Last week I shared an editorial written by Jim Haveman which appeared in the Detroit News. The editorial was about the state’s broken mental health system. I also shared that Jim would be testifying before Senate Majority Leader’s hearing on Senate Bills 597 and 598. Below is the transcript of Jim Haveman’s opening remarks before the hearing in Lansing earlier this week. Please read Jim’s comments and if you support Jim’s recommendations please contact Senate Shirkey and let him know you support the bill and would like to see the bills modified to include Jim Haveman’s additional recommendations. Senator Shirkey can be contacted at the following:
Senator Mike Shirkey
P.O. Box 30036
Lansing, MI 48909-7536
(517) 373-5932
SenMShirkey@senate.michigan.gov
Here is the transcript of Jim Haveman’s opening remarks at the hearing.
September 14, 2021
Government Operations Committee, Senator Mike Shirkey, Chair
Good morning, Chairman Shirkey and members of the Government Operations Committee. It
is a privilege to be with you this morning to share some of my thoughts regarding Senate Bills
597 and 598.
My name is Jim Haveman and I have had the privilege of serving as the Director of Mental
Health for six years and as the Director of Community Health for Governor Engler for six years. I
also served two years as the Director of Community Health for Governor Snyder. I was the Kent
County Mental Health Director from 1978 to 1985 and have also been the CEO of two nonprofit
agencies: Project Rehab and Bethany Christian Services. I was around when the first mental
health code began and led the team to rewrite and update the Mental Health Code in 1995.
I believe strongly in transparency and open dialogue as a means to fix outstanding issues.
Previous Legislatures passed legislation and worked on policy based on what we knew at the
time. I would submit that it’s time to modify our current mental health and behavioral health
services delivery system in Michigan. We must strive to have a holistic system that improves
access, is seamless, and integrates physical care with behavioral health services. This bill
offers a constructive path.
Our goals should be to strengthen primary care for behavioral health, expand access, build
community capacity for population health, improve systems of care, reduce administration
levels and complexity, and keep services affordable.
To achieve these goals, we need to stress accountability, person centered care, prevention
and wellness, community integration, evidence-based approaches, and payment for value. I
would add that providers should share financial risks with the State of Michigan.
I, like you, are tired of hearing how the system is broken; that mental health consumers die
25 years earlier than others, that 60% of chronic mental health conditions in Michigan go
unreported or, that those in need don’t receive services. We are seeing an increase in suicides
and limited choices for consumers. We have a rights system controlled by community mental
health. ‘High needs’ children are not getting the comprehensive services they need and after
hour services are often not available. Navigation becomes a challenge and families cannot
get access to testing and services. Consumers are falling between the cracks. They get ‘ping
ponged’ between providers resulting in terrible things happening in the community that
might have been prevented by earlier intervention. If you want different results than what
you’re getting, you have to try different approaches.
I am well aware that those working in the current system have had many successes and I
applaud those achievements. Let us build on those successes and make things better for all,
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while leaving no one behind. I was part of the public mental health system for most of my
career and we did our best with the knowledge and resources we had at time.
We can and must do better. I believe Senate Bills 597 and 598 and the discussion we are
having in Michigan begins the process of bringing Michigan up to a holistic standard. This
process will begin to address the change that is needed. True integration will allow providers
to address and treat behavioral health issues before they become threatening to one’s
health. I believe changing the paradigm will lead to less burnout for the health care staff. We
need a vibrant contemporary forward-thinking system of care which leads to more access and
services, not less.
The mental health code and models of behavioral health were designed before computers,
electronic medical files, managed care, waivers, and the Healthy Michigan Plan. It was before
the scourge of opiate addiction, methamphetamine abuse, gambling addiction, as well as
internet and social platforms. We never talked about risk sharing contracts, pharmaceutical
costs, social and health determinants, health literacy, covid and the list goes on. So, it is not
surprising today that we have a patchwork of services and funding sources. It is never clear
who really is in charge.
Back in the 70s when the mental health code first was introduced, the state carved out
mental health. Hospitals and primary care, due to stigma and the science of the day, did not
view mental health as a chronic illness or brain disease. The words co-morbidly and dual
diagnosis was not part of our vocabulary. How things have changed, and we see things
differently today.
We still have a bifurcated system in Michigan. Due to the continuing of the carve out,
consumers still face stigma, misconception, and misunderstanding. The way it is today, one
system services the mild and moderate behavioral health consumer and another serves the
most severe consumers. It truly fractures a seamless whole person approach to treatment.
I have said many times in my career that the integration of primary care and mental health was
inevitable. It was not a matter of when but how. Debate is still going on and unfortunately like
so much we deal with; the dialogue has gone from policy and principle to posturing and self-
preservation.
Medicaid funding for mental health should be accessible to all eligible Heath Plans to assure a
comprehensive treatment plan with all providers coming from a single source of payment.
Without this, true integration of services will not take place. We need to reward providers that
are lean, efficient, demonstrate good outcomes and welcomes consumers and families to be
actively involved in their treatment and decision making. Screening, authorization, and funding
should be managed by the same entity.
I would like to share some reasons why I like the proposed direction of the Senate Bills 597
and 598.
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They integrate physical health and mental health. It builds on the current Medicaid-
managed care organization model that has proven to be very successful in Michigan. For
example: Foster care youth and children with special health care services are already
part of the Health Plans.
The bills phase out the 10 Prepaid Inpatient Health Plans. The regional approach has not
met the objectives. It just became another layer of complexity and works better some
places than others. They certainly have had their financial struggles. The Prepaid
Inpatient Health Plans are not accredited and carry no risk like the health plans do. I
never liked that term Prepaid Inpatient Health Plans. The problem is that it’s not very
descriptive as most consumers are seen in the community and not in an inpatient
setting.
The health plans will have actuarially sound funding based on demand and need.
Implementation of Substance Abuse Disorder treatment services is phased in.
It is unfortunate families had to file a lawsuit against the state (KB vs MDHHS) for there
was no other way to attain the required services for their children from the community
health board.
Access to services will be improved significantly.
Accountability and provider panels will be expanded.
It enhances the role of insurance commissioner to assure financial stability.
The bills do away with the current bifurcation of mild, moderate, and severe mental
health needs.
The statute requires any savings resulting from improved services or decreased
administrative costs, be directed back into mental health services.
Offers choice for families and consumers. Today individuals are locked into their own
community mental health system or Prepaid Inpatient Health plan. This gives them (the
prepaid health plan) a monopoly and no incentive to improve its own operations to
attract new beneficiaries. It is important to give families and consumers opportunity to
choose those providers who have a proven success rate or provide better/more
services. I have heard way too many examples of CMH’s choosing themselves as the
provider and crowding out the array of private agencies.
It proposes a new ombudsmen role. Recipient rights will no longer be under authority
of the Health and Human Services Director, that controls the state’s mental health
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services. Consumers will have a level of protection they don’t have today if they are
denied services.
I like the portability within the state. This will stop community mental health programs
from deciding that some other county is responsible. Services should be available for
any eligible person statewide regardless of where they live currently, or in the past.
Community Mental Health continues as an option
It recommends consistency and standardization of services. The provision of services
needs to be based upon medical necessity and not subject to what may or may not be
contracted for at the local level.
Social determinants of health are addressed in holistic way. It is estimated that 46% of
heath care costs are caused by lack of transportation, inadequate housing, food
insecurity, lack of pharmaceuticals and public safety.
Interactive electronic medical records will be easier to manage.
The term Specialized integrated plan must put an emphasis on specialized.
The bills go beyond the current behavioral health homes. The behavioral health homes
are a good start but do not go far enough. Often it is community health workers and
peer support specialists who help consumers access the physical side. It is still a broken
holistic system. There is no guarantee that these individuals are getting the services they
need. Again, the Health Plans should be the coordinator of treatment.
A few thoughts to enhance the bills:
Add general funds for those not part of private insurance, Medicaid, or Healthy
Michigan Plan.
Address the concerns of counties per bonding.
Address Children’s issues and hold MDHHS, Health Plans and providers accountable.
Expand the national health service corps program and loan repayment program.
Fund new beds selectively for children, adolescents, and adults. 60% of the beds are
utilized in the state. Improve access, wrap around services, and creative outpatient and
crisis intervention programs
Consider having persons with a developmental disability be part of MDHHS long term
care strategy.
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The need to educate all those providing financing and services as to what ‘integration’
actually means and how to adapt accordingly. This might involve higher education and
their course offerings.
Health plans should be the lead for the kids lawsuit being finalized between the
plaintiffs and MDHHS.
Currently Recipient Rights pertaining to substance use disorder is processed through
the Michigan Department of Licensing and Regulation. I suggest it become part of the
ombudsmen recommendation.
Identify Centers of Excellence for complex cases and where a person can be thoroughly
evaluated for a treatment plan. For example, comparable to the way the University of
Michigan’s Health System is to physical care today or Pine Rest Christian Services is for
mental health testing.
Assist the MDHHS to reinvent itself to mirror the community model of integration.
We know behavioral disorders are diseases and it’s time to truly integrate care for them with
our outstanding health care systems in Michigan. We must not continue to hold ourselves to
legacy structures.
I believe this open discussion of the future is timely and thank you for the opportunity to share
my thoughts. The patchwork of the past needs to evolve into a seamless public behavioral
health managed system of care for Michigan. Senate Bills 597 and 598 are a great step in that
process.
Thank you.
James Haveman
Havemanjames@aol.com
1-517-881-0977
Stay safe. Wash your hands regularly. Social distance. Wear your mask. Schedule your vaccine and booster.
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