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.”
