Michigan’s community mental health agencies will do even more good work in 2025

Federal dollars, state initiatives, community partnerships, and a normalization of seeking and receiving behavioral health care have positioned Michigan’s community mental health agencies to do more good work in 2025. MI Mental Health spoke with Robert Sheehan, CEO of the Community Mental Health Association of Michigan, about how more Michiganders will be able to access high quality care in the new year.

This interview has been edited for length and clarity.
 
Q. What developments in community mental health will Michiganders see in 2025?

A. Michigan is expanding its Certified Community Behavioral Health Clinic (CCBHC) footprint. We'll have nearly 40 sites in Michigan. These clinics fulfill the promise that President Kennedy thought he was signing into law in 1963 to provide high quality, comprehensive mental health care to anyone in the community, regardless of payer — those with insurance, on Medicaid, Medicare, without insurance — and get top notch-care in rural and urban communities. Michigan leads the country — we have more CCBHCs than any other state.
 
Behavioral Health Homes are expanding. They now are in every county in Michigan. Health Homes and CCBHCs not only provide access to care, but also comprehensive, highly coordinated care.
 
Q. Community mental health has made progress in reducing stigma. How is that increasing access to care?
 
A. The pandemic was a terrible thing. However, it also made people far more willing to talk about mental health. It started with teenagers being more willing to talk about depression and anxiety because they were away from friends, away from sports, and away from face-to-face instruction with teachers. Then their parents started talking about it more openly. Now we have people talking about anxiety and depression like they're talking about the common cold.
 
Secondly, the pandemic forced us to use telehealth more. We've been able to reach people who were never reached before, often because of their geographic distance from a clinic. You’ll hear people say, “Yeah, I talked to my therapist over the phone.’
 
There are also a number of commercial products out there. These aren’t in competition with us because they actually normalize mental health care — it becomes as normal as going to the grocery store or calling GrubHub. That stigma is being reduced, and that is good.
 
Stigma still exists in the substance use disorder (SUD) world because often people don't understand that SUDs are a health care need. But they're coming around to realize that stigma around SUDs gets in the way of people getting treatment, getting into recovery. Blaming somebody for substance use disorder doesn't make them sober, doesn't make them stop their use. It makes them hide it.

Heather Pendygraft is a community health worker at Summit Pointe, the community mental health agency serving Calhoun County.
 
Q. How are partnerships between community mental health and schools helping students and their families?
 
A. Schools are destigmatized. A kid can say to their counselor, school nurse, or principal that they are not feeling too well, and what they mean is mentally. So, they can begin to get treatment. The partnership between schools and community health centers is getting rich. Schools are getting better at knowing what they can treat and what they can't. A number of schools have school-based clinics. Sometimes schools hire a CMH [community mental health agency] to come in and provide care.
 
State of Michigan 31n funding expanded school-based mental health care. A lot of schools are realizing that they do best when they work with their local community health center. More and more schools are contracting with a CMH. Schools have realized that while school-based care is really an important part of the mental health landscape, partnering with the community mental health center that does family-based, year ‘round, 24/7 crisis work is key.
 
Q. SUDs remain an urgent mental health concern. How will CMHs help more people recover in 2025?

A. Opioid Health Homes are broadening to Substance Use Disorder Health Homes. They started as Opioid Health Homes because they were financed with opioid prevention/treatment money. SUD Health Homes in 2025 will cover every county in Michigan.
 
Substance use treatment, when it started back in the '60s, was led mostly by people with lived experience, people who were recovering themselves. The peer recovery coaching movement says people with lived experience can help you recover — and be some of the best supports to help you live a full life.
 
Sometimes a peer is far more impactful than a graduate school trained clinician. We need them both. We've gotten over saying that people with lived experience don't have what it takes. They often have more than what it takes. The peer recovery coach movement has really changed a lot of lives.

Mental health care offers a wide range of career opportunities. Paulette Paehlig (L) and Tina Fick are program secretaries at Sanilac County Community Mental Health.
 
Q. Workforce shortages have been a challenge for community mental health. What state and CMH initiatives will build that workforce in 2025?
 
A. The MI Kids Now Loan Repayment Program is really stabilizing the workforce. The first phase was aimed at clinicians who serve kids and families, and the second phase was aimed at folks who serve kids and families and those who serve adults.
 
The Loan Repayment Program is actually a retention tool — a lot of clinicians who were in the public sector were paying graduate school loans off. This helped them pay those off and stay in public mental health. A lot of clinicians in the public sector who would probably leave for higher wages because of those loans were able to stay.
 
Our CMHA members have put a lot of other recruitment/retention efforts into place. If you're in a graduate school program in social work, psychology, nursing, PT, OT, you can now get paid for your internship in public health settings. In the private sector, it was common to pay stipends, but the public sector never had the dollars. Now they do.
 
Also, a lot of our CMHA members hired internship coordinators, and some of them have doubled their number of interns in nursing, social work, psychology, and psychiatry.

When people work in the public mental health setting, they find it's unique in many ways. It is team-based care. They work with other folks who are clinicians, as opposed to working in a private practice and being alone. The work mental health practitioners do is difficult work. You're carrying around the troubles that people have. Over time, that can burden you. But when you're part of a team, you can spread that burden around. You have peer support in dealing with it. You can get quick troubleshooting consults from other more experienced clinicians.
 
If I'm doing clinical work with this family, but they need a peer, they need respite, they need short-term residential, or they need psychiatry, in a community mental health setting, you have all that around you. People fall in love with that.
 
We also deal with some of the more complex cases. If you're in mental health because you want to deal with complexity, this is where complexity lives. So, people fall in love with a community mental health setting. They get to work with complex needs and make incredible changes to people's lives. If you spend a year hanging out with the CMH, the chance of continuing your career in a public mental health setting goes up dramatically.

Partnerships between community mental health and law enforcement can mean treatment instead of incarceration. Pictured: Sanilac County CMH CEO Wilbert Morris and Sanilac County Sheriff Paul Rich.
 
Q. How will community mental health agencies innovate to provide care despite rising costs?

A. The use of peers is a big one and the use of paraprofessionals and support workers because they work for lower pay. Second, by using a lot more telehealth. Third, by putting in place evidence-based practices that allow shorter episodes of care. If I used to see somebody for a year, some treatment techniques might allow me to cut that down to six months. It's that kind of innovation that has to happen.

Crisis work is key, and we're seeing a lot more partnerships there. More and more of our law enforcement and corrections partners have embraced the fact that mental health, especially how we can offer it, is a cutting edge practice.

Do I think we should be slimming down what we do? No, but there are fiscal realities. Our system is built in a resilient way. We can pivot rapidly, and we can continue to provide high quality care using those innovations, those evidence-based practices.
 
We're also in partnership with the Michigan Department of Health and Human Services to reduce administrative burden. If we can reduce that burden, then that same clinician can get rid of some of the paperwork and serve a third more clients.

Estelle Slootmaker spends most workdays as a journalist and book editor. She also writes poetry and will be publishing a new children’s book, “Places Where the Sun Don’t Shine.” You can contact her at [email protected] or www.constellations.biz. 

Photos by, in order of appearance, Roxanne Frith, John Grap, and Liz Fredendall.

The MI Mental Health series highlights the opportunities that Michigan's children, teens, and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of Michigan, Center for Health and Research Transformation, LifeWays, Michigan Health and Hospital Association, Northern Lakes CMH Authority, OnPoint, Sanilac County CMH, Summit Pointe, and Washtenaw County CMH.