Opinion: Michigan's plan to improve behavioral health care

Ensuring access to quality, affordable care is a unique challenge for individuals with behavioral health needs — those with serious mental illness, substance use disorders or developmental disabilities.

In nearly a year as director of Michigan’s health department, I’ve heard diverse Michiganians tell similar stories of heartbreak. Detroiters and Yoopers alike face shortages of medication-assisted treatment for opioid use disorders, and of specialized care for schizophrenia. From Grand Rapids to the Thumb, families describe bureaucratic processes for getting and keeping essential care for loved ones with autism. Individuals in crisis sit in emergency rooms, often untreated, because they have nowhere else to go.

Michigan’s system also has tremendous assets. Community-based organizations provide a safety net of crisis services for residents of every income in every county. Their leadership has enabled Michigan to keep more of our loved ones in our communities, not institutions. State law protects individuals in need.

Wednesday, I’ll speak with the Legislature about a new approach to Michigan’s behavioral health system. I’ll draw on a simple belief — that every human being has dignity — which I learned from my dad, a psychiatrist who spent more than 50 years serving individuals who were homeless or leaving jail. I’ll also draw on decades of unheralded, under-resourced effort by heroic providers across Michigan.

Our approach preserves the strengths of our system while also addressing its shortcomings. For too long we have treated people as though they were split in two. There’s “physical health,” handled by one set of providers and insurers, and then there’s “behavioral health,” handled by another. The two sides often can’t coordinate or share information. Dealing with two of everything makes life more complicated for everyone.

It’s a missed opportunity. Investing more in treating a person’s depression, for example, can make them likelier to take their diabetes medicine, especially if the therapist and endocrinologist communicate. This can help people enjoy life more and go to the emergency room less. But this smart approach is hard when spending is with one insurer and savings are with another.

For the last few years, Michigan has sought to integrate care under the leadership of physical health insurers. It didn’t work out. Yet, even amid deep disputes, physical and behavioral health organizations quietly launched joint efforts. We can build on their momentum.

Wednesday I will talk about three principles for change. First, we need to sustain and strengthen the public safety net that serves all Michiganians. Second, we need to promote integration — bringing together physical and behavioral care and payments.

Third, we should create new plans that specialize in treating individuals with significant behavioral health needs — so-called “specialty integrated plans” (SIPs). These plans bring together the management skills of traditional insurers with the expertise of behavioral health organizations. North Carolina, Arizona, and Arkansas all use SIPs. Our approach will offer individuals a choice of both providers and plans, including at least one plan sponsored by Michigan’s own public behavioral health leaders.

These changes will mean more access to quality care, less red tape, and more investment in better results.

This is just the beginning of a conversation — one I hope many of you will join. We intend to fill in the details together — advocates and families, legislators and MDHHS staff, health plans and providers, Republicans and Democrats. Officials like me can easily fall into the trap of believing we have all the answers. We don’t.

It’ll be a journey, but we’ll take it together. The people we serve will be our north star. They are the reason we keep pushing for better. And they are the reason we will succeed.

Robert Gordon is director of the Michigan Department of Health and Human Services.