Where Do You Land When Your Mind Falls Apart?

Editor’s Note: Some last names have been omitted to protect the privacy of the individuals.

Liisa suffered a nervous breakdown. She was transported to the emergency room at UP Health System Portage.

“Because there are no psych beds or a transitional holding area to be assessed in our area, I was placed in a small broom closet off the main room,” she recalls. “It had no windows and harsh lighting, and it was claustrophobic.

“I was there many, many hours while the hospital was waiting for a bed to open up at Marquette General or elsewhere.” 

Brett went off his psych meds and became manic. Instead of landing in a local emergency room, he went to Northland Counseling’s crisis house in Ashland, Wisconsin.

“It was a friendly and warm home,” he says. “In some ways, it was much better than my own living situation at the time. It had all the benefits of a hospitalization, but was more comfortable. The workers were responsible, kind, and much less stressed-out than at a hospital. We were allowed outside to play in the grass or talk or just smoke once an hour, which also kept the stress lowered for nicotine addicts like myself.

“It was a nice way to start taking better care of myself, and just to remember what a healthy, normal lifestyle is like.

“I think something like Northland Counseling Crisis House would be great for the community in this area. People with less serious crises could go there, if even just to wait for a hospital bed to open up somewhere else—instead of staying in an ER room. It would definitely be a major improvement.”

Liisa agrees.

“There is a pressing need for something like a transitional/assessment/holding house or center for immediately after a person in crisis is brought to an ER and for the next 12-24 hours or so,” she says. “Somewhere a person could be attended to while doctors or other professionals can figure out the best course of action for the patient. Perhaps in a softer, less sterile, less harsh, less intimidating atmosphere. I believe this would be beneficial for a patient who is already under duress psychologically.”

No Crisis Center Here

Sheriff Josh Saaranen

The Keweenaw has no such place where people in mental health crisis can go and feel safe, comfortable and cared for while awaiting further placement or referral. Houghton County Sheriff Josh Saaranen says that local law enforcement responds to mental health-related calls on an almost daily basis. 

Sheriff Saaranen likes the idea of a crisis center.

“While some individuals need long term care, many people in crisis need short term solutions,” he says.  “A crisis center could offer an opportunity for these individuals to stay within our community. It's healthier for the person to be closer to their family and or support groups. 

“Individuals are often placed in treatment centers throughout the state,” the sheriff said. “Oftentimes we see these individuals stay in these centers for a couple of days and be released; they then have to arrange transportation back home. I can imagine that this is a stressor that a crisis center could alleviate. 

“This would also be safer and healthier for the sheriff's office staff,” Saaranen says. “These trips require two deputies and tend to be long drives in all types of weather.  A short term crisis center would aid in limiting these strenuous trips for the patient and deputies.”

Data compiled by Copper Country Community Mental Health (CCCMH) showed that nine people have had to stay in an emergency room for two days or more since October 1, 2022.

“CCMH is very concerned about the problem of multi-day ER assessments,” says the mental health center director, Mike Bach.

A crisis center could serve as a step back into community for people coming out of the hospital, a short-term stabilization setting or a site to await placement instead of waiting in the emergency room. 

Pressing the Portage Health Foundation

Mental health support and advocacy groups in the area are working with the Portage Health Foundation (PHF) and CCCMH on the need for such a crisis center. PHF is planning a new “wellness campus” in the Keweenaw. The Mental Health Support Group-Keweenaw Area and Keweenaw Support 4 Healthy Minds are urging the foundation to include a mental health crisis center in the facility. Liisa, Brett, and several other mental health clients and family members have written letters to PHF in support of such a center.

Dr. Michelle Morgan, head of Keweenaw Support 4 Healthy Minds, wrote: “As a psychiatrist (now retired) for the local community mental health center, I witnessed the suffering of people in acute mental health crises as they languished in the emergency room for days while waiting for an inpatient bed to become available somewhere in the state of Michigan. With staffing shortages across the country, I know this situation has become all too common. Our rural community is particularly vulnerable, having limited resources as it is.

“A mental health crisis unit is a lower cost and possibly more effective alternative for patients who need increased support and supervision while they engage in treatment with local providers. Rather than being sent away to a hospital, they would benefit from the continuity of care locally, as well as the support of people who know them well.  Such a resource could be key to preventing a mental illness from reaching the point where the person might become dangerous to themselves or to others.

“I hope the Portage Health Foundation finds this idea compelling enough to support it.”

PHF Executive Director Kevin Store

PHF has made no decision, but “everything is on the table,” according to Executive Director Kevin Store.

“This is a complex issue,” he says.  “PHF is just one party engaged in finding solutions to these issues.  The community needs to find ways to work together.  

“PHF recognizes the need for a complementary model of mental and behavioral health services that helps meet the needs of all our community members,” Store goes on to say, “whether that be increased education/prevention services, expanding the availability of more acute, short-term counseling services, and finding ways to improve access to mental and behavioral health assessment and referral into the appropriate care.”

“There are many challenges to this issue,” Store adds. “Staffing to appropriate levels with the appropriate training that meets requirements; financial viability and the lack of adequate reimbursement for not only the clinical treatment services, but also to cover administration and support; complex licensing regulations, service provider credentialing, to name a few. All contribute to the complexity of this issue.

“There are a lot of folks and organizations in our region working on trying to find solutions to the needs that exist in our area,” Store goes on to say. 

Dr. Kelly Mahar, psychiatric residency director at UP Health System-Marquette, is heading a UP-wide effort to assess and address the mental and behavioral health shortfalls across the UP.  

“Like them, PHF is working with a number of partners to seek solutions to these issues.  PHF will continue to advocate on behalf of those providers who are working to try to meet the needs,” Store says.

The PHF wellness center is in its early planning stages, Store points out.  The foundation has reached out to the community for input and plans to release a report on its findings in April. 

Dial Help Anticipates Challenges

Dial Help, which operates a crisis hotline, has some reservations about a mental health crisis center.

“It could be helpful in theory, but the amount of staffing and resources that would be needed is probably prohibitive at this time,” says Rebecca Crane, director of Dial Help. “Typically, something like that would have to have 24/7 staffing, potentially including medical personnel and law enforcement or security. You'd essentially be recreating an ER outside of the supports of an ER. Additionally, people might not utilize something like this due to stigma and fear of being sent to an involuntary psychiatric hold, having their children removed, or friends, families, coworkers finding out that they went.”

Crane says that the number of mental health crisis calls that Dial Help receives are down because there are so many specialized crisis lines now.

“Our numbers have really dropped, not because there are fewer people in crisis, but because they're reaching out to the specialized lines for their specific issue,” she explains. 

There are still a lot of mental health challenges in the Keweenaw, Crane goes on to say.

“There is a lack of psychiatrists, lack of counselors in general, lack of mental health treatment options for youth, lack of funding for Copper Country Mental Health, poverty, lack of transportation to get to appointments in our large, rural service area, lack of childcare to attend appointments, difficulty accessing care due to insurance requirements, and there is still a lot of stigma around discussing mental health that prevents people seeking help until things get dire,” she says.

Copper Country Community Mental Health in the ER

CCCMH Director Mike Bach

CCCMH is trying to address those challenges. The mental health center contracts with two residential crisis centers downstate, but because placement is voluntary, patients have to find their own transportation there. The center’s case managers, therapists, and peer support partners try to help people resolve problems before they become a crisis, says Mike Bach, CCCMH director.

The community mental health center does crisis screening in the ER.

“If someone presents in the emergency room in crisis, we talk with the person, friends and family, medical staff, law enforcement and other concerned parties to determine whether safety planning is appropriate,” Bach says. “If a person can safely return home, we arrange follow-up with the person’s treatment team if they are a current consumer.  This follow-up may include more frequent contacts and medication adjustments.  If they are not a consumer, we help with a referral to this agency or private providers as is appropriate.  

“When a person is in the emergency room for multiple days, we work with hospital staff to help that person stabilize and possibly avoid the need for psychiatric hospitalization,” Bach goes on to say. 

Two local hospitals are contracting with companies that provide psychiatric consultation to emergency room doctors, Bach says.

“The hope is that appropriate psychiatric treatment can begin in the emergency room, so that the patient can stabilize and possibly return home with a safety plan,” he explains. 

Another alternative is EmPATH (Emergency Psychiatric Assessment, Treatment and Healing), a specialized hospital-based mental health emergency unit. There are EmPATH units in a number of hospitals nationwide, but no plans to establish one here.  

There are serious challenges to creating a stand-alone crisis center.  The State of Michigan has tightened licensing laws, and staffing with qualified medical professionals is difficult in the UP.  

“A huge challenge is adequate staffing, which includes psychiatric oversight, medical staff, clinical staff, security, and direct care staff,” Bach says. “Also needed are staff to maintain the building, purchase food and supplies, track staff training, and ensure appropriate IT support.”

Staffing presents one big obstacle. Another is creating a facility offering services that Medicare and Medicaid will pay for.

“If the services provided by the crisis center are billed to Medicaid or other insurance companies, it will need to comply with accreditation requirements and the myriad of regulations required by Michigan and federal laws and administrative rules,” Bach points out. 

He says CCCMH is working with many community partners to address issues with mental health crisis care.

“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,” Bach adds. “We will continue to partner with them as we seek a community solution to multi-day emergency room stays.”

UP Health System-Portage Relies On Partners

UP Health System-Portage spokesperson Alexis Jacques says that the hospital depends on community partners such as CCCMH.

“We are proud of the partnerships and working relationships we have with these organizations and rely heavily upon their expertise and engagement,” Jacques says. “While we understand that behavioral health patients may present to our emergency departments initially, our staff is trained, and resources are available to stabilize a patient so that we can properly establish the best and safest plan for the patient in need.”

Mental Health Advocates Making Waves

Cindy Harrison, a mental health activist and member of the Mental Health Support Group-Keweenaw Area—which used to be the Keweenaw chapter of the National Alliance on Mental Illness (NAMI)—recently wrote a letter to the Portage Health Foundation urging them to consider including a mental health crisis center in their new wellness campus. Houghton County Sheriff Josh Saarinen, whose deputies regularly deal with people in mental health crisis, endorsed it. So did Gail Ploe, prevention specialist and alcohol and drug counselor at the Western UP Health Department, Bill Fink, whose daughter deals with mental health issues, and John Ruuonen, a mental health client and author. 

“I can speak to this as the mother of two severely mentally ill children,” Harrison wrote. “I have been dealing with mental illness in the family for twenty years. 

“Although this community has many resources in health care, one of the major things we are lacking are resources in mental health. Twenty years ago, Marquette General had a capacity of 24 psych beds and the Soo had over ten. Those numbers have shrunk today, and even with the new UP Health System-Marquette, there are only 12 psych beds being used now, even though the new hospital announced that it was planning for 48 psych beds. We do not have Westside in Calumet anymore, and the Rice House is not being used for crisis care as it once was. 

“So, of course, in a psych crisis, more time is being spent in our local ER trying to find a hospital bed anywhere in the state. Sometimes this takes more than a few days, which is extremely hard on the staff and terrifying for the patient and family. Although it would be great to have psych beds available locally in Hancock, this does not seem possible, so the next best thing would be a ‘crisis center’ where people could go for short term care until a hospital bed is found or a place to go after getting out of the hospital when transitional care is needed before coming home.”

Harrison has been to the Ashland Northland Counseling Crisis House.

“It is wonderful, so therapeutic,” she says. “If we could get something like a crisis house for the mentally ill who are having psychiatric problems, that would be a wonderful addition to our community and the western U.P.”

PHF launches local Bridges Out of Poverty initiative

Community leaders met this week to learn about what, beyond money, those living in generational poverty need to succeed

This week, community leaders from a wide swath of sectors met to learn more about living in generational poverty from an expert, Treasure McKenzie. McKenzie knows about poverty not only because she’s the director of Bridges Out of Poverty, a program by aha! Process, Inc. that works to reduce the social costs of poverty by creating a common language between different sectors of the community, she also grew up in generational poverty herself.

To learn more about generational poverty, how it’s defined, how it’s different from situational poverty, and its prevalence in Michigan, read the Michigan Commission on Community Action and Economic Opportunity 2015 Generational Poverty Report.

McKenzie explained to the group of CEOs, superintendents, HR directors, bankers, detectives, and business leaders —who all voluntarily participated— that those who live in generational poverty tend to value their relationships with others first, before achievements like degrees or promotions.

Treasure McKenzie, Bridges Out of Poverty director

“That’s how you end up with names like Treasure,” she said.

McKenzie traveled to Houghton from Muskogee, Oklahoma, where the Bridges Out of Poverty program is well-established, with a series of classes and help for people with dental, legal and auto issues. She came at the request and with the financial support of the Portage Health Foundation.

“Poverty intertwines with almost everything we’re trying to do,” PHF Director Kevin Store told the group before the program began.

He said that BOP aligns with PHF’s mission to address the social determinants of health, and that’s why launching a local effort was important. The goal is for groups to start “silo-busting” and work together to address more of the root causes of poverty.

McKenzie said BOP is often associated with budgeting classes.

“That’s not what I do,” she said. “It’s not about budgeting.”

They do offer some “Getting Ahead” classes to those living in poverty that focus on learning how to make connections, navigate some of society’s hidden rules, and make planning choices, but about half of the education they do is actually for business owners and the middle class, working to dispel common misconceptions about poverty and the people living in it.

When those living in poverty, or the ‘under resourced’, as the program often calls them, join in BOP classes, they are called investigators, because they inform the organization’s work with their own life experiences.

McKenzie said that generational poverty in particular can be kind of like an addiction, and the person dealing with it may not be able to see the way out for themselves. Admonishments to “just do better” in some way are not going to help them.

“I call it being ‘should’ on,” McKenzie said.

Suggesting they should get a job, move away from a bad relationship, or work harder isn’t effective, but more money, in general, won’t necessarily be either. Generational poverty is about more than just money. It’s about resources which can include the financial, but also emotional, mental, spiritual, physical, relational, and perhaps most importantly, it can be about the hidden rules in a middle-class-focused society that someone didn’t learn growing up.

“You only know what you know,” McKenzie said.

Banks, schools, government buildings and more work on a set of middle-class norms that can be unfamiliar and unwelcoming to those from generational poverty, making access to a variety of opportunities and services uncomfortable at best.

It’s also not that those in poverty aren’t willing to work hard.

As an example, McKenzie shared a video about a woman named Tammy, who walks ten miles to her job at Burger King, and her sons.

“I don’t know what else to do,” Tammy says.

McKenzie pointed out there were things in the video that money wouldn’t fix, particularly the family issues; lack of a father figure for the sons, and the social strain between Matt and his mother and brother caused by Matt’s shame of his living situation, the lack of recognition from passersby at her job, and more.

The documentary checks in with Tammy again 14 years later.

The group also explored the ‘mental models’ of those living with poverty, in the middle class, or in wealth. Mental models are internal pictures of what things look like to us and determine how we act, often without our examination. There’s also a limited amount of space inside a mental model.

BOP’s mental model of poverty centers on relationships and includes things like food, childcare, time spent at agencies, jobs, legal issues, safety, mental health and chemical dependency, and housing. Accessible businesses in the neighborhood probably include pawn shops, fast food, check cashing services, dollar stores, and laundromats.

In the middle class, the mental model focuses on achievement and includes things like social media, childcare, careers, mortgage payments, long working hours, clubs and groups, mental health and chemical dependency, health and prevention, and vacations. The neighborhood probably has banks, bookstores, coffee shops, and office buildings.

There is some overlap, but those in poverty are focused on much more immediate needs and have less time and mental “bandwidth” to focus on planning for the future.

McKenzie explained that being able to construct a “future story” is a luxury of the middle class and wealthy because their immediate needs are usually taken care of. Those living in poverty have to deal with the “tyranny of the moment”, which is shorthand for the immediately necessary survival needs like food, shelter and safety. Even simple things like staying clean by doing laundry can take half of a day when a parent has to use a laundromat, doesn’t have access to childcare, and lacks transportation. This can lead to decisions that may seem wrong or bad to those living outside poverty.

One example McKenzie offered was the purchasing of an expensive TV. To someone in the middle class looking at someone impoverished, they may wonder why they wouldn’t use that money to fix something on their car or house, or to pay off debt. However, to someone in generational poverty, those problems are endless, and watching TV is the only vacation they ever get.

McKenzie said buying a television they may not “need” isn’t a moral or financial decision for those in generational poverty.

“It’s a mental health decision,” she said.

McKenzie led the group through several exercises designed to help them understand the behavior and decisions made by people living in generational poverty. She said it’s important that those in poverty, the middle class, and the wealthy learn to communicate better because it takes all three to make meaningful policy changes that will lift the community as a whole up.

Those making the policies are mostly the wealthy, and those making hiring and business decisions are most often middle-class, but if those policies and decisions aren’t informed by the realities of those living in and near poverty, then they can work against themselves.

McKenzie related the story of one business owner who, after attending one of her classes, made note of how many good employees he’d let go for being late to work because of strict company policy when often the conditions of their tardiness were outside of their control because of public transportation or family issues. A change in policy, or a little flexibility, could have saved him from the costly process of finding and training new employees.

Government policies that prevent agencies from sharing information with each other force people looking for needs-based help to spend time filling out paperwork, again and again, to prove they are poor to different agencies, a process that is both time-consuming and sometimes humiliating. A shift in policy to allow some information sharing could afford someone more time to look for work or cook healthy food.

“Think about having someone from all three circles when you start making decisions,” McKenzie said.

At the end of the meeting, small discussions were seeded about what policy changes and partnerships might be meaningful as the program moves forward.

Store said, at the end of the meeting, that bringing about measurable results would likely take at least 5 years, but that bringing about systems change for those in generational poverty was important to the health of the community, too.

“They’re very much hand-in-glove issues,” he said.

BOP has found that meaningful, long-lasting change only seems to be truly affected on a family-by-family basis, and so it takes time to take hold in a community, but they’ve calculated that in Muskogee alone they’ve saved the cost of social services more than $1 million, among other benefits like a larger, more stable workforce.

“We need to take a longer length look,” Store said.

Santori's Corner Gasoline Spill

What we’ve heard so far

I’ve cut together the overhead video and photo released by Superior Search and Rescue, and below is compiled information that has been released through the Portage Health Foundation, on behalf of the Hancock Fire Department.

From Portage Health Foundation at 3:23 p.m., Thursday:

Around 8 a.m. a gasoline tanker tipped over at Santori’s Corner on US Highway 41 in West Hancock. The tanker immediately started spilling gasoline. It was carrying about 8,500 gallons. There have been no injuries caused by the accident and spill. Drinking water has not been affected.

The Western Upper Peninsula Health Department (WUPHD), working in conjunction with the Environmental Protection Agency (EPA) and the Department of Environment, Great Lakes, and Energy (EGLE), issued a public health advisory for the Portage Canal near Houghton/Hancock due to the fuel spill that discharged into the Portage Canal in Houghton County.

Evacuations: West Hancock from Santori’s Corner on South Lincoln Drive (Highway 41) to Michigan Street, Michigan Street up to Elm Street and down to the Jutila Center, and Minnesota and Ohio Streets between Ethel Avenue and Michigan Street.

Traffic Detours: Through traffic is requested to use alternative routes, with northbound traffic asked to follow M-203 toward McLain State Park and southbound traffic asked to take Airport Park Road through Dollar Bay. This is especially true for tractor-trailers. Local traffic is open, and White Street in Hancock is currently open to two-way traffic because of the incident. There is a potential it will be closed overnight, possibly affecting the morning commute. 

The Environmental Protection Agency (EPA), the Department of Environment, Great Lakes, and Energy (EGLE), and Region 8 Hazmat Team are on scene to advise on cleanup efforts. Various contractors are on-site and on route for cleanup efforts.

Due to the petroleum release and the heavy equipment operating in the area, residents are requested to avoid the area if possible.

From PHF at 5:53 p.m., Thursday:

Late this morning, the tanker was emptied of the remaining 1,960 gallons of gasoline.

U.P. Environmental Services out of Bark River arrived on the scene around 4 p.m. to remove the remaining standing gasoline that had been kept on Santori’s Corner by berms built by the Hancock Fire Department, Hancock Department of Public Works, Superior Sand and Gravel, and B&B Construction. That work is still being done to clear the scene.

Around 5 p.m. the tanker was put upright and removed from the scene.

Air monitoring is in progress in the surrounding area by Mannik & Smith Group and TriMedia Environmental & Engineering.

From PHF at 8:17 p.m., Thursday:

There will be another update coming around 9:30 p.m. with the hope of announcing that evacuated residents will be able to reoccupy their homes tonight.

The Western U.P. Health Department is providing guidance to residents who will be reoccupying their homes with the assistance of the fire department.

Highway 41 will remain closed overnight into the morning. It is likely the highway will not be open for traffic until Saturday.

Beaches along the canal will remain closed until further notice.

Due to the petroleum release and the heavy equipment operating, residents are requested to avoid the area if possible. 

From PHF at 9:34 p.m., on Thursday:

The Hancock Fire Department is lifting the evacuation order that was in place. Residents are encouraged to return home.

The Western U.P. Health Department, with assistance from the Hancock Fire Department, provided printed guidance to residents who will be reoccupying their homes.

Air monitoring will continue to take place over the coming days.

Due to the petroleum release and the heavy equipment operating in the area, residents are requested to avoid the area if possible. 

From PHF at 8:09 a.m., Friday:

Highway 41 at the scene of the spill is being remediated and replaced today. It is still hoped the road will reopen Saturday. 

Access to The Tire Shop has been restored. Customers can access it through North Ethel Avenue. 

Drinking water has been and continues to be safe.

Detours remain in place. As a reminder, through traffic is requested to use alternative routes, with northbound traffic asked to follow M-203 toward McLain State Park and southbound traffic asked to take Airport Park Road through Dollar Bay. This is especially true for tractor-trailers. Local traffic is open, and White Street in Hancock is currently open to two-way traffic because of the incident.

Beaches along the Portage Lake Shipping Canal remain closed until further notice.

Due to the petroleum release and the heavy equipment operating in the area, residents are requested to avoid the area if possible. 

The next update will likely come when the road is opened.

From PHF at 5:44 p.m., Friday, on behalf of the Houghton County Office of Emergency Measures:

In response to the gasoline spill, there has been absorbent boom material around the outlet of the storm sewer line into the Portage Canal. Petroleum from within that boom area has been and continues to be safely removed for proper disposal.

The gasoline sheen on the water has been monitored from the shoreline, from the air via drone and plane, and from the water via boat since noon on Thursday. Air monitoring has been conducted along the shorelines of the canal. The ongoing monitoring of the sheen – size and location – has shown that the sheen has been naturally dissipating over the last 24 hours, especially east of the Portage Lake Lift Bridge.

The recommendation of both the Environmental Protection Agency (EPA) and the Michigan Department of Environment, Great Lakes and Energy (EGLE) is to continue to monitor the gasoline sheen as the sunlight continues to aid in its evaporation. That is expected to continue into next week, depending on the weather. Mechanical methods of surface recovery used with heavier oils are not effective with the gasoline sheen. Chemical methods of removing the gasoline are not allowed on the Great Lakes.

The Environmental Protection Agency has been overseeing and conducting air monitoring in the community. All levels in the community are safe. The only areas where gasoline compounds continue to be found are the storm drains and work areas.

The Western Upper Peninsula Health Department (WUPHD), working in conjunction with the EPA, EGLE, and Michigan Department of Health and Human Services (MDHHS), has updated the public health advisory for the Portage Canal following the recent fuel spill in the City of Hancock. The Portage Canal may reopen for recreational boating, fishing, and body contact swimming as long as the public avoids any areas with visible fuel sheen.

There is no update to the time frame for Highway 41 opening to traffic again.

Due to the heavy equipment operating in the area, residents are requested to avoid the area of the spill if possible. 

PHF announced at 9:50 a.m. on Saturday, on behalf of the Houghton County Office of Emergency Measures, that U.S. 41 reopened. Ethel Avenue remains closed while crews continue to flush the storm sewer.

Water sheen monitoring photos, courtesy of Superior Search and Rescue, via PHF, from Friday, June 25: