TRAVERSE CITY — Toni Stanfield and her son Karl used to call bipolar disorder an invisible monsoon that leaves families in terrifying and unsafe situations.
The disease is fatal, said Stanfield, something she knows firsthand after Karl’s suicide two years ago.
“It’s very sad because here I am a psychologist,” Stanfield said. “I work with people with mental illness and I could not help my son.”
Karl, who was 37 when he died, was diagnosed with bipolar disorder 15 years earlier and in that time had been hospitalized nine times and incarcerated five times, once for a full year. That made her hesitant to call 911 when he had a mental health crisis, knowing the cops would come, Karl would put up a fight and then would end up in jail for resisting arrest.
It’s a hesitancy she knows many families share.
Stanfield is co-founder of Before, During & After Incarceration, an organization that advocates for restorative programs, education and alternatives to incarceration. She cries when she thinks of how different things may have been if there had been a diversion center for people in crisis.
“I would have been much freer in calling 911 knowing that the cops would not have taken him to jail, but to the center,” Stanfield said.
The first steps have been taken to establish a community crisis center in the Grand Traverse region that would divert mentally ill people from hospitals and jails and get them the help they need.
Several grants are in the works that would fund the center, which may be a remodeled building or could be built from the ground up. The goal is to create a center close to Munson Medical Center where people in crisis could be assessed, treated and possibly admitted to one of six beds.
If longer-term care is needed, staff will work to find an available bed at a psychiatric hospital.
The charge is being led by Northern Lakes Community Mental Health, which has been criticized by some local mental health advocates for not seeking grant money that is available to offer more services, especially for those in crisis.
CMH will hear in August if it has been approved for a grant that would provide $5 million over two years — 2022 and 2023 — to establish a 24/7 community crisis center, said Joanie Blamer, CMH’s chief population officer.
The center would provide crisis intervention services, inpatient psychiatric screenings, 24-hour respite and observation and a residential unit where people can get intensive treatment for up to a week until they can go home or be transferred to a longer-term psychiatric unit or hospital.
The money is available through the Substance Abuse and Mental Health Services Administration (SAMHSA) Community Mental Health Centers grant program, which will distribute $3 billion in American Rescue Plan that is earmarked for behavioral health.
Another $1.8 million in Congressional funding has been requested for development of the crisis center. That grant notification is expected in September.
CMH also has pending approval for a Mental Health Block Grant for Adults from the Michigan Department of Health and Human Services. The grant is for $553,000 this year and $1.69 million next and can be used, among other things, to expand justice diversion programs and to staff the center.
There is also about $18 million in American Rescue Plan dollars that has been allocated for Grand Traverse County, with about another $1.55 million for Traverse City. Advocates plan to ask the municipalities for financial help to get the center up and running.
“It sounds like a good use of funds for society in general,” said county board Chairman Rob Hentschel, though the county is still waiting on guidelines for how the money can be spent. “Certainly there is a possibility, but I don’t want to get the horse before the cart.”
With a diversion program in place the county could spend less on jail corrections, he said.
Jail populations in Michigan tripled during the past last 40 years, with data showing that 23 percent of people in jail have a serious mental illness, according to a study by the Michigan Joint Task Force on Jail and Pretrial Incarceration. Numbers are even higher in rural areas — one in three, the study found.
Other studies suggest that up to 80 percent of people in jail have some history of mental illness and many also have have co-occurring substance use disorder. In addition, a Record-Eagle data collection effort that looked at 10 years of jail death records from Michigan’s 83 counties showed suicide is the leading cause of death in local jails.
A critical need
At a community crisis center a person who is in a mental health crisis could walk in and get services instead of going to the emergency room, Blamer said. They could also be brought to the center by law enforcement personnel.
“Our goal is to divert from the hospital and divert from the jail so police officers can bring them there if they feel they would be better served,” Blamer said.
Northern Lakes CMH serves six counties — Grand Traverse, Crawford, Leelanau, Missaukee, Roscommon and Wexford — and is the gatekeeper for about $63 million in behavioral health services that are primarily covered by Medicaid, according to information from the agency.
About 3,300 adults with serious mental illness and 927 children with serious emotional disturbance are treated across the six counties, according to the agency’s annual report. Each county pays for services, with Grand Traverse County paying about $683,000 and Leelanau County paying about $140,000 per year, the report shows.
About 60 percent of CMH services are provided through contracts with outside providers. If a crisis center is established, its services will not be contracted out, Blamer said.
Once a person arrives at the center, their symptoms will be assessed and they’ll be screened to see if they meet criteria for hospitalization, either for a longer-term stay at a psychiatric unit or hospital or in one of the six beds that would be established at the local center. The residential unit would be designed for an average stay of five to seven days, Blamer said.
A person could also be sent home after a few hours with a safety plan if their crisis has been resolved, she said. They could get follow-up care at the center, or individual or group therapy, which are services that would be covered by grant dollars, Blamer said.
“The idea is to help them overcome whatever is causing the crisis,” Blamer said.
Kathy Sanders, a member of the BDAI board who helped research and write the CMH grants, said the center is critical.
“Folks that are in crisis, their only option should not be going to jail or going to the emergency room,” Sanders said.
If a person is not physically ill or a danger to themselves or others, they cannot be held against their will. If released, many find find themselves on the streets or in jail, said Sanders.
“A jail is not a place to treat mental illness,” she said. “There are certainly better options where treatment can get them healthy again.”
Stanfield said jails are running psychiatric units without the proper staffing.
“Corrections officers are not the bad guys,” Stanfield said. “They are victims of the system as much as the family members.”
With only 32 adult psychiatric beds in the 17-county northern lower Region 7 — 17 at Munson Medical Center and 15 at Alpena General Hospital — there is an unmet need of 69 adult beds and 17 child and teen beds, according to the MDHHS.
In all, Michigan has fewer than 800 beds in its five state psychiatric hospitals, with another 2,550 licensed beds in community hospitals and private psychiatric facilities, according to the MDHHS.
Families in the region often find themselves having to drive a loved one to Grand Rapids and other areas during a crisis and sometimes in the middle of the night to be admitted to a hospital for care.
The need for mental health treatment is expected to be even more critical post-pandemic as the negative psychological impacts of a disaster can last for months or years and if untreated, can contribute to mental illness, according to SAMHSA.
A Household Pulse Survey done by the the Centers for Disease Control and the U.S. Census Bureau in 2020 shows that more than 30 percent of residents in Michigan reported symptoms of anxiety or depression during the seven days prior to being surveyed.
Those same statistics bear out across the country, according to the CDC.
Sanders solicited letters of support for the center that were submitted with the grant application. Letters were obtained from members of a Crisis Community Assistance Team made up of more than 40 advocates for the center, including representatives from Traverse City Police, the Grand Traverse Sheriff’s Office, jail and prosecutor’s office, the local chapter of National Alliance on Mental Health, Munson Healthcare, Addiction Treatment Services and Goodwill.
“The most successful models have that crisis intervention team in place,” Sanders said.
Blamer said several of those advocates have also been invited to form a community advisory group for the development and implementation of the crisis center.
Finding common ground
In its search for programs that work, Northern Lakes reached out to the Common Ground Resource & Crisis Center in Oakland County, a program that will likely be used as a model for the Traverse City center.
The Oakland center is housed in a former senior living facility purchased by the county and repurposed as the crisis center, said Jeff Kapuscinski, chief external relations officer for the agency.
Kapuscinski has some advice for Traverse City — take the anticipated bed needs and triple that number.
Common Ground offers eight adult and two children’s beds in a stabilization unit that is open 24/7 for those in psychiatric crisis or trauma, as well as a 16-bed crisis residential unit. For a county of 1.2 million people, that number is not nearly enough, he said.
“We are about one-quarter to one-third of the size we need to be,” he said.
Kapuscinski said the center was opened about 10 years before a 2019 Crisis Now study led by the National Association of State Mental Health Program Directors estimated that 200 people per 100,000 population per month will need behavioral health treatment, he said.
The building is leased to the Oakland Community Health Network — the mental health authority in the county — which in turn leases about 80 percent of the space to Common Ground.
When a person comes to Common Ground they meet with a crisis assessment triage team that determines the most appropriate and least restrictive level of care for them, Kapuscinski said.
People can stay up to 24 hours in the stabilization unit, though they are sometimes kept for up to two days because of the lack of psychiatric beds, Kapuscinski said. Those admitted to the residential unit can stay up to two weeks, with the average stay being seven days, he said.
The program diverts about 75 percent of those needing mental health treatment away from emergency departments, Kapuscinski said. With law enforcement offers having the discretion to take someone in crisis to the center, a significant number of people are also diverted from jail, he said.
Also in the works is a behavioral health urgent care for people in less acute condition that is meant to free up space at Common Ground and to ease pressure on local emergency departments, Kapuscinski said. A virtual urgent care will open in the fall, with a physical location expected to open six to nine months later, he said.
Blamer said the six beds planned for the local crisis center would be a good start that could be expanded in the future if it is shown the beds are used all the time.
But area advocates say that number falls short of what is needed in the region and none of the beds would be designated for children. Blamer agrees and said other crisis services offered at the center would be for all ages, but inpatient beds for adults and children cannot be combined on the same unit.
North County Community Mental Health and McLaren Medical Center in Cheboygan are considering opening a children’s unit, Blamer said. If that plan does not come to fruition, Northern Lakes may look at adding beds for children.