Michigan Continues to Cut Public Psychiatry Beds

In keeping with its practice of closing more publicly operated psychiatric hospitals than any other state, Michigan will put up for sale Northville Psychiatric Hospital, one of the last public mental health facilities in the metropolitan Detroit area. The hospital will be closed in July, and auction of the expansive property is expected to fetch at least $65 million needed to help ease the state’s budgetary crisis.

Once Michigan’s premier location for mental health care, Northville was built in the 1950s on 453 wooded acres where residents had access to forests and rolling hills. It had a peak capacity of 1,200, serving adults with mental illness from five surrounding counties.

News of the closing was greeted by strong reaction from advocates for the mentally ill, while township officials, neighborhood residents, local police, and land developers welcomed the decision.

In an announcement in November, Michigan Department of Community Health Director James K. Haveman Jr. said the decision was based on increased numbers of employees at Northville agreeing to an early state retirement option and initiatives local community mental health organizations had made placing patients in community settings.

The Michigan Department of Community Health is the state mental health authority.

“That the staff has gone down at Northville should be no surprise, given the early retirement program offered state employees,” Mark Reinstein, Ph.D., president and CEO of the Mental Health Association in Michigan, told Psychiatric News. He said the legislature had budgeted the hospital enough staff for all of Fiscal 2003, but the administration didn’t prevent staff from taking early retirement or make any provisions for replacing retirees.

“What health care entity in its right mind would say, ‘Gee, several staff retired so we’d better shut down an essential human service for which we have been fully funded?’ ” he asked.

Reinstein believes that Northville was targeted because the administration of Gov. John Engler (R) wanted to tie the hands of incoming Gov. Jennifer Granholm (D) on this issue as much as possible.

He said that the state had reneged on an earlier promise that if the Northville land were sold, the state was to lease back the grounds containing the hospital and operate it for a minimum of three years.

Michigan Psychiatric Society (MPS) President Michele Reid, M.D., who is medical director of Detroit-Wayne County Community Mental Health Agency (DWC), the agency most directly affected by the closure, will be responsible for implementing planning and working with the Michigan Department of Community Health to ensure appropriate services and supports are provided for the 228 Wayne County residents at Northville. Some persons will be transferred to other state facilities. Mt. Pleasant Center, Caro Center, and Kalamazoo Psychiatric Hospital will also be options for persons requiring continued state hospitalization. When clinically indicated, others will be discharged to community and residential settings according to a person-centered planning processes.

“We expect no problems with transfers, and the state has agreed to expand funding at the Walter Reuther Hospital in Wayne County so it can open another 100 beds to accommodate Northville patients,” Reid told Psychiatric News.

The Michigan Department of Community Health and the Detroit-Wayne County Community Mental Health Agency are being sued by Michigan Protection and Advocacy Services Inc. (MPAS) over concerns about discharge and person- centered planning.

“Our concern is that when people leave the hospital, there will be services in place that they need, but we are convinced that most people don’t need to be in a long-term psychiatric hospital,” Mark Cody, senior attorney for MPAS, told Psychiatric News.

He believes that many of the patients could have been moved out of the hospital a long time ago if adequate community services had been in place.

“There may be some people that psychiatrists would say need long-term care, but we have not seen Wayne County develop the services needed to support people in the community. That is one of the problems just now—that you have the hospital making decisions about who can go back to the community, with no understanding of what resources are available or what can be developed in the community,” he said.

Reinstein said that the Northville dilemma stems from the Engler administration’s view that intermediate and long-term psychiatric hospitalization have no value.

“And with Detroit/Wayne CMH turning management responsibilities over to a new ‘middleman’ layer of provider networks, the disincentives for community utilization of longer-term hospitalizations may be even greater than ever,” he said.

But Reid said, “The Detroit-Wayne County Community Mental Health Agency is not turning its management responsibilities over to a middleman. We are complying with Michigan Department of Community Health and federal procurement requirements to allow competition for mental health services in the development of vertically integrated provider-sponsored specialty networks.”

According to Reinstein, the community mental health system is so overburdened and underfunded that it has created an epidemic of mentally ill in Michigan’s prisons and jails.

A study by Michigan Department of Community Health found a 50 percent rate of mental illness and a 34 percent rate of serious mental illness among jail inmates in three counties, while an older study with which Michigan State University was involved revealed that at least 20 percent of state prison inmates had serious mental illness. Yet state officials continue to claim only 6 percent of prison inmates undergo mental health treatment. The Michigan Coalition Against Homelessness found that a key contributor to a crisis in statewide shelter bed space has been “increasing numbers of people inadequately treated for mental illness.”

“Michigan can scarcely afford to lose the state hospital beds at Northville,” Kathleen Gross, executive director of MPS, told Psychiatric News. “The outgoing administration has always pointed to unfilled private psychiatric hospital beds to justify the closing of state hospitals. But many private beds licensed by the state are affected by managed care and the cash-strapped community mental health system.”

Unfortunately, the private health care industry lacks the interest or funding sources to create long-term psychiatric beds, said Gross. Unlike Northville, Community Hospital beds are usually not arranged in a way to provide common space for daytime and rehabilitative programming and lack access to the out of doors. In addition, the staffing is often inadequate, with high turnover rates. She believes unionized staff at state hospitals have historically been more stable and more supportive than at most private hospitals.

Closing Northville is not the state’s first brush with controversy. In the past 10 years the Engler administration has closed 10 of the state’s 15 psychiatric hospitals. Several groups tried to block the closings by court order but failed, turning hundreds of people over to inadequately staffed and underfunded support networks.

Not everyone was upset by the decision to sell Northville. Township supervisor Mark Abbo admitted that some people had lost patience with the hospital because patients issued passes had wandered away and some had become involved in car jacking, assaults, robberies, and other crimes. But most have proven harmless.

Haveman said that the best practice is providing community-based services. “We made tough decisions to close all those institutions and lay off 5,000 people. But Michigan today is a national leader. People say it’s a failed policy, but I say, ‘Compared with what?’ Show me a state that’s done better.”

Robert Geake, a former state senator from Northville, said that hospitals are important because a segment of the mentally ill should never be placed in neighborhood settings now commonly used for the developmentally disabled, drug abusers, and paroled criminals.

“There needs to be an acceptance of mental illness, rather than believing it is someone’s fault.”

Contrary to claims by politicians that closing large state psychiatric hospitals is based on economy, H. Richard Lamb, M.D., a professor of psychiatry at the University of Southern California, said that it is merely cost shifting.

“While the number of beds has gone down, the number of people in jail has gone up. So really you are not closing a bed, you are just moving it. I wouldn’t think it is cheaper to keep someone in the criminal justice system than in hospital. Besides, you have all that security to pay for. And as far as treating people is concerned, you can’t treat people really well in jail.

“So it is not an economy—it’s cost shifting. That’s my opinion. These are people who are against hospitals, but they are not much against having people in jail.” ▪