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Tom Watkins
Tom Watkins

Change, Adapt, or Die

August 11, 2017 

Healthcare integration makes sense. A concept whose time has come, it is a not a matter of “if”, but rather “how and when.”

As Jay Greene, the exemplary health journalist for Crain’s Detroit Business reports, the process is ongoing to design four pilot projects to test mental health integration.

Those who care about assuring the highest level of care and support for Michigan’s 350,000 plus citizens dependent on public funding for their survival and allowing the maximum benefits accrued from this investment, need to pay attention as this process unfolds.

We are witnessing disruptive change wash over our lives from the economy, transportation, retail, and healthcare, all driven by technology and ideology. We, those of us that believe in the value embedded in public behavioral healthcare, are going to have to learn very quickly to adapt and lead, or we simply won’t be able to survive.

Make no mistake, health care is undergoing massive disruptive – a transformational sea-change that is washing over many good people, families, and communities. Nothing short of bold new thinking will truly move us forward. Who wins the idea war for health care will help shape our collective future for decades to come.

This means not simply railing against the Michigan Legislature, Congress, whoever is sitting in the Governor’s chair or the “big, bad, deep pocket, bully, profit-making insurance companies/health plans.” It means not only having the best ideas, but the will and drive to convince people to follow you to the “promised land.” Ideas and the ability to operationalize great ideas matter.

We have all witnessed the force of poorly thought-out change wash over the system when a compelling counterforce does not step forth to push back against the ideology, power and entrenched interests. What is needed is the counter force of ideas going forward. The day to retrench and simply protect the status quo is over. To put it bluntly, it is change, adapt, or die time.

Change That Produced Progress

I am extremely proud of the improvements we have made here at the Detroit Wayne Mental Health Authority (

The improvements the DWMHA team has made to both operations and service are remarkable, universally acknowledged and documented in the annual report and the numerous national recognitions, awards, and documentaries the Authority have produced (

By any measure, we are a significantly better and more functional organization, having strived continuously to be:

  • Consumer and community focused
  • Data-driven, and
  • Evidence-based.

DWMHA has not only paid off tens of millions of dollars in legacy debt, but has generated tens of millions of dollars in new revenue, increased direct care staff wages by over $2 an hour, acquired a more professional work environment, and integrated SUD services into our system of care, saving over $4 million in administrative costs and standardized provider rates. We have successfully rebid our system of care, established 23 crisis mobilization teams, trained thousands of first responders and others in mental health first aid training, saved over 65 lives with our Naloxone First Responder training, and received national recognition from the National Council of Behavioral Health for our Mental Health First Aid Training. Recently, NAMI helped us produce two award-winning, anti-stigma documentaries, “Opening Minds Ending Stigma”. (

All the while, we have engaged consumers and built strong community partnerships throughout Detroit and Wayne County.

Make no mistake, the Health Plans have much room for improvement as well. There is much more work to do at DWMHA and across the PIHP and CMH systems. As the advocates will quickly point out, they like and support the public behavioral health system over the Health Plan/Insurance Companies, but believe me, we are far from perfect— and their assessment is accurate.

Change vs. Progress

The landscape of community mental health is forever changing. As we look to the future the one certainty we can predict is that there will be constant pressure to adapt and change or risk becoming irrelevant. Some might say change is easy. But producing change that adds value to the consumer and taxpayer on both a short term and long term basis proves to be far more difficult.

Decisions that are made on behalf of consumers and taxpayers vs. the “system” will take us down the right path, adding value and making a difference to consumers. If power, control, politics, and ideology- drive policy decisions in the coming years, I predict future policy makers will have a huge mess to clean up.

Examine Our Past to Prevent Mistakes

One needs to look no further than the closures of multiple state hospitals in the early 90’s, which was a laudable goal, but the implementation of which – shifting priorities and lack of oversite and funding – resulted in the crisis erupting today, where denial of hospitalization for people with serious mental illness by local hospitals is at epidemic proportions. Our jails and prisons have become de facto mental health institutions in the 21st Century.

House Speaker Tom Leonard recently announced a new bipartisan mental health task force led by Republican State Reps. Hank Vaupel of Fowlerville and Klint Kesto of Commerce Township. Vaupel chairs the House Health Policy Committee while Kesto heads the House Law & Justice Committee.

Rep. Hank Vaupel

Rep. Klint Kesto

It is good to see Speaker Leonard recognize this moral and fiscal crisis impacting our state. Governor Snyder’s office reports 23 percent of Michigan’s more than 41,000 prisoners are classified by the Department of Corrections as mentally ill, and about 64 percent of county jail inmates. Prisoners with severe mental illnesses can cost an annual average of about $95,000 to incarcerate compared to about $35,000 for an average prisoner without a mental illness.

Speaker Tom Leonard

As The Detroit News points out, the 14-member task force is led by two Republicans but is split between the two parties. The seven Democrats include Reps. Fred Durhal III of Detroit, Abdullah Hammoud of Dearborn, Robert Kosowski of Westland, Sylvia Santana of Detroit, and Robert Wittenberg of Oak Park. Among the other GOP members are Dave Pagel of Berrien Springs and Mary Whiteford of Casco Township.

Advocates, consumers, and providers need to educate, yet another “Blue Ribbon” task force on sensible policies and resources needed to better care and support persons with behavioral health issues more humanely and less costly.

Going Forward

The vision, values, and dedication to the public behavioral health community in Michigan are second to none. We never shied away from advocating for what is right. There are leaders among us. Stand up and be willing to lead going forward. We must act as though the decisions being made will impact someone we love – because ultimately it will.

When I took the reins of the Detroit Wayne Mental Health Authority, I presented a mantra that we would be consumer and community focused, data driven, and evidence based in all we do. We need to encourage all in the behavioral health and healthcare business to adopt this mantra. I know the road ahead seems uncertain. It is for this reason I implore my colleagues to not simply sit back and adapt to change, but boldly lead it!

While I am leaving my role at DWMHA at the end of the month, I am not abandoning the field. Collectively we need to join with advocates to change what needs to be changed while preserving the value and the values of the public mental health system. In mid-September, look for more, expanded ideas expressed in Connections @

There are so many good people past and present at DWMHA, CMH, PIHP’s, MACMHB, MDHHS, advocate groups, providers, and more that I have worked with over the years. There are equally good people at the Health Plans that can be productive partners going forward. Thank you for your support, friendship and for standing up for what is right.

Together we have and WILL continue to make a difference!

Tom Watkins has an eclectic career that includes leading two major departments of state government (Mental Health and Education) serving as the president and CEO of the Economic Council of Palm Beach County, FL., and politics, being elected to the Wayne County Charter Commission, and serving in the first successful Blanchard for Governor campaign as Deputy Campaign Manager and later as Deputy Chief of Staff to Governor Blanchard. He can be emailed at:, or followed on twitter at:@tdwatkins88


August 10, 2017 · Filed under Tom Watkins



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