Michigan Psychiatric Care Improvement Project
Over the last several decades, individuals with serious mental illness and children and youth with serious emotional disturbances have increasingly been transitioned out of hospitals and into community-based settings. As the number of inpatient psychiatric beds has decreased, health care providers have increasingly struggled to secure inpatient services for individuals who are in psychiatric crisis. The lack of psychiatric beds has escalated the pressure on hospital emergency departments, which are called to serve individuals on voluntary and involuntary psychiatric holds while awaiting transfers to psychiatric facilities.
The State of Michigan and Michigan Legislature have pursued several strategies over the last few years to expand access to inpatient psychiatric services. These strategies include: (1) expanding the number of psychiatric beds that are available through the Certificate of Need program, (2) approving funds to pursue the building of a new facility to replace the existing Caro Center, (3) establishing a new unit at the Center for Forensic Psychiatry, (4) collecting and examining data on the causes of denials for inpatient services, and (5) facilitating transitions of care through the Children’s Transition Support Team pilot. Despite these various efforts, the crisis in access has continued unabated.
In July 2017, the Michigan Department of Health and Human Services (MDHHS) launched a new initiative, which was known as the Michigan Inpatient Psychiatric Admissions Discussion (MIPAD), to respond to this crisis. As part of this initiative, MDHHS convened a workgroup that was composed of providers and payers to investigate ongoing barriers to inpatient psychiatric services and produce a set of recommendations to overcome these barriers. The workgroup submitted its final recommendations to the department in October 2017.
MDHHS identified a sub-set of the recommendations for short-term action and has been working with stakeholders to implement several related projects in 2018. MDHHS has assigned responsibility for implementing these projects to specific agencies within the department, and the various agencies will continue to work on implementing the projects in 2019. MDHHS has also acquired a significant amount of experience and identified several lessons learned during the initial implementation process, and MDHHS will use this information to guide the implementation of the new Michigan Psychiatric Care Improvement Project and other future statewide efforts to address the crisis. MDHHS will continue to consult and partner with stakeholders on implementing the projects.
To learn more about some of the specific projects, click on the buttons below.
Report from TBD Solutions on Emergency Department Boarding
Securing inpatient psychiatric services for individuals who present at emergency departments has become increasingly complex and time consuming over the last decade. This trend of “Emergency Department Boarding” has generated a national conversation which recognizes that psychiatric patients that are most in need of inpatient services are often made to wait the longest for a host of complicated reasons.
To gain a better understanding of this problem, MDHHS commissioned TBD Solutions to survey and complete a thorough analysis of behavioral health service capacity within emergency departments across Michigan. MDHHS and TBD Solutions partnered with the Michigan Health & Hospital Association (MHA) to conduct the survey process of emergency departments. The Michigan Health Endowment Fund (MHEF) also supported this work through the provision of grant funding for the study. TBD Solutions submitted the final copy of its report and related recommendations to the department in the spring of 2019. The full report can be found at the link below.
MDHHS will explore opportunities to address the recommendations within its programs, policies, and initiatives. The department will also continue to collaborate with stakeholders on addressing emergency department boarding and improving access to inpatient psychiatric services and other crisis services.