When a child in the Michigan juvenile justice or foster care systems needs in-patient mental health care, they often join a waitlist of dozens of other kids.
The Michigan Department of Health and Human Services is trying to change that by restructuring how they contract with child-caring institutions.
The new model would rearrange how money reaches the facilities by financing a given number of in-patient beds rather than basing it off of the number of patients. Those beds would be specifically dedicated to children in the foster care or juvenile justice system.
The new contract model comes in the wake of a statewide demand for juvenile justice reform. Organizations like the Michigan Probate Judges Association and the Michigan Center for Youth Justice have called the lack of youth placement options a crisis.
MDHHS has contracts with 31 child-caring institutions to provide 800 in-patient beds, however, due to nationwide staffing shortages these facilities currently provide fewer than 500 beds.
The crisis comes at a time when more kids across the country are struggling with mental illness.
Twenty percent of juveniles in the state are living with a diagnosable mental illness and an additional 10 percent are experiencing a “significant mental-health impairment,” according to a 2021 report from the Citizens Research Council of Michigan.
Juveniles who are ordered by a court to seek residential care have an especially difficult time finding an available bed for treatment - especially if they have a violent record.
An investigation by the Record-Eagle and Interlochen Public Radio found these issues were especially common in Northern Michigan where in-patient beds are a rare commodity.
Juveniles can sometimes be lodged in emergency rooms for weeks awaiting placement in a dedicated mental health facility.
Now, rather than financing facilities based on how many children are admitted, MDHHS will pay for a certain number of beds to be available and properly staffed all the time.
MDHHS Director Elizabeth Hertel said the idea of the new contract model is to encourage greater innovation in caring for the unique needs of children in the state’s foster care and juvenile justice systems.
“Currently, the money follows the child. So the child is placed in a facility, we pay the facility for taking care of the child and once they move out we stop paying,” Hertel said. “Now instead, we’re paying for the bed to keep it open and staffed for when we need to place a child in it.”
It all starts with congregate care providers submitting plans for placement in their facilities which will include things like cost estimates.
Hertel said there are two new requirements for submitting proposals this year. Facilities will now need to explain how they will help a child transition from the residential facility back to their own homes. They’ll also need to show a “higher standard for rejecting or requesting to move a child out of a facility.”
Those who often send kids to these facilities say this is an improvement. For Marquette County Probate Court Judge Cheryl Hill, the rural upper peninsula has few options for in-patient care.
Oftentimes, she has to send children to places downstate or even out-of-state — a reality for many courts in northern Michigan.
“It's my hope that this type of contract would allow service-providers to be assured that they are going to have income streams so that they can hire people, staff facilities and allow us to treat our children in our own communities,” she said.
Hertel said she hopes the new process will give MDHHS better control over how the dollars are being spent.
The 2023 state budget includes $325 million for mental health services.
According to MDHHS spokesman Bob Wheaton, some of this money has already been used to increase payments to facilities for staff wages and development projects.
“While there are other issues to tackle in the overall child welfare system,” Hill said. “This is a good step in the right direction to solving the crisis in care issues we face.”
