Michigan’s Mental Health Failure
February 27, 2015
DETROIT – Wayne County Chief Probate Judge Milton Mack is deeply frustrated with the mental health system in Michigan. He’s seen a lot of mentally ill people pass through his courtroom in the nearly quarter-century he’s been on the bench. Many show up again and again. Some are jailed, treated for a brief time and then released, only to start the cycle all over again.
Soon after Judge Mack got to the Bench, Michigan closed most of its mental hospitals, part of a wave of “deinstitutionalization” that swept the nation. Unfortunately, arrangements were never made to ensure adequate facilities for outpatient care. “Legally, we still have an inpatient system in an outpatient world,” he told me during an interview in his chambers last week.
Lawmakers haven’t been willing to do what needs to be done. For some quarters, talking about mental illness is still difficult. Many people who would readily admit to a physical ailment have great difficulty admitting or even recognizing that they are mentally ill. Worse, the Judge said, “Policy makers don’t understand that mental illness is treatable,” and are therefore reluctant to establish the programs and appropriate the funds needed.
Concerns about not infringing upon a person’s right to self-determination also have come into play. Now, “It is easier for me to order an amputation,” than mental health treatment, Judge Mack said.
The tragedy of this is that this cockeyed system is certainly costing the state heavily, both in terms of money spent and in wasted human potential. Michigan currently has about 43,000 inmates in state prisons, who cost the state nearly $2 billion a year. Mack estimates that perhaps a quarter of these are mentally ill but treatable, representing vast potential savings. He believes county jails may have an even higher proportion. Ironically, prisoners do get mental health treatment in prisons and in some county jails, though the standard of care can be uneven and sometimes astronomically expensive. Some inmates have racked up hundreds of thousands in costs at state expense.
Sometimes, the failure of Michigan’s system takes on comic proportions.
The Judge’s wife—Laura Mack—is a District Judge in the small, nearby city of Wayne. One day, she had a case where a prosecutor and a defense attorney agreed to bargain down an inmate’s sentence to time already served, then release him. But the plea bargain was interrupted by the prisoner. “Excuse me, Your Honor, but could you sentence me to a little longer?” he asked. “I’m getting treatment for my mental illness here, and it makes me feel better.” Startled, she offered him another 30 days.
“What we really need to do is to move to a recovery model for mental health care,” Milton Mack said. For years, he has made a study of the situation, and consulted the nation’s top experts. “Some people, yes, are beyond recovery,” he said. This is also a problem, since Michigan now has fewer public psychiatric beds than all but five other states—and far too few for the need. The Washington-based Treatment Advocacy Center found a few years ago that Michigan had less than one bed available per 10,000 people; less than a fifth of the recommended number.
Outpatient resources aren’t much better.
Ten years ago, the Michigan legislature passed something called “Kevin’s Law,” named for a brilliant young graduate student murdered in a restroom by a paranoid schizophrenic who had stopped taking his medication. The law was supposed to make it easier for judges to order outpatient care to make sure people who needed medication are taking it. Milton Mack was originally enthusiastic about it. But, as a report by WXYZ-TV’s Ross Jones revealed last fall, the law has been a failure. Mentally ill patients’ guardians or family members need to file a petition with a court to trigger the law, but few do.
Kevin’s Law was passed with little funding, and the dollars for mental and community health programs have been repeatedly cut.
There is one relatively easy change that could have a powerful, positive impact: Give Probate judges the power to use Kevin’s Law to order outpatient treatment, whenever someone asks that a loved one—or their “ward”—be hospitalized for mental health reasons. But, that would require the Governor and Legislature to change the mental health code. This hasn’t happened.
Milton Mack looked out his window on the 12th floor of Detroit’s government complex. He is, incidentally, about as authentic an old Detroiter as they come: Two of his ancestors were in the canoes with Cadillac when the French explorer founded the city on July 24, 1701. From his office, he can see the site where they landed. “I’ve always been interested in systems; how they run, how to make them work better,” he said. He is proud that back in the 1980s, before he was on the bench, he helped get rid of Wayne County’s old and inefficient drain commissioner’s office.
Now 66, Mack has a resume’ full of recognitions for his probate work. But, improving Michigan’s broken mental health system would be a far greater achievement; one that would potentially save the state millions of dollars and return thousands of people to productive lives.
“There’s nothing partisan about this,” Judge Milton Mack said. Yet, bafflingly and tragically, common sense approaches to reforming a broken mental health system have proven hard to sell, no matter who is in power.
Jack Lessenberry, the longtime head of journalism at Wayne State University, can be heard on his podcast on YouTube via the Zing Media Network. He also is a winner of a National Emmy Award for a 1994 Frontline documentary on Dr. Jack Kevorkian, has served as The Toledo Blade’s writing coach and ombudsman and is now a columnist for and a consultant to both that newspaper and Block Communications, Inc. He is also the co-author of “The People’s Lawyer,” a biography of Frank Kelley, the nation’s longest-serving attorney general, and is working on a book on a pioneering newspaper family and race.