DETROIT – Earlier this year, a 19-year-old man diagnosed as both autistic and severely mentally ill allegedly killed an elderly man in an adult foster care facility.
The younger man, one Darius Michael Smith-Blackmon, allegedly kicked, stomped and punched John Bagget until he was fatally injured. That was in March. Smith-Blackmon was then taken to the Wayne County Jail, charged with first-degree murder.
Finally, in September, he had a hearing in Wayne County district court, where Chief Judge Laura Mack found he was incompetent to stand trial or even understand what he had done.
“There wasn’t any question about that. He just stood there and smiled at her when the charges against him were explained,” said Milton Mack, now the state court administrator.
Mack, a former probate judge and a national expert on mental illness and the prison system, is married to Judge Mack. “So my wife asked if he was in treatment, and she was assured he was.”
He was then released from jail. But in truth, he wasn’t receiving any treatment at all. “So he is back in a group home, where she is very concerned that the same result will happen again,” Milton Mack said.
Welcome to Michigan’s messed-up mental health system, where there’s almost no money to treat mentally ill people who aren’t impoverished and on Medicaid.
There are also very few hospital beds for the severely mentally ill, which means many of them wind up in prison or county jails, which is disastrous for both them and society.
“Nobody believes you are receiving the best possible mental health treatment in prison – and it is the most expensive place to house them,” said Kevin Fischer, the executive director of the Michigan chapter of NAMI, the National Alliance on Mental Illness.
He added, “I say ‘house’ them because that’s exactly what it is — they do get drugs to make them compliant, but nobody believes you are getting effective mental health treatment in jails or prison.”
“Someone said that 19-year-old fell into one of the cracks in the system. I’d say he fell into one of the canyons in Michigan’s mental health system, and there is no excuse for it,” Mack said.
What’s most frustrating, he added, is that “we know what to do, but the legislature won’t appropriate the money for it.”
Bob Sheehan, the head of CMHA, the Community Mental Health Association of Michigan, an umbrella group of more than 150 agencies, said the stigma that still unfairly surrounds mental illness is a big part of the problem.
“Nearly everyone has someone in their family who has (mental illness) but people don’t want to talk about it,” Sheehan said.
The result is a crazy system that neither treats people successfully nor saves money. Thirty years ago, Mack noted, the state had a network of mental hospitals designed to treat patients.
Then came the push for deinstitutionalization, and Michigan closed most of the state’s mental hospitals, with the understanding that they would be replaced by a network of community mental health centers that would provide effective outpatient treatment.
Trouble is, neither Congress nor the state legislature ever provided the funding. “I hate to say it, but don’t come to us (for mental health treatment) if you have private insurance,” Sheehan said. “Call the number on the back of your insurance card.”
Milton Mack added “Bob Sheehan reminds me of George Washington at Valley Forge – he was charged with winning our independence, and they didn’t give his troops any shoes.”
“What’s frustrating is that we know what to do, and we aren’t doing it. The legislature simply needs to be willing to spend money.”
Ironically, all three mental health experts agreed, spending money now in the right way would save Michigan a lot more money in the not-even-very-long run. The problem is this, all agreed:
Michigan has gone to a “Medicaid-only model” where nearly all the mental health dollars are allocated for patients on Medicaid – the near-indigent. “We have $2.6 billion allotted for Medicaid mental health care, and only $100 million for everyone else.”
That’s done in large part because Washington provides some funding for Medicaid – but otherwise, it makes no sense. Two years ago, Mack published a major, highly-praised paper, “Decriminalization of Mental Illness: Fixing a Broken System,” that argued that Michigan could save vast amounts of money and keep many severely mentally ill people out of prison by identifying at-risk people early.
Then, get as many as possible into a program of outpatient monitoring and mandatory medication.
But that largely hasn’t happened. “I think that is partly because everyone is in their own rigid little silos,” unable to see the bigger picture,” Mack said – and other mental health experts agreed.
Instead, he said, Michigan has a system where one-fourth or more of its 38,000 state prisoners now have severe mental illness..
“Some of them cost the state $100,000 a year,” he said, to be confined in a setting that is not at all conducive to their getting better.
An even higher proportion of inmates in the county jails – perhaps half –are mentally ill.
The good news, he added, is that the legislature has finally removed legal barriers to effective outpatient treatment.
The bad news is that they haven’t provided the money to do that. “The legislature needs to fund our mental health system so that it is, again a truly public mental health system,” the former judge said. If they do that, he added, thousands of people “won’t have to be hospitalized, won’t have to be incarcerated, and won’t end up homeless living under a freeway overpass.”
He and his colleagues have been lobbying the lawmakers to make that happen. Perhaps any one whose families have been touched by mental illness ought to do the same.
