As Michigan continues to struggle with how to address a lack of available beds in its psychiatric hospital in the town of Caro, the legislature is proceeding with hearings on legislation to exempt, among other areas, psychiatric beds from certificate of need (CON) approval.
Senate Bill 672 would repeal the CON requirement for licensed psychiatric beds and children and adolescent patient psychiatric beds. Hearings and testimony regarding the change occurred on December 5 and 12, 2019, and the bill will continue to be debated in the legislature.
According to the Michigan Department of Community Health, the state’s CON program is intended to ensure only needed services are developed in Michigan. Supporters of the legislation to exempt psychiatric beds argue CON hinders the ability to provide desperately necessary mental health treatment in the state.
John Snook, executive director of the Treatment Advocacy Center, a national organization, says such a CON requirement reduces the number of psychiatric beds and keeps people from getting mental health treatment they need.
“Certificate of need requirements for psychiatric beds unnecessarily hinder treatment access and put up costly roadblocks at a time when the system can ill afford it,” Snook said.
The bill cleared a Republican-controlled Senate committee on February 26 along party lines. Republicans control both chambers of the state legislature. Gov. Gretchen Whitmer is a Democrat.
Sees Multistate Problem
The CON problem continues to strain the mental health care system in Michigan and other states. John McNamara, manager of state government relations for McLaren Health, who testified in favor of the exemption at the December 5, 2019 hearing, says exempting psych beds from CON review can help alleviate the mental health crisis.
“We see that there is a national epidemic,” stated McNamara. “It’s not an epidemic here; it is an epidemic everywhere. We think this is one of the many things that needs to happen in order to help address that epidemic. Adding psych beds is not going to be the be-all, end-all, but we believe it’s one of the many necessary things that needs to happen to adequately address the mental health crisis our nation is facing.”
Snook says other states are also grappling with psychiatric bed shortages caused by these regulations.
“This issue has come up in a number of states,” Snook said. “I can think of cases in both Iowa and Virginia, in which CON requirements limited psychiatric capacity, despite obvious needs within the state.”
Jails Fill the Void
The demand for mental health treatment and psychiatric beds has become a prominent issue in Michigan.
“Anyone who has paid attention to headlines coming out of Michigan over the past five years should understand that the state is in desperate need of additional treatment bed capacity,” said Snook. “Without access to needed care, people end up in the systems that can’t say no: our emergency rooms and jails.”
While Michigan continues to grapple with its shortage of psychiatric beds and how to provide quality mental health treatment for its residents, CON is standing in the way of efforts to expand and improve care, says Snook.
“I can only speak to psychiatric care, but given the crisis that Michigan is undergoing, state officials should look long and hard at anything that raises the costs and complexity of building needed psychiatric capacity,” Snook said.
ERs as Waiting Rooms
The shortage of psychiatric beds appears to be increasing the burden on emergency rooms.
During his testimony, McNamara told legislators about a patient who was referred to the emergency room by a nursing home because he was hurting himself and tried to harm staff and other residents. He remained in the emergency room for 264 days until McLaren Health could find a nursing home that would accept the patient.
This story is not unique to McLaren Heath, and there are other examples of patients spending extended periods in emergency rooms instead of being able to go to a facility designed to provide mental health care, McNamara says.
“We recently had a pediatric and adolescent in our ER for three and half weeks because there was nowhere for them to go,” McNamara told the lawmakers. “Every health system is going to have similar stories.”