How and where mentally ill people are treated has changed dramatically during the past generation.
County commissioner David Marshall of Glen Arbor is one of two people representing Leelanau County on a 16-member board that sets policy for the Northern Lakes Community Mental Health (NLCMH) agency.
“In my past life, in Indiana, I worked as a certified counselor and a marriage/family therapist and for many years with adolescents and families,” said Marshall, who is now a shop owner.
From around 1980 to 2000 Marshall worked in an outpatient clinic of Methodist Hospital in Indianapolis, the largest hospital in Indiana and one of the largest private hospitals in the nation. Marshall’s career also included time as a counselor in an outpatient mental health center attached to Butler University.
“At that time, the mental health system was transitioning from a institutional model to an outpatient model,” he said.
A couple of actions triggered the change in tack for treating mental illness. In 1963, President John F. Kennedy signed the Community Mental Health Act that for the first time created a role for the federal government in states’ mental health arenas. The legislation called for a 50 percent reduction in state institutional hospitals within the next 10 years. The same year a new Michigan Constitution was adopted that altered the institution-based approach to mental illness, providing for services for the “care, treatment, education and rehabilitation of …inhabitants who are physically, mental or otherwise seriously disabled….”
State legislators followed up in 1974 with adoption of a new Mental Health Code. It enabled the conversion from institutional care to a community-based treatment and support model.
“Another thing that helped out is that the medicines got better,” Marshall said. “The chronically schitzophrenic could be functional if they stay on their medications—that’s a struggle whenever you’re working with the disabled or someone who resists treatment, begins to feel well and stops taking their medication.”
In Michigan, the criteria for involuntary commitment requires that a person be a danger to himself or others, can’t care for themselves, or that based on previous history is in immediate danger of breakdown.
The court and mental health system got some help in 2005 in the form of Kevin’s Law, named for a 24-year-old University of Michigan graduate student who was killed in a Kalamazoo bus station by a mentally ill man who had not taken his medication. The law amended the Michigan Mental Health Code to enhance the definition of a “person requiring mental health treatment.” Kevin’s Law forces involuntary mental commitment to people whose “non-compliance” with treatment over 48 months has been a factor in at least two psychiatric hospitalizations or incarcerations, or one or more acts or threats of serious violent behavior in the last 48 months.
State law treats differently individuals for whom a guardianship is sought and those for whom involuntary mental health treatment is requested. The court can appoint a guardian for a person who lacks the ability to make informed decisions due to mental illness — but not if the person is developmentally disabled. Before mental health treatment may be ordered, the subject has to be a danger to himself or others.
The requirement often pertains to youth age 17-21. “During my last 10 years of practice, 90 percent of my work was with males in this age group referred to me through the court system,” Marshall said. “The problem with this group is that they love high risk activities and act impulsively.”
The issue was also a concern of a state mental health commission formed by Gov. Jennifer M. Granholm. The commission found that early intervention is the hey to effective treatment. In addition, they concluded that a delay in delivering the right care at the right time resulted in “overuse of the juvenile and criminal justice systems as well as increased homelessness.”
Early treatment is something that Helen Stimson stresses. A retired registered nurse from Leland, Stimson sits on the NLCMHA board with Marshall.
“There is help out there for those who need it,” Stimson said. “It’s important that the public learn about the signs and symptoms (of mental illness) so that there’s early detection and that people can be funneled to the proper care.”
Mental illness knows no age barriers. The number of mentally ill children in Leelanau County served by the NLCMHA agency increased by five from 2009 to 2010, according to statistics from the agency. NLCMHA covers a 6-county area that includes Grand Traverse, Leelanau, Missaukee, Roscommon, Wexford and Crawford counties, operating on a $49 million budget for 2009-2010.
Stimson called for parity in health insurance coverage for those with mental illness, saying that 1 in 4 people are affected by mental illness.
“The impact across the board is enormous if people don’t get help,” she said.