Views split on merging substance abuse mental health services

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LANSING — Some health specialists question a legislative proposal to merge public substance abuse and mental health services. They say the measure could reduce access to local services, especially in the rural areas of Northern Michigan, and could hurt urban communities, as well.

Rep. Earl Poleski, R-Jackson, the primary sponsor of the bills, said mergers would save administrative costs and improve services to individuals who have substance abuse and mental health problems.

“It is an important step to improve access to mental health care for folks with addiction, if they need them. Also, it will potentially improve health care services under a single entity and potentially save money that could be used for further treatment.”

Currently, substance abuse agencies treat patients with drug and alcohol addiction. Community mental health agencies treat those suffering from mental illnesses.

Judy Hazle, community outreach liaison for Community Mental Health Authority of Clinton-Eaton-Ingham counties, favors the bills.

“Substance abuse and mental health service go hand in hand. We could have better coordination of the two services as a one-stop shop,” she said.

However, some health experts argue that substance disorders are so distinct from other forms of mental health that they need their own type of treatment.

According to George Miller, director of Health and Human Services for Oakland County, substance abuse needs a distinctive protocol for treatment and must be recognized properly.

“Substance abuse is not a mental illness; rather, (it is) a chronic disease. Seventy-nine percent of our clients don’t have mental issues,” Miller said. “For 40 years, our health division has been successful in identifying the at-risk population. If this practice falls under mental health services, it can be drowned by other priorities.”

Substance abuse agencies in Oakland County keep data on emerging drug issues in the area. This information is useful for health providers, coalitions and schools to provide prevention messages and education, Miller said.

“There is a failure to recognize local systems of care that vary across the state, especially those in densely populated areas. Efficient systems that have developed over the decades and have incorporated best practices that fit the community will be fractured by this bill,” Miller said.

Michael Reagan, chief external relations officer for Cherry Street Health Services in Grand Rapids, said he supports the merger concept but is concerned that the proposals don’t clarify the funding mechanism and might not provide equal access for every patient.

He said the bills would give priority for patients with severe disorders, but many might not fall into that definition and might remain in the gap, where they can’t receive state aid and don’t have money for treatment.

Under Michigan’s health system, patients with both minor and severe disorders can receive treatment under Medicaid and state funding programs.

Mark Reinstein, president of the Mental Health Association in Michigan, said he agrees with the concept of the bill but isn’t sure if mergers would save money.

“There is no guarantee that these facilities will save money by merging two-in-one,” he said. “They will still need to keep those specialists and providers and conduct additional cross-over training.”

According to Sue Winter, director of Northern Michigan Substance Abuse Services, to maintain the proper level of access to treatment, a merger would require a 188 percent increase in administrative costs in her area.

Her agency, which is based in Gaylord, contracts with substance abuse service providers in 30 counties in Northern Michigan, including Alpena, Emmet and Cheboygan. It also works with four inpatient mental health facilities in the same region.

Terry Newton, executive director of Harbor Hall Drug and Alcohol Center in Petoskey, said he doesn’t see any administrative efficiency and worries a merger might eventually shut down some residential services.

“We have a fully functioning system that has worked during the last 20 years. When funding would be distributed among four mental health entities, then 30 counties, it cannot be equal in the long run and possibly will close some services,” he said.

“These bills are basically destroying our service provider network,” he added.

According to Newton, the center has already suffered state funding cuts over the past 17 years.

“With lack of funding, the appropriate level of care will be limited to people with minor disorders and can create long waiting lists,” he said.

Greg Toutant, executive director of Great Lakes Recovery Center in Marquette, noted that lack of adequate funding could also create a challenge for people seeking treatment in remote areas in the Upper Peninsula.

“We do not have public transportation in our areas. The coordination dollars are very important for us, as sometimes we provide limited funds or transport clients from St. Ignace to Sault Saint Marie or elsewhere,” Toutant said.

The center provides substance abuse services to 15 counties across the U.P.

In the last five years, eight centers around the state merged their substance abuse and mental health services.

Michael McCartan, executive director of the St. Clair County Community Mental Health Authority, said such a consolidation benefited public access to treatment, but administrative management remains an obstacle.

“We have managed to improve quality services and cross-trained our service providers in both substance abuse and mental health treatment. However, administrative obligations doubled and make it difficult for us to have any savings,” McCartan said.

The bills are pending in the House Health Policy Committee.

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