Michigan Community Mental Health Services
CMHSP expenditures per client as reported in DCH's fiscal year-1998 Boilerplate report
to the Legislature were distributed to persons with developmental disabilities at
approximately $26,000 per client, to adults with mental illness at roughly $3,900 per
client, and to minors with emotional disorders at about $2,550.

BACKGROUND ON MICHIGAN'S PUBLICLY FUNDED MENTAL HEALTH SYSTEM

Michigan's publicly funded mental health system is a community mental health system supervised by
the Department of Community Health (DCH). Forty-nine Community Mental Health Services Programs
(CMHSPs), connected to county government by existing state law, act as gatekeepers to various treatment
and support services for adults with mental illnesses, minors with emotional disorders and developmentally
disabled individuals. Some of these services are provided directly by CMHSPs, while others occur by
contracts arranged by the CMHSPs. During the 1998 state fiscal year, CMHSPs reported serving 206,000
consumers. Of these, approximately 66% were adults with mental illnesses, roughly 20% were minors with
emotional disorders and about 14% were individuals with developmental disabilities. During that same
period, DCH reported that less than half of CMHSP service recipients were enrolled in Medicaid. Forty-
five percent of adults and minors with mental illness/emotional disorders were Medicaid enrollees,
compared to over 65% of individuals with developmental disabilities. In the state fiscal year-2000 budget
the Legislature has assigned $1.7 billion to Michigan's CMHSPs, with $1.2 billion of this amount to be
allocated to Medicaid care.

For the last few years, CMHSP expenditures for the three major disability classifications served by the
system have been distributed approximately as 35% to adults with mental illness, 7-8% to minors with
emotional disorders, 48-49% to persons with developmental disabilities and 8-10% for administrative
overhead and other costs (see Table 1). Under current state law, CMHSPs are directed to give prioritized,
not necessarily exclusive, attention to individuals with the most severe forms of mental illness, emotional
disorder and developmental disability, as well as assist any persons experiencing an emergency/urgent
situation related to any of these three classifications. CMHSPs are required to at least provide the
following services and activities within their community:

1) Crisis response and stabilization which may include the use of an inpatient psychiatric setting or
an alternative protective treatment environment;

2) Case identification, assessment and diagnosis;

3) Service planning, coordination, monitoring and follow-up through individualized service plans
which employ a person-centered planning process;

4) Specialized consumer training, treatment and support;

5) Mental health advocacy;

6) Diversion programs for persons mentally ill who may face incarceration in jails;

7) Prevention activities to inform and educate consumers, family members and citizens about mental illness.

Presently CMHSPs have at their disposal five state-operated psychiatric hospitals. Northville, Walter
Reuther, Kalamazoo and Caro Psychiatric Hospitals serve mentally ill adults and Hawthorn Center serves
emotionally disturbed minors. Southgate and Mt. Pleasant Centers care for the developmentally disabled. In
addition, the state has two forensic inpatient facilities. The Forensic Center serves the courts directly on
issues regarding mental illness and mentally ill offenders. Huron Valley Center treats mentally ill inmates
of the Michigan Department of Corrections.

Ten Department of Community Health psychiatric hospitals were closed during the 1990s (see Table 2).
An important factor which led to this reduction was a state government policy implemented in the early
1980s to apply managed care-like funding procedures to CMHSP use of the state hospitals. In October,
1998, Michigan implemented a more formal, extensive managed care program for CMHSP clients. Under
this program, it is possible that by October 2002 there will be fewer service regions across the state than the
current 49 represented by the present CMHSPs.

Michigan has 1.4 million adults with various forms of mental illness. The federal Center for Mental
Health Service has projected between 253,000 to 485,000 Michigan adults have "serious mental illness."
Using different methods, DCH projects about 140,000 adults in the state have serious disorders.
Based on CMHSPs' reports since 1997, in any given quarter CMHSPs serve between 50,000 to 60,000
adults meeting DCH's criteria for "serious mental disorder." During the 1997 fiscal year, 74,524 out of
130,740 adults served by CMHSPs or 57% met the criteria for seriousness.

The Department of Community Health roughly estimates that 300,000 Michigan minors, or 11.8% of
state youth, have a "serious emotional disturbance." The Department reported that CMHSPs served 45,390
or 15% of these youngsters during fiscal year-1998. National estimates of the prevalence of emotional
disturbance among minors vary somewhat. The highest estimates assess 20% of our youth have emotional
disorders. The Methodology for Epidemiology of Mental Disorders in Children and Adolescents Study has
projected that 11% of youngsters between nine and seventeen have mental illness with "signifcant"
functional impairment while 5% have "extreme" impairment.

Source: The Mental Health Association in Michigan Public information - Copy as you please http://www.mha-mi.org/backgrd.html