one day be looked upon as pioneers that taught the rest of us how to create the behavioral health safety net that America has lacked for too long,” Linda Rosenberg, president and CEO of the National Council for Behavioral Health, said in a statement.

It is a three-year process of reform.

The one-year planning process for a demonstration program will take place, during which states like Michigan can close gaps and attain certification processes. The two-year Excellence Act demonstration program will ensue in which states will “live out” the planning process, gain financing and demonstrate how reform will improve care and reduce quality costs.

When the Excellence Act is fully implemented, $1 billion in congressionally-backed funding will significantly increase nationwide access to comprehensive community mental health and addiction treatment services. That is the largest federal investment in mental health and addiction services in a generation.

Twenty-eight states originally applied for the one-year planning process — which involves Certified Community Behavioral Health Clinics — and 24 were chosen. States with comprehensive medical health centers that meet CCBHC standards will participate.

Robert Sheehan, chief executive officer of the Michigan Association of Community Mental Health Boards, said only 28 states applied because “it was a relatively complex application process” in which each state had to be willing to show their billing certification process and elaborate financing systems between the federal and state governments.

A lot of states weren’t willing to do that, Sheehan said.

The first criteria was to make planning work, while the next step involved having a comprehensive approach toward behavioral health.

Only eight states will be chosen to participate in the two-year process because of funds available. When Stabenow first issued the bipartisan bill, it was unclear how many states would be involved. As Sheehan said, it’s difficult to divide $1 billion among too many states and spread that money around enough to make a difference.

The advantage of the bill is that it focuses on behavioral health in the form of mental health care and substance abuse treatment, with other positive aspects coming as a result: Emergency department use will drop; ambulance primary care will drop; the use of prisons and jails will drop; and homeless shelter use will also trend downward.

It’s based on the idea that by having comprehensive health reform, poverty, housing and employment will be impacted in a positive way and provide more overall stability.

Michigan will receive $982,373 from the federal government for the one-year process.

“It’s mostly to fund staff and technical assistance to build the certification process and guide community health centers in Michigan to become certified,” Sheehan said.

There are about 46 community health centers in the state, along with 70 comprehensive providers. Only eight to 10 centers are chosen by the Michigan Department of Health and Human Services.

Sheehan noted two specific benefits of certified community behavioral health clinics. First, you end up with a comprehensive service in your home community. Second, it opens the door for federal funding to pay for comprehensive care.

That second point mostly refers to Medicaid, which expanded through the Affordable Care Act as part of a state expansion process in which states can choose to expand coverage for people ages 19 to 64. Previously, Medicaid was only issued to low-income children or adults with severe disabilities. It’s now been expanded to all adults.

The Michigan Association of Community Mental Health Boards works with the Michigan Department of Health and Human Services, community mental health centers, mental health providers and dozens of advocacy and ally groups.

Sheehan acknowledged that the bill was first introduced as a way to combat the overwhelming amounts of violence nationwide.

“Violence and lack of behavioral health care has sparked the interest,” Sheehan said. “It’s sad and that’s what does it. It’s the public’s concern for safety, I think that’s what gives the major message.”

He added that a lot of community centers for mental health are doing national readiness assessments, and dozens are coming into the process and seeing where they stand. He called it “quite encouraging” to see the same kind of action across the nation.

State ramps up other substance abuse efforts
The initiative should complement efforts made at the state, county and municipal levels to aid those with mental illness and developmental disabilities and also get a handle on Michigan’s growing drug abuse epidemic.

Around the same time the health act reforms were announced, Gov. Rick Snyder updated the public on the progress that the Michigan Prescription Drug and Opioid Abuse Task Force had made since he formed the group this past June.

The task force was asked by the governor to examine recent trends in opioid drug use, which affects millions of people in the United States. The highly addictive class of narcotics, which can range from prescribed pain killers to street heroin, is one of the fastest growing drug trends in the county, with Michigan ranking 10th nationally in per capita prescription rates of opioid pain relievers and 18th in the nation for all overdose deaths.

Chaired by Lt. Gov. Brian Calley, the task force comprises officials representing law enforcement, state Legislature, prosecutors, mental health commissioners, doctors, hospitals and insurance companies. After several meetings, public hearings and subcommittees, groups provided Snyder with a list of 25 targeted recommendations to start making a noticeable impact on Michigan’s opiate epidemic.

“Prescription drug and opioid addiction is a serious problem that is having a significant negative impact on our families and communities,” said Calley in an email. “Half of all overdoses in our nation are from the tragic misuse of prescription drugs and opioids.”

Among the items the group recommended are to examine currently successful addiction intervention programs and replicate them around Michigan, increase the number of addiction specialists practicing in the state, increase training for law enforcement officers who regularly come into contact with addicted individuals and provide easier access to the medication Naloxone, or Narcan, which can reverse an opioid overdose and reduce overdose-related fatalities.

The group also considered initiating a pilot program that would develop the ability to test for neonatal abstinence syndrome, a condition suffered by babies born to opiate-addicted mothers that can result in severe withdrawal symptoms for the child.

But perhaps most important, Calley indicated, is the need to update or replace the Michigan Automated Prescription System, a prescription monitoring program to be used by prescribers and pharmacists to identify and prevent potential abuse of prescribed controlled substances.

The task force determined that the system has become ineffectual since the outdated technology makes it difficult to participate, and they’ve recommended MAPS be overhauled and prescribers and pharmacies alike be required to register for and use the system.

“We clearly have a lot to address, but one of the goals of the task force was to present recommendations that we knew were achievable,” Calley said. “By working with our partners in the state Legislature and the medical community, I am certain we can achieve the recommendations presented.”

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