What is a psychiatric hospital? Some private hospitals have inpatient psychiatric units as part of their behavioral health services. Apart from placement in a state-run institution, these units are the most intensive form of mental health treatment that exist in Michigan.
Why is a person admitted to an inpatient unit? People admitted must meet certain criteria, such as imminent risk of harm to self or others due to a mental illness, or being so disorganized they cannot care for themselves.
Where are these located? There are two inpatient units for adults located in the U.P. There are about two dozen units located downstate, some of which admit children.
What happens when a person is admitted to one of these units? Most people are in the unit for a week or less. The main goal of admission is to stabilize the person’s symptoms through medications enough to return them to the community for follow-up with an outpatient treatment provider.
Can a person be admitted to a psychiatric unit against his or her will? Yes, this is called an involuntary admission, and it requires the involvement of the Probate Court in the county of the person’s residence. An involuntary admission involves the temporary suspension of a person’s legal right to freedom of movement. This is why it is only appropriate when there is an imminent risk of harm to self or others as a direct result of a mental illness, as determined by qualified behavioral health experts.
Can a person be admitted to a psychiatric unit because of homelessness? No, homelessness alone is not a sufficient reason. A psychiatric admission only because of homelessness is a misuse of Medicaid funds. It also adds to the problem of overcrowding in these units and takes away resources from people in a true psychiatric emergency. Homelessness is a serious social problem, but the remedy is not psychiatric admission, unless the person is also at imminent risk of harm to self or others due to a mental illness.
Why does it sometimes take days or weeks to get someone from the emergency room to an inpatient unit? CCMH makes the decision whether to hospitalize a person or safety plan them back home within three hours of the time we are contacted by the emergency room. However, psychiatric units do not have to accept patients for whom we request admission. They can deny our request for any reason. The most common reasons they give us are: no bed space, the case is too acute, the unit environment is not appropriate, and the person has serious physical health problems that cannot be managed on the unit.
Why don’t you place people in Wisconsin hospitals? This can most easily happen if the person seeking admission has private insurance and is seeking voluntary treatment. If someone is being hospitalized involuntarily, which is most of the people CCMH hospitalizes, law enforcement is not able to transport a person across state lines without an agreement with the counties in Wisconsin. In addition, the lawyers and psychiatrists involved in these cases must be licensed in both Michigan and Wisconsin. For these and other reasons, CCMH is usually limited to searching for beds in Michigan hospitals.
Why does local law enforcement have to transport people to these hospitals? This is a huge burden on them and takes resources away from the community. Michigan law is very detailed regarding involuntary psychiatric admission, and it describes the process for transporting patients to inpatient units.
What is CCMH doing to address the problem of multi-day hospital stays? Many events can precipitate a crisis, such as relational problems, loss of housing, and worsening health conditions. We work with people to help them resolve these issues and develop skills for coping. Many times our case managers, therapists, and peer support partners help people resolve problems before they become a crisis. Some people are seen multiple times per week for support.
When someone is in the emergency room, we have seen success in some cases by working with the emergency room physician to start or adjust medications that help a person stabilize, so they can return home. We also help some people return home by increasing services such as daily medication deliveries and help in the following areas: finding social supports; managing a budget and apartment; finding employment; and getting involved in recreational activities.
But CCMH cannot solve this problem on our own, which is why we strive to develop strong working relationships not only with patients and families, but also with private providers and foundations, schools and intermediate school districts, hospitals, law enforcement, courts, and local DHS offices.
Our mission is to support the independence of children and adults with the most severe forms of mental illness and intellectual/developmental disability. We are very thankful for our local partners and see them as essential for our community to care for those of us who are the most vulnerable. We will continue to partner with them as we seek a community solution to multi-day emergency room stays.