Michigan’s behavioral health care system is at a critical juncture. More than one in five U.S. adults live with one or more diagnosable mental health disorders. Michigan residents in 49 of the state’s 83 counties live in mental health professional shortage areas. The cultural shift toward more open talk about mental health, while necessary, has also resulted in adding strain to critically under-resourced mental health systems, which have largely been operating separately and unequally across the state.
For those in crisis, the situation is even more dire. Having minimal treatment options can result in extended emergency department stays, premature hospital discharges, or time spent in jail—all options that can worsen the crisis.
The good news is that the state is building a better, stronger, and more accessible crisis behavioral health care system—and partnering with Public Sector Consultants to set the stage to ensure this system meets the needs of those seeking care.
A new approach to mental health intervention
The Michigan Department of Health and Human Services used the Substance Abuse and Mental Health Services Administration guidelines to build an accessible system based on the idea that the structure for mental health emergency services should mirror that of emergency departments and EMS services for physical health emergencies. This system follows SAMHSA’s three pillars of crisis care: ensuring all residents have someone to call, someone to respond, and a safe place to be.
Several cornerstone projects based on these ideals are already in place and growing, including the 988 Suicide & Crisis Lifeline (formerly the National Suicide Prevention Lifeline) and mobile crisis intervention services. Others, such as crisis stabilization units, have longer timelines because they require significant changes to laws and regulations before they can begin to have an impact.
The three pillars of behavioral health crisis care
Someone to call
Someone to respond
A safe place to be
988 behavioral health crisis intervention calls received in Michigan in March 2024
Someone to call: 988 Suicide & Crisis Lifeline
One essential element of crisis care for communities is regional or statewide 24/7 crisis call centers staffed by trained crisis specialists. In Michigan, the national 988 Suicide & Crisis Lifeline answers this need. 988 is accessible by phone, text, or chat. Whatever method is used, the person seeking support is connected to someone who can provide behavioral health crisis intervention. Launched in July 2022, the MDHHS reported that in March 2024, Michigan received the seventh highest volume of 988 calls in the country with 8,845 calls.
Before and after the launch, MDHHS partnered with PSC to ensure the 988 Suicide & Crisis Lifeline meets all callers’ needs. Beginning in 2021, PSC facilitated an advisory group to develop the state’s 988 implementation plan and organized community listening sessions with populations at higher risk of behavioral health crises and/or suicide to learn what unique needs they may have when calling 988.
PSC has continued to engage high-risk communities, including young LGBTQIA+ community members (ages 18 to 24) and older adults. Both populations experience higher rates of suicide than their respective counterparts. LGBTQIA+ youth are considered at higher risk because of the way they are often mistreated and stigmatized. Men aged 75 and older have higher suicide rates than men under age 75 and women in any age group.
PSC’s findings on public awareness of 988, the likelihood of use of 988 in a behavioral health crisis, and barriers to use will help MDHHS and providers set priorities and expectations to improve services for all Michiganders.
Someone to respond: Mobile crisis intervention services
Another pillar of effective crisis care is the establishment of mobile crisis response teams to offer community-based interventions and immediate response to someone having an acute mental health or substance use crisis wherever they are. Services include assessment, care coordination, assistance with follow-up resources, and support scheduling further care for needed services.
MDHHS is expanding mobile crisis services through several programs, including providing $7.5 million in grants to community mental health services programs for mobile crisis care.
“Imagine a Michigan where anyone can access the right crisis care anywhere at any time, where law enforcement, mental health providers, and families work together seamlessly to ensure individuals feel safe, supported, and connected to ongoing help."
If you or someone you know is struggling or in crisis, help is available. Call, text and chat the lifeline at 988 and 988lifeline.org.
A safe place to be: Crisis stabilization units
CSUs will provide specialized behavioral health care along with the necessary follow-up support to all people experiencing a behavioral health crisis, regardless of diagnosis or health care coverage. Michigan Public Act 402 of 2020 adds CSUs to the state’s mental health code and requires MDHHS to establish minimum standards and requirements and provide for certification of CSUs.
For CSUs, standards, requirements, and certification aren’t just meaningless bureaucratic red tape. Behavioral health crises are rife with complexity and uncertainty. Often, the person experiencing the crisis requires a treatment plan that must weave together physical health care, family and/or caregiver involvement, and connections to community-based services.
Establishing certification rules for such complex challenges requires the involvement of multiple state departments, regulatory bodies, behavioral health experts, community providers, and others. MDHHS reached out to PSC to use its extensive knowledge and facilitation capabilities to help the state develop a plan. After gathering input from state officials, behavioral health service providers and users, and rural law enforcement representatives, PSC developed the Michigan CSU model for children and adults, which lays out key concepts and priorities for CSUs in Michigan.
PSC continues to assist MDHHS by facilitating monthly meetings of a cohort of organizations working toward establishing CSUs. These meetings provide an opportunity for these organizations to share ideas and review best practices for implementing CSU certification rules.
A brighter future for Michigan’s crisis mental health care system
From launching the 988 Suicide & Crisis Lifeline to increasing the number of mobile crisis intervention teams to piloting CSU facilities, Michigan is building the foundation for a more accessible and responsive crisis care system.
However, the work has just begun. Michigan needs to continue filling gaps in care, building public and provider awareness of new and expanding services, and mental health workforce.
How do we make sure all Michiganders know when to call 988? What does it take to create mobile crisis intervention teams in every community? How much money and how long will it take to build CSU facilities throughout the state?
To answer these questions as well as others, PSC will continue to support the rich collaboration between advocates, healthcare professionals, and local, state, and federal entities to ensure no one in Michigan experiencing a mental health crisis is without support.