For the past several years, the Michigan Health and Hospital Association’s (MHA) annual Strategic Action Plan has addressed behavioral health. As the COVID-19 pandemic began winding down, MHA started collecting data on the numbers of patients presenting to emergency departments (ED) across the state who were stuck, waiting for the behavioral health care they needed.
 
“We learned that on average, there are at least 155 patients that are stuck in emergency departments across the state that need some level of behavioral health care,” says Lauren LaPine, MHA senior director of legislative and public policy. “Of those, at least 17 children at any time are boarding [stuck waiting] in an emergency department across the state.”
 
Because only 50 to 60% of Michigan’s hospitals reported data, the real numbers are most likely much higher.
 
Lauren LaPine“It is important for us at the MHA to focus on pediatric mental health, in particular, because we know that there's a need in that space," LaPine says. "Our data in Michigan reflects some of the trends that we see nationally in terms of the increasing need for behavioral health services for children and youth. So, we are paying really close attention to that need and want to make sure that our member hospitals and health systems are able to address the need when pediatric patients and their families come to the hospital in a behavioral health crisis.”
 
One MHA strategy for meeting this need is advocacy at the state level. Last year, MHA worked with the Michigan legislature and the Michigan Department of Health and Human Services to appropriate $50 million to expand hospitals’ inpatient pediatric psychiatric care and another $10 million to expand psychiatric residential treatment facilities for patients under the age of 21.

As distributor of the funding, MHA offered a competitive grant application process that resulted in funding for seven Michigan hospitals interested in expanding those services: Corewell Health  in Grand Rapids; HealthSource Saginaw; Holland Hospital; Memorial Healthcare; Munson Healthcare; Pine Rest Christian Mental Health Services; and Straith Hospital.
 
“We continue to work hand in hand with our members to make sure that they're able to deploy those resources and really increase the care that children are able to receive across the state,” LaPine says. “We also have a behavioral health bill package that we have been working on for the last couple of years that addresses the behavioral health capacity concerns that our hospitals see across the state.”
 
Grand Traverse Mental Health Crisis and Access CenterOne of the bills, the “Three Hour Bill,” would specifically help Medicaid beneficiaries who come to hospital EDs for behavioral health care. Current laws require that a community mental health (CMH) agency send staff to screen patients for an inpatient psychiatric stay. This can prolong waiting times. The bill would change policy — if the CMH cannot send personnel out within three hours, trained hospital staff can complete the assessment.
 
“We'd like a clinically qualified health care provider in the emergency department setting to be able to do that assessment," LaPine says. "We tie this directly back to that ED boarding data that we collected. We know that we have these patients that are getting stuck in the emergency department. One of the reasons is that they're waiting for either an assessment or an inpatient bed.”
 
LaPine is especially excited by MHA grant-funded projects underway in Grand Rapids at Corewell Health and Pine Rest Christian Mental Health Services that will serve pediatric patients. Corewell recently stood up Michigan’s first dual psychiatric and medical unit in its children's hospital, providing both kinds of care in one setting.  
 
“We are a whole person. It's very possible to have a medical condition as well as a behavioral health condition at the same time," LaPine says. "Those types of patients tend to be the most challenging to provide care for, mainly because of the way that our physical and behavioral health insurance systems are separated.”
 
In collaboration with Corewell Health Helen DeVos Children’s Hospital,  Pine Rest is in the process of creating the Pine Rest Pediatric Center of Behavioral Health to serve children from across the state.  
 
“They're even building in a slide in the hospital," LaPine says. "When a patient is discharged, they can take the slide to leave.”
 
Michael Corby, behavioral health director, Grand Traverse Mental Health Crisis and Access Center.

In Northern Michigan, Munson Medical Center has partnered with Northern Lakes Community Mental Health Authority to stand up a pediatric crisis center with a crisis stabilization unit and walk-in pediatric mental health urgent care within the Grand Traverse Mental Health Crisis and Access Center.
 
“The thing that is exciting about this — and what we're seeing our member hospitals do more often — is our hospitals are starting to create programming in the community that will address a behavioral health crisis before you have to go to the emergency department," LaPine says. "That is some unique work that our hospitals are undertaking.”
 
LaPine hears from MHA hospital members that the need is not only for additional inpatient psychiatric beds across the state, but also more services tailored for both pediatric and geriatric patients — the two populations with the greatest need, especially in terms of being stuck in the ED.  
 
LaPine concludes, “Ideally, no one should have to go to the emergency department for a behavioral health crisis.”

Estelle Slootmaker spends most workdays as a journalist and book editor. You can contact her at [email protected] or www.constellations.biz. 

Photos courtesy MHA and Grand Traverse Mental Health Crisis and Access Center.

Masthead photo by Kampus via Pexels.com; introductory photo by Flammenwerfer 35 via Pexels.com.

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 Community Mental Health Authority, OnPoint, Sanilac County Community Mental Health, St. Clair County Community Mental Health, Summit Pointe, and Washtenaw County Community Mental Health and Public Safety Preservation Millage.