Robert Sheehan, executive director, Community Mental Health Association of MichiganThis article is part of MI Mental Health, a new series highlighting 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 and its community mental health (CMH) agency members. 

The National Alliance on Mental Health Issues (NAMI) reports that nearly half the 60 million Americans living with mental health conditions go untreated. To make matters worse, COVID-19 has increased rates of anxiety and depression and exacerbated symptoms of mental illness for those who had been living with a diagnosis before the pandemic. Like the rest of the United States, Michigan is experiencing a steep increase in demand for mental health services. Here’s the good news — within this broader crisis, Michigan’s community mental health agencies (CMHs) are innovating to meet the increased demand for mental health services. According to Robert Sheehan, executive director of the Community Mental Health Association of Michigan (CMHAM), Michigan’s mental health landscape offers cutting-edge opportunities in mental health supports and services.

“Our state is unique in that we serve four populations: adults with moderate to serious mental illness, children and teenagers with emotional disturbance, people with substance use disorders (SUDs), and people with intellectual and developmental disabilities,” Sheehan says. “The advantage of that is that a person doesn't have to pre-diagnose themselves in order to know which door to walk into. If they have a mental health condition of any type, they know they can walk in the CMH door.”

CMHAM serves as an advocacy group and a trade organization for Michigan’s community mental health agencies. Its staff advocates with policy makers on behalf of Michiganders who need mental health care. It represents mental health care providers and payers in all of Michigan’s 83 counties. Its weekly electronic newsletter reaches nearly 2,000 readers across the state. When the state hosts a workgroup on a specific mental health topic, CMHAM provides subject matter experts.

“In addition to representing our members and advocating on behalf of clients, we also provide about 300 trainings, workshops, and seminars each year. These are primarily on evidence-based and promising clinical practices as well as on a range of policy and financing issues,” Sheehan says. “We train about 20,000 participants a year through those training initiatives. We also are the go-to site for information about mental health.”

In Michigan, more than half of all mental health care services are provided in people's homes, in schools, or in the workplace.

“What Michigan offers is community-based care, some of the most comprehensive community-based care in the country. We're talking about very strong community-oriented outreach and support,” Sheehan says. “A lot of states still use hospital- or institutional-based care, not the caregiving in someone's home or community that we do.”

Another strength of Michigan’s community mental health system is case management. Mental illness doesn’t take place in a vacuum. In addition to the experience of trauma, social determinants such as poverty, lack of housing, lack of transportation, unemployment, or chronic physical illness all impact mental health. When mental health professionals utilize a case management approach, they not only consider these factors, they take action to help the person being treated resolve challenges by connecting them to community resources to address those needs.

“People who have serious mental health needs need support in obtaining and retaining affordable safe housing, employment, school performance, family ties, and meeting physical health care needs,” Sheehan says. “When a person lives in poverty or has a physical health need, that makes it tough for them to organize their day. When our CMHs manage the care for a patient, they look at everything from housing, to employment, to psychotherapy, to physical health.”

Michigan is one of the few states in the country where community health centers not only oversee the mental health system but also provide the care. When a person walks into the CMH, they are immediately connected to care provided by the CMH's network of providers.

“It's a closely held network, not ‘Here's a list. Call one.’ The CMH actually schedules the appointment for you or sees you right then. So, if you are having a rather urgent mental health need, you can just go to the local CMH,” Sheehan says. “A lot of the clients that we serve, we serve for decades. We spend time planning with them. We provide ongoing support. In total, we serve about 325,000 Michiganders. When you include their families and loved ones, about a million and a half people are touched every year by the CMH system.”

For example, North Country Community Mental Health, which serves six counties in Michigan's northern Lower Peninsula, looks for creative ways to successfully connect people with the resources they need.

Brian Babbitt , CEO, North Country Community Mental Health“In addition to providing services to those who are eligible for our services, we maintain extensive resource lists and can assist by linking people to appropriate resources even if they are not eligible for our services,” says Brian Babbitt, CEO, North Country CMH. “This includes the social determinants of health, which are so critical to people’s health, well-being, and quality of life, such as access to nutritious food, safe housing, transportation, and educational opportunities. We provide training and support to our law enforcement partners and other first responders to extend our reach into the community where and when it is needed.”

Crisis care is another area of mental health service where Michigan CMHs are breaking ground. A current push to establish crisis stabilization units (CSUs) and more crisis residential beds has already yielded results. An alternative to the hospital emergency room, CSUs are sites where a person experiencing a mental health crisis can stay up to 72 hours for assessment and initial mental health care. Crisis residential facilities entail a longer stay so patients can stabilize. The staff also may help them find housing, employment, or reconnect with their families. Northern Lakes Community Mental Health Authority, which serves six counties in Michigan's northwest Lower Peninsula, is developing both of these modalities. 

Brian Martinus, interim chief executive officer, Northern Lakes Community Mental Health“Our 24/7 mobile crisis teams meet people in crisis where they are in the community and we’re opening a 24/7 Crisis Welcoming Center in Traverse City where people may drop in if they are experiencing a mental health crisis,” says Brian Martinus, interim chief executive officer, Northern Lakes CMH. “We have focused on adding new services as stepping stones to continually improve the crisis continuum of care. It’s important to have a full continuum of care, beginning with prevention and education, and increasing ease of access at every touch point possible.”

Michigan also leads the nation in the Certified Community Behavioral Health Center (CCBHC) movement. In concert with local CMHs, 34 CCBHCs currently operate across the state. Eleven of these are state demonstration sites that serve as models as additional CCBHCs are established.

“CCBHCs allows anyone, regardless of payer, to come in and get cutting-edge mental health services,” Sheehan says. “It doesn't matter if you have commercial insurance, Medicaid, Medicare, or no insurance. The federal/state financing is structured to provide support for any Michigander.”

Over the following months, CMHAM members will tell their stories in this series, sharing how they are helping Michiganders deal with depression, anxiety, substance abuse, chronic mental illness, or acute crisis events—and how they are making it easier for all Michiganders to access services.

Estelle Slootmaker is project editor for the MI Mental Health series and author of the State of Health series. You can contact her at [email protected].

Robert Sheehan photo by Roxanne Frith. Brian Babbitt photo courtesy of North Country Community Mental Health. Brian Martinus photo courtesy of Northern Lakes Community Mental Health Authority.