I am reporter Julie Mack and I am here to discuss Michigan’s mental health crisis and the glaring issues in the state’s mental health system. Natasha Robinson, a mother personally affected by this crisis, is here with me. AMA!

Hi, Julie. First of all, I want to say I appreciate what you're doing here. Visibility is so important for "invisible diseases" like mental disorders.

I don't live in Michigan, but what advice would you give for someone who wants to get help, but can't afford to, even with insurance coverage. I'm currently unemployed, but have benefits through my spouse. I'm unemployed because of health issues, including mental, and now we can't afford for me to get help. How do I break the cycle?

Thanks for reading this, and for helping people you've never met. You're a life saver.

This is Natasha. I started with reaching out to our local Community Mental Health (CMH) organization. In most states, you can call 2-1-1 and they can give you information about your local CMH. Your local CMH should be funded to accept you regardless of your income level. You're already breaking the cycle by having a desire to get help! Additionally, if you're near a health system that also has outpatient psychologists or psychiatrists and you're low income, they may have foundation funds or a patient assistance program that will help cover co-pays. Don't stop trying!

I live in Michigan and was turned away from CMH because I didn’t have Medicaid. I turned to a different place they recommended and that place refused to see me because they couldn’t help with manic depression (bipolar 2 to be specific) they diagnosed me with. I’m almost 30 and I’ve never been medicated for any mental health issues, but I know I should be.

I have a baby and would like to be regulated by the time she gets older. Should I try CMH again even though I have blue cross or just go to the local walk in and ask for meds?

This is Natasha. There should be a phone number on your Blue Cross card for customer service. If you call them, you should be able to speak with a representative who can tell you which psychiatrists are covered under your plan and what your specific benefits are. I hope that helps! I'm proud of you for wanting to get treatment so you can stay regulated.

Natasha: Do you know if most states have a CMH system? Or is that unique to Michigan?

Each state receives federal funds to have a CMH program. They may have different names, but the types of services provided should be the same on a basic level. Visit https://findtreatment.samhsa.gov/ for a Mental Health Treatment facility near you.

Thanks for your comment and your question. I would reach out to the National Alliance on Mental Illness to find out what resources are available in your state. There are programs and support groups available for people in your situation, so I would highly recommend reaching out to others.

And Natasha, do you have any ideas for this person?

Why are outcomes for treatments of mental illness like depression so poor?

Appreciated x

This is Julie. My editor and I were talking about this just yesterday! There's still a LOT we don't know about how the brain works and how to effectively address mental-health issues.

Thank you for your work and responses in this thread.

I’ve had anxiety and depression since I was a child (diagnosed at 9 and 14 respectively).

I am fortunate that even with my mental health issues I was able to make it through college and get a job in my field (all while unmedicated) and now am able to see a psychiatrist regularly through my insurance (which took about 7 months to finally get the first visit).

Even with the financial aspect being covered and the long waiting time to get a foot in the door, trying to find the right balance of medications is literally a guinea pig test, trying out nearly random medications until you find what suits you over a long period of time.

The brain is super complex and we are still quite early in understanding how to manipulate the brain for things as complex as mental health.

A fun little tidbit: I’m diagnosed with depression but I’ve found an anti-psychotic class drug to be the most effective!

This is Julie. Your story reminds me of Elle Sovereign, one of the people I profiled. Here's a link to her story: https://www.mlive.com/news/2019/09/to-hell-and-back-one-womans-journey-to-recovery-from-serious-mental-illness.html

Hi Julie, last year, only 84% of US fourth-year medical students were able to match into a Psychiatry residency program (compared to approx 95% of students wanting to pursue Neurology). That means, 16% of qualified US students who wanted to pursue Psychiatry could not because there were not enough training spots. This shortage is largely to blame on the fact that Congress has not significantly increased the number of residency positions (even though more medical schools have sprung up, and more students are applying).

What are you thoughts on this as being part of the issue? How can we encourage congress to increase the budget and open more residency spots to meet the demand?

This is Julie. I don't know any good solutions, but top on my reporting to-do list is to look harder at the shortage of psychiatrists and how to address it.

Thanks for looking into this. It is a nationwide problem, and the bottleneck is not people wanting to become Psychiatrists. The bottleneck is that the federal government needs to open more training spots. Thanks for all the research you are doing.

This is Julie. If anybody reading this has insights to offer on the psychiatric shortage, either as a provider or a patient, my email is [email protected].

Is there something specific to Michigan's systems that make the mental health crisis more pronounced there, or is this really a nationwide problem?

Hi! This is julie. Thanks for the question! This is a nationwide issue, although it plays out a little differently in each state. We focused on mental-health issues in Michigan because MLive is a Michigan-based media group that focuses on state and local issues.

Michigan used to have a very robust mental healthcare system, even if it was (in hindsight, seemingly) a pretty terrible place to be.

But, then the Republicans happened.

Specifically:

In Michigan, governor John Engler closed almost all state mental health institutions in his quest to cut fiscal spending and to balance the budget.

So, where did all the patients go when they abruptly shut down all their hospitals?

... the mentally ill comprise 23 percent of Michigan's 41,000 prisoners. And about 64 percent of county jail inmates in Michigan have a mental illness.

This is Julie. Most went into the community. And yes, more than one person has noted that Michigan's correctional system is now essentially the state's largest in-patient mental-health provider.

As someone who moved from Pennsylvania to Michigan two years ago, I was appalled at the lack of psychiatric care--especially those who would take my (Medicaid) insurance. I'm lucky enough to live near Ann Arbor, but even here it's a struggle.

How would you urge psychiatrists to take more insurances, especially Medicaid? And how would you draw more psychiatrists to Michigan specifically?

This is Julie. Not sure about the insurance issue. But in terms of luring more psychiatrists to Michigan, one idea being floated is a loan-forgiveness program to offset medical-school debt. Pay is another issue -- psychiatry takes lots of training and the reimbursement rates aren't great, so improving that would help. A third idea I've heard is working with medical school programs in the state to encourage more medical students to go into psychiatry.

Can you comment on LARA's attempt to limit the scope of practice of LPC's and the legislature's attempt to pass legislation to stop them?

This is Julie. It certainly seems troubling the state may be pulling 10,000 counselors out of business at a time when there is a big shortage of mental-health providers. That said, I get that LARA feels a need to enforce what they feel is the law. I was at a legislative hearing yesterday, and got the strong impression that lawmakers are working hard to fix the issue. Here's a link to a story I've written about the situation. https://www.mlive.com/news/2019/09/new-rule-could-leave-tens-of-thousands-in-michigan-without-their-mental-health-counselor.html

This is Natasha. It's terrible. My personal therapist is an LPC and I value the service provided, the connection offered and the fact that I don't have to wait months to be seen. If my LPC and others aren't able to provide the level of services they are now, it will be a disaster and I'm guessing folks will probably want to leave the state in favor of jobs that allow them to continue to provide therapy!

Are those on Medicaid less likely to get help? It seems to me that they might have a higher percentage of folks who need mental health assistance.

It's certainly true that people on Medicaid are more likely to need mental-health assistance -- which makes sense, since mental-health issues can impact your ability to work and thus you're more likely to be low-income. In terms of less likely to get help, I think it can work both ways. On one hand, CMH has a lot of resources for families such as Natasha who rely on Medicaid. On the other hand, private insurance might provide quicker access to some providers. Thoughts, Natasha?

This is Natasha. I wouldn't say that those on Medicaid are less likely to get help. It may be harder for those on Medicaid to access services due to barriers (transportation, health literacy concerns, mistrust of healthcare providers, disabilities, unsure of what's available etc.). I will say that when I had private insurance when Isaiah was a toddler and I worked full-time, it was harder and took longer to see a mental health provider. Some of that was because of his age. There were also restrictions on the number of times he could have XYZ service even if the need was still there. He has Medicaid now and we're able to access services through CMH pretty well and not be super worried about a 20-visit maximum or really high co-pays.

Hello Julie! How do you feel about democratic Governor Gretchen Whitmer putting her whole campaign being pro health services, yet turning around and cutting $210,000,000 to health services, including mental health? Do you feel like she has really turned her back on the people who need her most?

Source: https://www.scribd.com/document/428294053/2020-statewide-veto-list#fullscreen&from_embed

I haven't looked closely at Whitmer's budget decisions or her rationale behind it, so I can't offer much.

One major reason for people in acute crisis not to seek help is that they're afraid of being locked up (committed involuntarily). How does this possibility jive with the inaccessibility of inpatient care to those who want it?

This is Julie. Both can be true, right? There are some people who don't want in-patient treatment, even when those around them feel it's necessary, and those who want in-patient treatment and can't get it.

Do you think that there's a clear way forward to reverse the growing trend of mental health episodes in Michigan? Is there a lack of funding, a lack of focus, or a lack of prioritization from the legislature/DHHS?

This is Julie. Certainly, the lack of funding and priorization are issues. We're hoping this series puts more attention on this issue.

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This is Julie. Family dysfunction can certainly contribute to mental-health issues, but it's incorrect to chalk this off to solely a matter of "broken" families. One of my profiles was on Elle Sovereign, an Oakland County woman who has had severe mental illness and came from a loving two-parent family. Here's a link to her story: https://www.mlive.com/news/2019/09/to-hell-and-back-one-womans-journey-to-recovery-from-serious-mental-illness.html And depression and anxiety run in both my husband's family and in mine, which shows that stable, two-parent families are not immune from mental-health issues.

This is Natasha. Just curious - what is your definition of a stable family?

Hi - how exactly is that bipartisan funding intended to be used to help people in crisis situations?

From my experience, and from others I’ve known, in-patient facilities are a useless, dehumanizing experience that’s only good for racking up medical debt. That isn’t to say that there aren’t people who need it, but the treatment received on facilities is to take away any autonomy you have and leave you to rot in some crappy rec room.

This is Julie. In talking to lawmakers and MDHHS folks, there most definitely is a push to expand the range of services so that people don't have to use in-patient services. Those expanded services would include things such as behavioral health urgent care, mobile crisis teams and more intensive day programs.

/u/mlivesocial

How can I get a hold of MLive's Political investigative journalism?

After:

• Ethics committee reviewing complaints about Tlaib, Huizenga campaign spending
• House ethics panel reviews complaint over GOP Rep. Bill Huizenga's campaign spending
• House Ethics Committee Reviews Claims Against Rep. Rashida Tlaib and 2 Republicans

I started digging into the personal expenses of all michigan representatives, Bill Huizenga is a statistical outlier: https://www.reddit.com/r/Michigan/comments/dcndf5/michigan_representative_campaign_disbursements_to/

His ethics probe parallels the 2015 case of Aaron Shock who also had "lavish but legal" hotel expenses. His wife has earned a considerable amount of money from his campaign. Only 2 spouses have expenses, despite other members having minor children and spouses.

You can contact our Lansing office at [email protected].

This is a question for Natasha. How is your son doing? In the series, he was just starting to finally get some of the help you had been seeking for months. Is it helping? Also, how have people responded to learning about your story?

This is Natasha. He's doing alright. We are weaning off meds and I'm happy with the progress made so far. It's hard for him to be away, but he's trying to enjoy the activities, schooling, and friends he's made there. He is starting to engage better with his therapist there. I'm hopeful we'll have positive momentum that will transfer to home life.

People have been incredibly kind and sensitive for the most part. Many have been giving, which has been so helpful because the financial hardship is REAL! Other parents are reaching out saying they thought they were the only ones with this type of problem and now they don't feel alone. It's really heartwarming to know that people all over the world are praying for my family. I'm glad that people saw my heart and that I'd do anything to help my son be happy. I am making new mom friends. I've also gotten lots of information about other possible diagnoses to look into/rule out. It's a blessing.

Glad to hear he's making progress and that you have received a lot of positive feedback. You are courageous for sharing your very personal story -- which I think is a situation more common than people realize because of the stigma surrounding mental illness, especially with children. Hope things keep going in the right direction and that you get an opportunity to yourself to take a breath, relax and recharge.

Thank you! I appreciate the feedback.

Why wean him off medications if they’re working?

This is Natasha. The meds really weren't working well how they were.

Can you give me any advice?? As a veteran I've been to the VA for the past 5 years on and off. In and out of psych wards. I've been on about 20 to 25 different medications. Two different suicide attempts. I've tried to seek care through civilian Healthcare and they keep telling me I'm better off going back to the VA. After one suicide attempt I begged to not get sent to the VA and that's where the civilian hospital forced me to go. I was cooperative as well but they said the cops would have to come in if I kept refusing to go the VA. I was requesting a civilian psych ward in Marquette as well. I was trying for help just not the VA. Now I quit my medication in April slowly tapered off and now my mental health problems mainly extreme panic attacks and anxiety are coming back. I'm so sick of being stuck in that circle at the VA I'm scared to go back.. Do I have options better than the VA at my disposal?? I'm located in the Upper Peninsula.

This is Julie. Wow. I'm so sorry to hear your story. Feel free to email me at [[email protected]](mailto:[email protected]) if you would be willing to be interviewed for a future story. Off the top of my head, I would contact your CMH and/or the Michigan Alliance for Mental Illness to see if there are other options.

Is there anything primary care doctors can do to fill the gaps? I don’t feel like there is nearly as much emphasis on mental health during primary care visits in MI as opposed to when I lived in CO, but that may be simply anecdotal.

This is Julie. One reform urged by policymakers is making sure that primary-care doctors have more training on mental-health issues and medications, particularly doctors in rural areas where mental-health providers are more scarce.

This is Natasha. I think it's important for PCPs to just be really aware of local resources for support if they're not comfortable diagnosing or prescribing medications. It's important to check in for compliance if meds or therapy are recommended.

This is probably not going to be something you can really answer because it requires a lot of personal internal reflection. I dont know if you have or have not done that.

But why do you feel assisted suicide is so looked down upon.

Why do we not give those who feel they no longer wish to live a safe option to speak with a medical professional about that?

Right now if I were to tell a doctor that I run the risk of a 72 hold.

This is Julie. My husband lost his father to suicide in 1968 and his brother in 1974, so suicide is a deeply felt issue in our household. And I agree there is lots of stigma about it. I hadn't thought about the 72-hour-hold issue, but it's a good point. I absolutely agree there should be "safe" resources for people with suicidal thoughts.

If it came across that I was saying suicide was not personal or you had not reflected on that I apologize

I was only meaning reflect on assisted suicide. Not the overall issue of mental health.

On assisted suicide: I think that's a MUCH different issue than suicides related to mental health.

This is Natasha. Personally, I think it's looked down on because suicide is so permanent. You can't undo it. Our society exists under the premise that everyone wants to live a long life and that anything other than that is abnormal. All that said, please let us know if you need some resources for support. You may already know this, but the national suicide hotline is 1-800-273-8255.

What I would really like is the option to speak off line in length about this.

I believe I have a mind that processes things differently and I also have a very personal stake in this.

This is Natasha. Feel free to email me.

Do you think that the reopening of asylums are a valid way to address the mental health crisis?

This is Julie. As I said below, because state psychiatric hospitals don't qualify for Medicaid, there is no appetite for reopening or expanding those facilities. The focus has been on expanding beds in the private sector, which do qualify for Medicaid as well as private insurance.

So amidst this mental health crisis, why do you think Michigan is trying to take away the ability of Licensed Professional Counselors from doing their jobs with the LARA rule change. Seems pretty amazing to me that the legislators are not doing more to prevent the rule changes before the new house bill goes into effect. This has the potential of stranding 300,000 patients by tomorrow. Any new info you can add to the state of the rule change, or the new bill to permanently set LPCs as legal mental health providers as they are in every other state to circumvent the rule change?

There is a LARA hearing tomorrow, but the earliest the rule change would go into effect is November. It appears state lawmakers are scrambling to pass a rule before than to head off the rule change.

Hopefully I'm not too late.

Do you think that many of today's major crimes could have been prevented with better and more accessible mental health care? It seems like a common trend among major issues today (ie mass shootings) is mental health. Whether it be the person never got treatment or it was just ineffective.

I do live in michigan so it's great to see this post. Thank you for doing it

Most people with mental-health issues are NOT dangerous. In fact, they are more likely to be crime victims vs. perps.

That said, the percentage of people in the Michigan correction system with mental-health issues is shocking. So yes, untreated mental illness can most definitely result in anti-social, problematic behavior.

This is Natasha. I think so in a sense. When I look at my son's behavior, I'm always thinking - yeah, in 10 years, he'd be serving time for this. That's why it feels so important and so urgent for him to have intervention now. He's young enough to have effective behavioral, lifestyle and medical interventions that will help him become a more well-rounded adult who understands his triggers and has the necessary coping skills to manage when things don't go as he expects.

Has Michigan thought of modeling it's system after another state that's more successful? I'm sure no state is perfect, but I'd assume there are at least a few that are doing a good job. I used to work in Virginia, and in the Hampton Roads area we could almost always find a bed for someone while getting them evaluated during our 3 hour window.

This is Julie. I know that state lawmakers such as Mary Whiteford, the state rep from South Haven, and the new state director of mental health services are looking at other states to think about what Michigan could be doing.

Hi Julie. Thanks for doing this AMA... Has any research been done as to the effect of the drinking water crisis, lead exposure and the mental health trends that you're all seeing?

I haven't looked at that angle specifically, but I did see a headline recently that indicated Flint schools is seeing an uptick in special education enrollment. Here's a link: https://www.edweek.org/ew/articles/2019/08/28/special-ed-concerns-loom-large-after-flint.html

Native Michigander here. I suffer from autism, depression, OCPD, anxiety, PTSD, and dysgraphia. However, I spent most of my childhood in Northern Ireland, which isn't exactly stellar when it comes to mental health either. Despite my own issues, I find myself to be fairly well adjusted.

However, I have major concerns about two of my siblings. See, two years ago, our oldest sister committed suicide, and this event has deeply affected my family. In fact, I'd say it eventually caused my mom and dad to split, though there were other issues. Anyway, one of my sisters still hasn't fully coped with her death, but the way she handles it sometimes amounts to 'I'm throwing a temper tantrum because I miss my sister,' even though she's almost twenty. I strongly suspect that she has unaddressed mental health issues, as this isn't anything new.

I'm also strongly concerned about my younger brother, who didn't take my parents splitting up very well or that my mother moved to Michigan and took us kids with her. However, his behavior has gone from mildly acceptable to outright abusive towards everyone around him, especially my mother and sister. He's also been abusive to me, at one point showing me his gentiles when I called him out for his actions. I worry he may have inherited my father's narcissism, but can't be sure.

As the oldest living child of twelve children following my sister's death, I feel a tremendous amount of responsibility to care for my siblings, but I am at my wits end with these two. What should I do?

This is Julie. I would strongly encourage your family members to talk to the primary doctor about undiagnosed depression or anxiety. There is a strong genetic component to mental-health issues. I would stress to your siblings that mental-health issues are chronic health problems that need to be taken as seriously as diabetes or asthma or heart disease, and there's no need for unnecessarily suffer when medication and psychotherapy could make a huge difference in their quality of life. I've got multiple family members who can testify to that.

What can I as a Californian do to help?

This is Julie. Mental health is a nationwide issue, I think we can all work de-stigmatizing mental illness. That includes compassion about health issues such as depression, anxiety and bipolar syndrome. These are health issues, not character flaws.

Absolutely. I’m on the Autism spectrum and deal with depression, anxiety and attention deficit. Therapy and medications make a world of difference, I recommend them for anyone struggling with mental health.

This is Natasha. Thank you for being here. My thoughts are this: Be an advocate as much as possible. Share information with families like mine so that we can raise children who become adults that can still function in society and enjoy life.

Hi Julie, do you have an opinion on the role of economic insecurity and its effect on mental health? How has automation displacing work effected the many in places like Michigan that have been forced to seek other paths.

This is Julie. It's not the only factor, but it's certainly a factor. It's not a coincidence that mental-health issues are more prevalent in communities under economic stress, and suicide rates tend to be higher in those communities, too. (Interestingly, on how it's not the only factor: While African-Americans are three times more likely to live in poverty than whites, blacks are less likely to commit suicide and slightly less likely to be diagnosed with a mental illness.)

Are you aware of the moves made by LARA to limit the scope of practice of licensed professional counselors?

I am an LPC who will be affected by the rule changes should they choose to push their SOC changes into place. There is a bill currently going though the house (HB 4325) which rectifies the issues LARA has with our license. However, for some reason LARA wants to push its rule changes prior to the bill even being voted on. There is a hearing tomorrow in Lansing regarding the issue.

This is Julie. Yes, we're following that story and I'll be at the hearing tomorrow.

I live in Wisconsin and I haven't been able to find a psychiatrist for 8 years. 🤷‍♀️ have you heard of obtaining a psychiatrist through teladoc? I've been thinking about going that route as psychologists cannot prescribe meds.

This is Julie. Teladoc is definitely gaining in popularity in rural areas.

Hello, Julie The state of Michigan has several mental health courts correct? Governor Whitmer for the month of October has declared it Youth Justice Awareness Month. https://www.michigan.gov/whitmer/0,9309,7-387-90499_90639-508320--,00.html

A years ago (2005) Kevin's Law signed into law: Wasn't that supposed to make it easier to seek mental health treatment?

The "at risk youth" got a raw deal by inaction in the Mich budget according to reports by WashPost and Mlive. The per pupil school funding while increasing at most schools would get on average 3 percent more....

https://www.washingtonpost.com/national/michigan-governor-signs-budget-with-1b-in-line-item-vetoes/2019/09/30/7900ccae-e3d7-11e9-b0a6-3d03721b85ef_story.html

https://www.wxyz.com/news/local-news/investigations/the-fix-that-failed-how-kevins-law-never-delivered-on-its-promise-to-help-the-mentally-ill

https://mjieducation.mi.gov/documents/online-learning-videos/969-2019-kevin-s-law-training-materials

https://www.bridgemi.com/children-families/revision-kevins-law-means-quicker-treatment-mentally-ill

https://www.bridgemi.com/michigan-government/what-gov-gretchen-whitmers-budget-cuts-and-shifts-mean-michigan-residents

https://www.bridgemi.com/michigan-health-watch/budget-fight-looms-over-changes-medicaid-mental-health-michigan

https://www.mlive.com/news/2019/09/michigan-budget-bill-draws-fire-for-provision-to-increase-privatization-of-mental-health-services.html

https://www.mlive.com/news/g66l-2019/10/d5ef49863f6980/11-winners-and-losers-in-whitmers-budget-vetoes.html

https://www.wilx.com/content/news/Governor-Whitmer-signs-budgets-issues-with-line-item-vetoes--561816801.html

https://www.grbj.com/articles/94400-gov-whitmer-signs-budget-with-1b-in-line-item-vetoes

When I went through the aforementied articles from Bridge Michigan Mag and Mlive(your employer Julie) I personally feel that the signed Michigan state budget that Gov. Whitmer approved comes up short Agree or disagree?

Edit: Welp my formatting is messed up Oh well..

This is Julie. I haven't looked at the final state budget at all, and I'd have to look at all this more closely to offer an opinion.

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This is Julie. There is research that suggests one factor in the increase in mental-health diagnoses is related to modern lifestyles. People are more likely to live alone and be socially isolated, which can contribute to depression and anxiety.

This is Natasha. It's certainly all related. This TEDTalk is really interesting: https://www.ted.com/talks/susan_pinker_the_secret_to_living_longer_may_be_your_social_life/

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you're welcome!

Hi, Julie and Natasha!

My question isn’t that deep but, how has your day been? :)

This is Natasha. Mine started with a migraine, but it's getting better! :-) Thank you for asking.

This is Julie. Great so far!

What impacts have you seen on Emergency medicine? Is how does Michigan compare to other states as far as in-patient and out-patient beds?

I work in an ER in SW Michigan that routinely holds patients from anywhere 10 to 72 hours seeking placement for psych. If it is pediatric psych or geriatric psych the struggle to find beds is even tougher, often times requiring EMS transport across state lines.

This is Julie. Good question. I don't know how Michigan compares on in-patient psych beds. (I do know the state ranks roughly in the middle in regards to rate of mental illness and overall access to care.)

How does the work requirement for the Medicaid expansion affect people getting care for mental illness, seeing this doesn't seem like an exception to the requirement?

This is Julie. The work requirement is exempted for people with a disability, including mental illness. But I'm unclear on what standard will be used to determine whether someone is "disabled."

This is Natasha. It's possible for a person getting care for mental illness to be exempted as medically frail (https://www.michigan.gov/healthymiplan/0,5668,7-326-90904_90941---,00.html). The recipient should have received a letter from the state with information about next steps in fulfilling work requirements.

What alternative options exist for placement of people suffering from mental illness who do not have health insurance outside of jail? What does the state of Michigan do? I live in the southeastern United States but this is a huge contributor to the overcrowding of our city jails.

Michigan does offer Healthy Michigan, which is a Medicaid program for people without insurance whose income is 133% of the poverty level. Obamacare also offers heavily subsidized insurance for people under 250% of the poverty level and some subsidies for those 400% of the poverty level.

what do you think would be the most appropriate course of action? what do you think needs to be done or reformed to amend this problematic?

This is Julie. In talking to lots and lots of people about this issue, it's clear that we need to increase funding for mental health -- that would help address the shortage of various services and increasing reimbursement rates would increase the number of providers. That said, addressing the stigma is also is a huge issue -- and that's not about money but rather changing attitudes. Yet another course of action is talking a proactive approach to mental health, such as making sure that people have social networks, because we know those connections can help, and making sure that individuals can address depression and anxiety before they blow up into a big issue.

What do you think of House Bill 4325?

This is Julie. I think it would maintain the current status quo for LPCs, which most people would see as a good thing. I'm still trying to understand the specific concerns of the Michigan Psychological Asssociation, in regards to what training they think LPCs should have compared to what LPCs actually get now.

What's your favorite pokemon?

This is Natasha. Psyduck :-)

Is there a point in a person’s psychiatric evaluation where it’s determined that there’s no explanation for their behavior other than that they’re a selfish jerk?

This is Julie. I'm not sure selfish jerks are self-aware enough to be seeking a psychiatric evaluation. Just sayin'.

What would you say were the golden years of mental health treatment?

Is there some period of time when a much higher level of care was available and somehow the government didn’t go broke, thereby showing that funding said care was affordable and possibly prevented further economic loss (lost working hours, suicide of a parent, etc)?

This is Julie. Honestly, for all the issues in accessing care these days, that's nothing new. We're understanding a lot more each year about brain health, and what works and what doesn't in regards to mental health.

Is the word “retarded” actually offensive even if used to describe someone acting like an idiot or describing something dumb? Or is it just normal people virtue signaling?

This is Julie. I would not use the word "retarded" in any circumstance.

Im sure there is a crisis there and its horrid but I think the same can be said for the country as a whole. Would you agree?

Yes

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If you had diabetes or asthma, would you really try to address it without medical intervention? I'm guessing not. Depression is often a brain chemistry issue; it's as much of a physical-health problem as heart disease. This is a chronic health problem that needs immediate attention. Please, please, reach out to your primary-care doctor ASAP.

This is Julie. I'm going back to my other work now, but feel free to post additional questions and I'll check back later to answer this. Thanks to everyone who participated!

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This is Julie. One thing that is working for Michigan is the Healthy Michigan program, which is part of the Medicaid expansion under Obamacare. Certainly, making sure people have insurance is a first step.

Honestly, one of the best ways to advocate for better mental-health services is encouraging people to share their stories -- with friends, family, on Facebook, etc. It's best way to change attitudes and show the extent of the issues, IMO.

How did you lose your finger?

I have all my fingers. But I do have an owie, the unfortunate result of misusing a corkscrew.

Have you heard of the new wellness app called KeepAppy? You should check it out, I enjoy it!

This is Julie. I have an adult daughter who used a counseling app and was very happy with the quality of services.

Thanks for covering this. I know several people (across multiple states) with what most would consider extremely serious mental illnesses. What is unique about Michigan’s mental health crisis, or is it fairly spread across the country? Seeing the lack of psychiatric beds (and how long it takes for patients to get in one) is wild....has there been talk of reopening/renovating any of the many hospitals which were shut down in the last decades?

This is Julie. Because state psychiatric hospitals don't qualify for Medicaid, there is no appetite for reopening or expanding those facilities. The focus has been on expanding beds in the private sector, which do qualify for Medicaid as well as private insurance.

I'm more than likely late for this but I live in Michigan and have a story which will lead to my question. Back in 2016 I went through a extremely bad patch, long story short my whole life; job, relationship housing just everything went BOOM. I was starting a new job one that I was excited for but I knew that I needed help I called multiple services and they all asked the same thing more or less if I was going to harm myself, I had no inclination to hurt myself but I needed help sooner rather than later. It felt that the only options were to either commit myself which I felt would have made things worse ie. losing new job and what little pieces of my life I was putting back together or waiting weeks to get a refferal. Neither I felt I could do.

Now for my question, What are some options that someone like me from a rural county to get help without having to do something drastic and lose my freedoms and possibly have that mark on my record but still get some form of help privately and without having to upend whatever steps I've been taking to try and move forward?

I honestly don't mean this to sound jaded or mean spirited but the first week after everything went kablooey the only thing I could do was talk to friends and most of them didn't have any experience of what I was going through and I could have really used the help of council or a psychologist. I am glad that you are bringing this issue to the forefront though!

This is Julie. According to Natasha, calling 211 is a place to start. I'd also contact the Michigan Alliance for Mental Illness or the local CMH to find out what resources might be available. Yet another idea: Look to see if there are nonprofit counseling agencies in your region who might offer help to people in need. And a final thought: If you have a primary-care provider, get in touch with that person and ask for a referral. Lots of medical practices have resources and contacts to people struggling with depression, anxiety or situational mental-health crisis.

What do we get back as a nation for all the money spent on mental health care? How much of it is just bad parenting, letting school, church, tv, and internet raise your kids? Or just liberal ideals that everything is okay, instead of just a swift smack on the ass? And who's to say if you save these turds, they might live semi successful lives, and go one to fuck up other people's lives. Isn't that just selfish?

This is Julie. Do you think it's "selfish" to spend money on diabetes? Heart disease? Cancer? Mental illness is a health issue every bit as much as other chronic illnesses. It's not a character flaw. It's something separate and distinct from bad parenting. If we want healthy, productive citizens, mental health has to be part of the equation.

I plan on moving to Michigan soon, and I want to attend college to become a psychiatrist, do you think I could do much good up there? I know how important mental health is, and I want to be able to give people the help I never received

This is Julie. There is a nationwide shortage of psychiatrists, so you could pretty much go anywhere. Good luck!

If you had a way to take in say, approx 8k per Michigan resident, or around 928million a year and put that towards mental health help in your state, would you take that money?

Also, how do doctors determine who needs legit mental health help vs. the people who use it as an excuse for their failures or ways to get attention?

This is Julie. I don't even know how to answer the first question. Where is the money coming from? Where is going to?

And I'm perplexed by the second part of the question: "Legit mental health help vs. people who use is as an excuse for their failures or ways to get attentions." I think most of us can benefit professional counseling at some point in our lives -- I know I have. Just as it's legit to see a doctor when you feel physically sick, it's legit to seek professional help when life feels overwhelming or when you're trying to work through a difficult family or relationship issue.

And here's another way to consider it: If, from your standpoint, someone is so desperate for attention that they're willing to jump through the hoops necessary to see a counselor, doesn't that itself suggest a mental-health issue? And if someone is experiencing repeated failures, it seems a professional counselor might be useful in figuring out how someone can avoid repeating past mistakes.

And here's another way to consider it

I... hadn't thought of that. That is so damn simple and yet makes sense...on the surface. So yes, I agree, those people looking for repeated attention may need some sort of help anyhow. I was more talking about the people who pretend to need a service dog (the Amazon-bought dog vest for "therapy"), the people who immediately blame everyone else on their issues "i'm out of shape because my sister said.." etc. The people who are making excuses, those people who show up looking for meds or excuses for their failures. Not the people looking for help, the people looking for ammo for excuses.

When you find these "jump through the hoops" people, does anyone get tough on them and tell them to stop making excuses if they obviously are?

In my first part, it's money going to people who are illegally in the US.

For most people, it's difficult and expensive to get mental-health services. It's usually a mix of medication (which has some unpleasant side effects) and psychotherapy. If someone feels they need it, then they probably need it, IMO. Moreover, one focus of therapy is get past "excuses" and figure out how to improve and move on.

Why are there so many new mental illnesses.

Or... Why do so many people suddenly have mental illnesses now? I don't remember it being this much of a thing through the 90s and 2000s. Now it seems like it's a fashion statement.

I think a lot more people are coming forward to be diagnosed. I'm 60, and I can remember a time when there was a HUGE stigma around even acknowledging a mental-health issue and people just drank themselves to death.

what do you think are the causes of so many nut jobs and crack heads in michigan?

This is Julie. Speaking of stigma .... That said, I don't think Michigan has a disproportionate share of people with mental-health issues.

What makes Michigan’s mental health crisis more important than any other?

This is Julie. I don't know that it is THE most important issue out there for everyone, but there are many families where this has enormous impact. Natasha can certainly speak to that.

This is Julie. And I should note that I do have some personal experience with this. One of my sisters has a 19-year-old daughter with severe epilepsy and cognitive delays as well as mental health issues. The daughter has had to have pyschiatric hospitalization twice, and it's been a scary experience. Last fall, I spent several days in a metro Detroit emergency room with my sister as we waited for in-patient placement for Grace.

This is Natasha. It's not that Michigan's crisis is more important than any other, but to my family, it's direr and personal because this is where we live and would like to continue to live. Our story is a Michigan story but the problem is prevalent nationwide.