Michigan is working to implement a sustainable crisis response system that provides access for everyone. Service providers discussed system progress at the 2024 Michigan State of Reform Health Policy Conference last month.
Wendy Martinez Farmer, regional vice president of Account Management and Crisis Services at Carelon Behavioral Health, said the Substance Abuse and Mental Health Services Administration (SAMHSA) has some pretty lofty goals for crisis systems. She said SAMHSA aimed to have 90 percent of 988 Suicide and Crisis Lifeline calls answered within the state they originated in by the end of last year.
“And many states are very close to that,” Martinez Farmer said. “By the end of 2025, the goal is that 80 percent of individuals will have access to mobile crisis response in their communities. That is still pretty spotty, but that is happening more and more across the country. And by 2027, the goal is that 80 percent of Americans will have access to crisis stabilization programs so they don’t have to use emergency rooms or go straight into inpatient care when there’s a crisis.”
Krista Hausermann, manager of the Crisis Services and Stabilization Section at the Michigan Department of Health & Human Services (DHHS), said the state’s crisis system will be for all Michiganders, regardless of their diagnosis.
“A person could have mental health issues, an intellectual developmental disability, or a substance use disorder,” Hausermann said. “In order to access crisis care, the person does not have to meet a certain level of acuity. We are building one infrastructure for everyone. A single infrastructure promotes the easiest access and is the most sustainable for cost and workforce. Michigan is unique in that it is really focused on developing one infrastructure for all payer types.”
DHHS is partnering with Blue Cross Blue Shield and other community partners to acquire diverse, sustainable funding for its crisis system, Hausermann said.
“This is an important step in our crisis system; pulling in private payers, because we need to align around the service expectations for each of the (system’s) components,” she said. “And it will help reduce the administrative burden if mobile crisis looks the same for a private payer as it does for the Medicaid system. This model is being co-created with our providers.”
Local crisis hubs will offer 24/7 crisis response services for people who need more attention than the phone, text, and chat support available through the 988 line, Hausermann said.
“The crisis hubs will have common components, and there will be a common framework. Within that framework, each local hub can customize services to meet the needs of the community. The crisis hub will have somebody that can receive calls 24/7. Those calls could come from 988, local law enforcement, (or) people in the community that have needs. The person answering that phone will be an ‘air traffic controller’ and will hold on to that person to ensure they get the appropriate next step in care.”
— Hausermann
Michigan’s crisis system will include a Someone to Respond component, which will provide telehealth and mobile crisis response services, Hausermann said. It will also feature A Safe Place to Be services, which will include pre-admission screening units, crisis stabilization units, and psychiatric urgent care.
“All of those services will connect people to post-crisis stabilization services,” Hausermann said. “And there’s an array of those services.”
Grace Wolf, vice president of Crisis Care Services at Detroit Wayne Integrated Health Network (DWIHN), said Wayne County launched its mobile crisis team in December 2023. DWIHN’s crisis system serves adults and children seven days a week from 7 a.m. to 3 p.m., and officials plan to begin offering services from 3 p.m. to 11 p.m. soon as well. It aims to offer 24/7 services by the end of summer, Wolf said.
DWIHN’s crisis line calls are currently answered by third-party representatives, although staff are preparing to move that service in-house, Wolf said.
“And we’re moving more towards a centralized call center for Wayne County that will be able to dispatch our mobile crisis teams directly, and steamline that process instead of having to go through a third party for that. We’ll be launching our crisis call center in May. We also are launching crisis stabilization units for adults and children. Our first one is going through inspection and certificate of occupancy (certification) now. Those should be open very shortly.”
— Wolf
Jill Smith, senior director of the Michigan Crisis & Access Line at Common Ground, said the line takes 988 calls for 76 Michigan counties, and serves as a backup for the state’s remaining seven counties.
“Michigan answers 90 percent of the calls routed to us,” Smith said. “Our average speed of answer is 17 seconds. Knowing people can get somebody really fast, I think, is really something to highlight. You’re getting someone to support you within moments of making that phone call. Our average monthly volume is about 6,500 calls. That is ninth-largest in the country. We’re constantly hiring. We’re budgeted for 76 (full-time employees).”