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Health
Matters,
by Bill Birch, Lou Martin, Jane Ryan, Jim Dwyer and Dianna Seymour
Healthy
Spirits, Healthy Minds
In honor of Mental Illness Awareness
Week October 1 through 7, Marquette Monthly takes a brief
look at the history and future of mental health services in the U.P.
In 1962, when community mental health was born (again, because it was
the only option prior to the establishment of the state hospital system
in Michigan in the mid-1800s), 33,000 persons were in our state hospital
network. Today, there are less than 2,000.
The community mental health movement was due in part to
the high cost of institutional care and its widespread "inhumane
human warehousing" image. Prior to the focus in the 1960s on de-institutionalization
and community placement of persons with mental illness and developmental
disabilities, state hospitals had evolved over the previous century
as much more than an in-patient treatment resource. They also had become
room-and-board repositories for the elderly, the poor, oppressed and
misunderstood minorities, and the generally homeless with no other means
of support.
As a consequence, community mental health work was considerably
easier in its earlier years than it is today. In fact, many persons
released from state facilities in the 1960s, ‘70s and ‘80s
are gainfully employed, fully contributing members of our communities
with minimal if any support from formalized mental health service systems.
Many others, who may be more severely impacted by their mental illness
or developmental disability condition, are still living more humane
and rewarding lives as our community neighbors.
Much of the fear and discomfort associated with the development
of neighborhood group homes and programs has disappeared because of
the education the public has gained through these now common experiences
with successful personal relationships.
—Bill Birch, retired CEO, Pathways
Time Line of the Modern Community Mental Health Movement
1962 to 1963
Under the Kennedy administration, Community Mental Health Centers were
created and received federal support. A minimum population base of 100,000
people was required in order to receive funding. Marquette, Alger and
Delta counties collaborated to meet the minimum population requirement
and began providing services.
Mid-1960s
Michigan Public Act 54 was established and facilitated state funding
of local mental health centers. At this time, outpatient clinic services
were provided by social workers, psychologists and psychiatrists.
1974
Michigan Public Act 258 was established, creating Community Mental Health
Boards. It clearly identified and separated the responsibilities of
the Department of Social Services (DSS), State Hospitals and Community
Health Centers.
Late-1970s
Case management and residential services were transferred from the DSS
to Community Mental Health Centers. Funds could be issued to the location
where the consumer was living, thus promoting local service for each
consumer.
Early 1980s
Community Mental Health Centers became full management agencies, accepting
responsibility for all public funding for mental health services, including
outpatient services, inpatient care, residential services and case management.
Alger-Marquette Community Mental Health Center (now known as Pathways)
was one of four state pilot boards for the Department of Mental Health's
trial of full management contracting.
Newberry State Hospital patients continued to be placed into the community.
To facilitate community living, day programs were established to help
teach the needed skills to successfully adapt to community life for
both the developmentally disabled and mentally ill populations.
Mid-1980s
Medicaid allowed for reimbursement of outpatient and partial day program
services.
Assertive Community Treatment (ACT) programs were established to provide
case management services to the chronically mentally ill, and focused
on community technology as opposed to institutional technology. ACT
promoted skill development that would allow consumers to live as independently
as possible.
Late-1980s
Coordinated Community Planning began to promote collaboration among
agencies and more efficient use of resources.
Fifteen final placements from Newberry State Hospitals into the community
occurred. In 1992, Newberry State Hospital closed.
Today
Upper Peninsula Community Mental Health Centers employ hundreds of people
and provide local services to thousands of area residents. Pathways
covers Marquette, Alger, Delta and Luce counties, with a budget of $29
million and staff of 500.
CMHs are now preparing for managed care through internal restructuring
and networking with other provider agencies to organize a regional managing
entity for Medicaid benefits. This entity is known Great Lakes Behavioral
Health (GLBH).
County CMHs consider merging with surrounding counties to divert money
from administration and operate more cost effectively.
Douglas C. Morton, A.C.S.W., MBA, takes the reins as Chief Executive
of Pathways, replacing Dr. Bill Birch, who retired after eighteen years
in the position.
For the future, the primary challenge Morton sees is the development
of a regional public entity that can meet all the requirements of a
managed care organization in order to retain Pathway's role as a manager
of public funds. Morton states that Pathways is just one part of the
equation in improving life for the mentally ill and developmentally
challenged. He hopes "to maintain the strong support of our local
communities. Such support has allowed a significant amount of positive
community placement of some of our most disabled citizens over the last
several decades. County commissioners, churches, advocacy groups, local
hospitals and the business community have all stepped to the plate and
helped us accomplish our mission of healthier communities and acceptance
of mentally ill and developmentally disabled individuals into our everyday
lives."
—Time Line (abbreviated) by Lou Martin, Pathways
We've Come a Long Way?
Mental health issues have always been tied to emotion and
finance. Consider these statements from U.P. newspapers in 1893:
"It appears that every county seat and town in the
Upper Peninsula is petitioning against Newberry's selection as an asylum
site. It is generally conceded that the asylum, no matter where it is
located, is an undesirable affair. Some disappointed cities, however,
are making much ado about nothing."(Manistique Tribune)
"The case after the Upper Peninsula insane asylum is
beginning to look much after the fashion of the two great political
parties. Newberry has got [theirs] while several other townspeople are
hot in the collar because they were not so successful." (Peninsular
Record)
—contributed by Jim Dwyer, retired, Pathways and various state
mental hospitals
According to Laurie Flynn, Executive Director of the National
Alliance for the Mentally Ill (NAMI), "Twenty years of tireless
advocacy efforts are paying off: a new public perception of mental illness
is emerging—one focused on early intervention, effective treatment,
rehabilitation and recovery.
"No area of health care is changing more than mental
health. Science and research, the information revolution, significant
public policies that protect those with mental illness, and the essential
role [the public] plays in our movement have collectively brought us
to this important juncture.
"But as we all know, the fight is not yet over. Despite
tremendous strides made in the battle against mental illness, five million
Americans still struggle to get adequate treatment and services. Moreover,
as U.S. Surgeon General David Satcher emphasizes in his 1999 landmark
report on mental health, ‘stigma remains the single most significant
barrier to people getting the help they need.'"
One way to help people get the help they need is through
support groups. NAMI has several chapters in the Upper Peninsula. These
groups provide education and support for families who have loved ones
suffering from severe mental illness. Most of them meet at least once
a month in community settings. The format of meetings varies, but confidentiality
is respected, and meetings are designed to:
Provide a comfortable, nonthreatening opportunity to share
common experiences
Provide information on mental health resources to the mentally
ill and their families
Provide current information via guest speakers and discussion
Establish new friendship networks that can provide support
in time of crisis
Offer yearly the "Families in Action" Program/Workshop,
an eight-week program to help families develop skills for supporting
and assisting ill family members.
Visitors and new members are always welcome.
The NAMI-Alger/Marquette Group has been meeting in Marquette
since 1987. Its educational meeting is usually held on the last Monday
of each month, at 7:30 p.m. in Marquette General Hospital's Mount Marquette
room (next to the cafeteria). Its support group meeting is usually held
on the second Monday at the same location. An outreach spirituality
group is held on the first Monday of the month at St. Paul Episcopal
Church. Call 226-8551 or 225-0487 for further information about the
educational and support meetings and 249-9180 or 228-5653 for information
about the spirituality group. In Delta County call 786-1752 or 428-9527;
in Menominee/Marinette call 863-8947.
In the Iron Mountain area, there is the Wishigan Mental
Illness support group. To learn more call 563-8520.
For a variety of information on mental illness, NAMI has
an excellent web site: www.nami.org
—contributed by Jane Ryan
Pathways to Healthy Living
Pathways is our area's state-supported mental health provider, working
to assist those with mental illness or developmental disabilities and
educate the public about the needs of people facing these challenges.
Pathways uses a process called Person-Centered-Planning,
where the customer guides the mental health team in creating a treatment
plan that reflects his or her individual goals.
Because family and community are so important in achieving
the best possible outcomes, Pathways supports treatment in natural environments
that promote independence.
The agency offers a variety of services for customers and
their families, including twenty-four-hour, seven-day-a-week crisis
services; help with daily living and employment skills; outpatient counseling,
education and medical services; residential care; respite services;
and community wellness and education programs.
Community members can play a big role in assisting people
with mental illness and developmental disabilities by accepting and
including them in employment and social activities. The general public
can donate furniture, clothing, TVs, food, entertainment, etc. to mental
health programs or tax deductible financial contributions to the Ray
of Sunshine endowment for persons with mental illness. Or volunteer
your time, skills or talents.
For more information call Pathways at 888-PATHWAY.
—Dianna Seymour, Pathways
We're fortunate in the U.P. that our economy of scale is small so that
most people who need help don't fall through the cracks, and in that
we have a great many effective programs and caring, qualified staff.
As mental health care continues to move into a community-centered approach,
it's the people of the community who will determine how those with mental
illness are viewed and cared for in the future.
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