Hospitals and community mental health agencies (CMHs) in Michigan are working together to address gaps in behavioral health care that contribute to long emergency department stays and delays in treatment. While these partnerships vary across the state, several recent initiatives are aiming to improve care coordination and create new models of crisis response.
Collaboration challenges and system gaps
Lauren LaPine, senior director of legislative and public policy at the
Michigan Health & Hospital Association, says that although there are strong examples of collaboration, many hospitals still face challenges coordinating care across county lines and with multiple CMHs.
“If you come to a hospital emergency department and you’re in some level of a behavioral health crisis, that hospital has to work with the CMH in the area where the patient lives,” LaPine says. “That takes a lot of time and a lot of coordination.”
One of the most significant barriers involves pre-admission screening assessments, which are required to determine the appropriate level of care. Currently, only CMHs are authorized to conduct these assessments for Medicaid beneficiaries. Hospitals often report delays in obtaining assessments, contributing to extended stays in emergency departments.
A bill introduced in the state legislature,
Senate Bill 316, would allow qualified hospital staff to complete these assessments when a CMH is unable to respond within three hours. According to LaPine, the proposal aims to reduce boarding times and alleviate administrative burdens on hospitals and CMHs.
Another obstacle is the absence of a shared electronic medical record system between hospitals and CMHs, resulting in frequent phone calls and secure emails to coordinate patient care. In addition,
hospitals must negotiate reimbursement rates separately with multiple CMHs and prepaid inpatient health plans, resulting in duplicative processes and inconsistent payment structures.
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Hospitals and CMHs are collaborating to shorten emergency department stays for mental health care.
Crisis stabilization units as an alternative model
One partnership between
Network180 and
Trinity Health Grand Rapids has established
The Behavioral Health Crisis Center to divert patients in crisis from emergency departments and jails.
The facility allows adults experiencing a behavioral health crisis to receive care for up to 96 hours. Network180 provides behavioral health staff, while Trinity Health supplies medical personnel, safety teams, and facility services.
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Beverly Ryskamp“This is meant to be an alternative to individuals experiencing crisis in an emergency department or a jail,” says Beverly Ryskamp, chief operating officer at Network180. “It’s a blending of resources and expertise.”
Carrie Mull, clinical services director of behavioral health at Trinity Health Grand Rapids, says the collaboration was one of the first major innovations she has seen in her three decades in the field.
“This behavioral health crisis collaboration has truly impacted patient outcomes,” Mull says. “Merging our expertise with Network180 has shown amazing results for patients.”
According to Mull, before the Crisis Center opened, patients of all acuity levels were routed through the emergency department, often waiting days for an inpatient bed. Now, patients with lower or moderate needs can be stabilized quickly in the Crisis Center, while psychiatric hospitals can focus on the most severe cases.
“We’re seeing patients stabilized in less than two days on average, compared to seven to ten days in an inpatient unit,” she says. “That reduced wait time has also resulted in fewer individuals returning to the emergency department.”
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Carrie MullIn its first year, the Crisis Center served over 2,000 unique patients on the brief intervention side and nearly 1,200 on the crisis stabilization side. Mull says 87% of patients admitted to the stabilization unit were successfully stabilized without needing an inpatient stay. Only about 1.5% required inpatient care within 30 days.
“An episode of care in the Crisis Center costs about half as much as inpatient care,” she added. “That’s how this service is going to be sustained. It pays for itself by reducing the need for costlier care.”
A
recent policy change by the
Michigan Department of Health and Human Services enables ambulances to transport Medicaid patients directly to crisis stabilization units, an important step in reducing unnecessary hospital visits and beginning treatment sooner.
Ryskamp notes that crisis services vary by region. For example, some areas of northern Michigan have chosen not to build crisis stabilization units, instead developing different crisis response strategies based on community needs and available resources.
“Crisis services work, but collaborations with hospitals are going to look different depending on the community,” she says.
Funding remains a concern as Network180’s Crisis Center currently relies on grant dollars to provide services to all adults regardless of insurance status. Sustaining access in the future will require engaging health plans, Medicare, and commercial insurers to establish reimbursement structures.
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Another collaboration: Munson Healthcare and Northern Lakes CMH Authority collaborate in the Grand Traverse Mental Health Crisis and Access Center.
A future of collaboration
LaPine says streamlining funding and reducing administrative duplication are key areas for policy improvement. MHA supports efforts that would simplify the process for patients and providers, particularly during behavioral health emergencies.
“Anything that would remove the duplication across county lines and the differences in the way hospitals are paid could make it easier to provide care,” LaPine says.
As partnerships continue to evolve, both CMHs and hospitals are exploring ways to expand crisis services and improve access to treatment across the state. Mull emphasizes that sustainable funding is needed to expand crisis centers statewide.
“What’s missing is that the state does not have a code to be able to bill for this level of care, and that needs to happen,” she says. “We’ve proven that the program works. Now it’s time to put the infrastructure in place so others can build similar services.”
Reflecting on the broader impact of these partnerships, Mull adds, “When we change how psychiatric hospitals are reimbursed so they can care for the sickest patients, and crisis centers handle those with moderate needs, it benefits everyone.”
Dr. Brianna Nargiso, a graduate of Howard University and Mercer University, specializes in media, journalism, and public health. Her work has appeared in The Root, 101 Magazine, and Howard University News Service, covering profiles, politics, and breaking news. A Hearst journalism award nominee and active member of the National Association for Black Journalists, she has also worked with Teach for America and the Peace Corps. A doctoral graduate of American University, Brianna is dedicated to advancing social justice, public health and education on a global scale.
Photo of Lauren LaPine by Doug Coombe.
Photo of emergency department by RDNE via Pexels.com. All other photos courtesy subject.
The MI Mental Health series highlights the opportunities that Michigan's children, teens, and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of Michigan, Center for Health and Research Transformation, LifeWays, Michigan Health and Hospital Association, Northern Lakes Community Mental Health Authority, OnPoint, Sanilac County Community Mental Health, St. Clair County Community Mental Health, Summit Pointe, and Washtenaw County Community Mental Health and Public Safety Preservation Millage.