Ashley Markovich, Summit Pointe recovery coach“When I was in jail, most times that’s when I wanted to change,” says Markovich, who is now a recovery coach for Summit Pointe, Calhoun County’s community mental health agency. “That’s when my mind was the most clear. I didn’t have the distractions of the world. That was when I was ready.” 

Medication-assisted treatment programs, Narcan kits, and recovery housing are just some of the programs that could be funded through a nationwide opioid settlement agreement. The State of Michigan is set to receive nearly $800 million over an 18-year period with the funds being split 50-50 between the state and county and local governments. 

“What I liked about what Michigan has done is it had a strategy before the opioid settlement money came,” says Robert Sheehan, executive director of Community Mental Health Association of Michigan. He noted  Michigan has been providing methadone since the 1970s and suboxone the past couple of years. Both of these medications are used to treat opioid use disorder.

CMHAM executive director Robert Sheehan addresses conference attendees
Increasing Accessibility

In 2022, Michigan created the Opioid Advisory Commission focused on substance abuse disorders and co-occurring mental health conditions. The commission has put together a detailed plan for the use of the state’s portion of the settlement funds following the guidelines established in the settlement, according to Jared Welehodsky, senior analyst, Policy and Strategic Initiatives Policy and Planning Administration, Michigan Department of Health and Human Services. 

Jared Welehodsky, senior analyst, Policy and Strategic Initiatives Policy and Planning Administration MDHHS“Our state has a statewide strategy that we’re focusing on prevention, treatment, harm reduction, retaining, and recovery,” Welehodsky says. He adds that these are the guidelines set forth in settlement. “The guidelines are not all encompassing, because if it’s not in there, it does not mean you can’t spend the money on it. But it gives communities pretty strong guidelines as to what type of programs are part of the expectations for how these dollars can be used.”

For the 2023 fiscal year, Welehodsky says that the state’s biggest expense will be on naloxone (brand name, Narcan). Other state initiatives include increasing staffing, expanding facilities, and improving transportation for better access to clinics and treatments. There are also plans to partner with the Michigan State Housing Development Authority on recovery housing programs and the Michigan Department of Corrections to expand treatment capacities in the jails.

Welehodsky says because of litigation with Ottawa County – the county questioned how much money it was receiving, and the case was dismissed earlier this year – some things were delayed, but funding is starting to roll out and communities will begin to see the impact from the state funding.

The litigation also delayed the funding to county and local governments, which are making plans for their 2024 fiscal year. To help with that planning, The Michigan Association of Counties has put together a template designed to aid county leaders in thinking through what would be best for their community. 

Another key asset to county governments are the prepaid inpatient health plans, which manage Medicaid mental health, developmental disabilities, and substance abuse services in Michigan.

“We’ve been urging the counties to work with them, because those organizations have been purchasing substance abuse treatment — well they have been the predecessors for 50 years,” Sheehan says. “They really know treatment and prevention, and they know the opioid world.”

Robert Sheehan, CMHAM executive director, addresses conference attendeesFilling gaps, breaking down barriers

About 18 months ago, Summit Pointe started a jail initiative funded through MDHHS Boundary Spanner grant. The program fills the gap for people with mental health and/or substance abuse disorder needs who end up in jail by connecting them to services after they are released. 

While still new, the jail program has seen success. From April 1 – June 16, 2023, the program screened 774 inmates, contacted 178, and connected 128 of them to services. Taneisha Pointer is clinical advisor and boundary spanner for Summit Pointe’s jail initiative. 
Taneisha Pointer, Summit Pointe clinical advisor
“Summit Pointe has been super innovative with coming up with ideas on how we can remove barriers for people to access treatment and access it right here, right now. right away,” Pointer, says. “Having that availability and being able to touch the specialty courts, the jails, the shelters, and all of the different areas along with going to people’s homes is helping to remove some of those barriers and lets people know that there is access to care.”

Community mental health organizations such as Summit Pointe offer a range of substance abuse disorder programs. Along with its intensive outpatient program (IOP), Summit Pointe has Opioid Home Health, which connects a person with a recovery coach who can help the individual through the barriers they are facing.

To help fill gaps in services, Summit Pointe started an overdose response program partnering with LifeCare Ambulance for the Marshall and Albion areas. Markovich receives a list from LifeCare with staff going out into the community to work with those needing support.. 

Continuing to remove barriers to access is the goal, Pointer notes, Both she and Markovich state that they would like to see expanded medication-assisted treatment programs and more recovery homes.

“If you can get into a sober living environment from jail that would be like a 10-stars score in helping to keep you in or engaged in recovery and engaged in service,” Pointer says.

St. Clair Community Mental Health reception area.
Linking  people to services

Research has shown that medication-assisted treatment “significantly increases a patient’s adherence to treatment and reduces illicit opioid use compared with non-drug approaches.” To help increase access to medication-assisted treatment, St. Clair County Community Mental Health (CMH) added a substance abuse disorder program about five years ago to complement its co-occurring disorders programs. The SUD program offers individual and group therapy, case management, a medication-assisted treatment program, and most recently started a recovery court — a diversion program with the 72nd District Court. 

Marocco says that they have seen a lot of success in the recovery court program. It has helped divert people from jail to treatment along with offering medication-assisted treatment programs and connections to community partners who have worked hard to provide easy access to Narcan kits. Because of the increased number of Narcan kits in the community, the Portland Police Department recently reported having seen fewer overdoses than this time last year. 

Kathleen Gallagher, St. Clair CMH program directorSt. Clair County has allocated some of its opioid settlement money to a Mobile Overdose Response Program, overseen by Odyssey House. St. Clair County CMH program director Kathleen Gallagher is part of a community committee made up of organizations that, like St. Clair County CMH, have been working on substance abuse issues and will make recommendations to the St. Clair County Commission.

More recovering housing for rural St. Clair County is on Jason Marocco’s bucket list. Marocco, is the assistant division director for adult services at St. Clair County CMH. 

“The closest one to us is Sacred Heart,” he says. “It is on the border of our county and Macomb County and is about 30 miles away.”

Distance is not the only barrier. Due to a shortage of these residential facilities, people in need of services have a wait time of three to seven days. Gallagher notes that this can be a critical period as a person has a high potential to overdose during that time frame.

“Trying to patch people through until they get treatment is always a race for us,” Gallagher says. “Getting people linked quickly to services is always a key to success.”

Joanne Bailey-Boorsma has 30-plus years of writing experience having served as a reporter and editor for several West Michigan publications, covering a variety of topics from local news to arts and entertainment. 

Photos of Community Mental Health Association of Michigan and Robert Sheehan by John Russell.
Photo of naxolone by Steve Koss.
Photos of Kathleen Gallagher, Taneisha Pointer, and Ashley Markovich courtesy Summit Pointe. Photo of Jared Welehodsky courtesy Michigan Department of Health and Human Services. Photo of St. Clair Community Mental Health courtesy St. Clair Community Mental Health.

The MI Mental Health series highlights the opportunities that Michigan’s children, teens, and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of Michigan, Center for Health and Research Transformation, Genesee Health System, Mental Health Foundation of West Michigan, North Country CMH, Northern Lakes CMH Authority, OnPoint, Sanilac County CMH, St. Clair County CMH, Summit Pointe, and Washtenaw County CMH.
 

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The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team.

“We are in a tough spot right now, no doubt,” Kevin Bovenkamp, the assistant secretary of the Washington Department of Social and Health Services acknowledged in federal court Wednesday, speaking about the lengthy delays people in jail are facing while waiting for beds at state psychiatric hospitals.

“You were in a tough spot eight years ago,” Judge Marsha J. Pechman of the U.S. Western District of Washington replied wryly. 

Washington officials and advocates have been locked in a legal struggle for nearly a decade over how to ensure people with mental illnesses aren’t being warehoused in jails while their court cases stall. In four days of federal court testimony this week, advocates accused the state of not living up to its end of a settlement meant to resolve the issue. 

Throughout the hearing, Pechman appeared frustrated with the state’s efforts. She reminded them that while the previous settlement established seven- to 14-day timelines for people to receive timely services, officials have in fact never been able to meet those timelines in the history of the case.  

“Does anybody at DSHS think about the money?” Pechman asked, referencing the nearly $100 million in fines that have been leveraged against the state for their failure. 

“Whose attention do I need to get?” she asked. 

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The Trueblood settlement, stemming from a civil dispute between DSHS and Disability Rights Washington, aimed to protect the constitutional rights of detained people with severe mental illnesses, by ensuring they could receive services that determine their competency to stand trial, as well as treatment. 

The last settlement, which imposed the seven- to 14-day timelines, occurred in 2018. But earlier this year, plaintiffs with Disabilities Rights Washington accused state officials of being in breach of that agreement: According to the court monitor’s early data from April, people in jail are now waiting an average of 130 days before they’re admitted to a state facility for inpatient services. 

Disabilities Rights Washington is asking the court to increase the state’s fines in order to bring them into compliance, as well as prevent certain lower level felony, misdemeanor and civil patients from taking up beds at state facilities. They are also asking DSHS to make plans to divert 90 civil patients from Western State Hospital to make room for people who fall under the settlement agreement.  

At this week’s hearing, representatives for the state pointed to challenges they’ve faced in resolving the backlogs, including the effects of COVID-19, the time it takes to get new facilities up and running, and most importantly, the surging demand they’re facing from local jails. 

That surge is largely due to county and municipal prosecutors creating a unique patient known as a “civil conversion,” where defendants switch from a criminal track to a civil one, and are committed to involuntary treatment. State facilities have struggled to keep up with the demand, and ultimately gave civil conversion patients priority for beds, instead of the criminal defendants who fall under the court settlement.

Snohomish, King and Pierce counties were represented as amicus curiae or friends of the court and complained that DSHS’ failures have affected local criminal legal systems across the state.

Pechman is expected to issue a ruling in the case in a couple of weeks, but could ultimately decide to force the state to pay increased fines, change who is accepted as a patient at Western State Hospital or come up with a new settlement agreement. 

At one point, after suggestions from the counties, Pechman wondered out loud if she should force DSHS to purchase a hospital to deal with the backlogs. Earlier in the week, officials shared that they planned to tour Cascade Behavioral Health, a 137-bed facility, as a possible alternative to deal with the flow of patients coming from jails. 

Dr. Danna Mauch, the federal court monitor assigned to the class-action settlement, testified that the current wait times for defendants are the longest she’s seen. She also pointed to 2022 data that found 55% of people at the heart of the case experience homelessness or are unstably housed. 

State officials are asking that Pechman finds them not in breach of the settlement. On behalf of the counties, King County Deputy Prosecutor David Hackett asked the judge to reconsider the settlement, or to push state officials to speed up the construction of new facilities. 

In a declaration submitted to the court, Hackett wrote, “King County consulted with a real estate broker and was readily able to find two properties that appeared suitable to provide inpatient mental health services. It took just a couple weeks to identify two properties,” remarking to the judge that DSHS has “not shown urgency” for the current crisis. 

Reporter Michelle Baruchman contributed to this story. 

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The Mental Health Project is a Seattle Times initiative focused on covering mental and behavioral health issues. It is funded by Ballmer Group, a national organization focused on economic mobility for children and families. The Seattle Times maintains editorial control over work produced by this team.

Wait times for people in Washington jails to get into state psychiatric facilities continue to “skyrocket” five years after a settlement promised to prevent that from happening, a court monitor told a federal judge in Seattle on Monday.

In downtown Seattle, federal Judge Marsha J. Pechman of the U.S. Western District Of Washington heard arguments in a civil dispute that’s gone on for nearly 10 years, regarding the rights of people in jail to access basic mental health services. Three more days of testimony are expected as the court, state officials and advocates try to decipher a way forward after years of a settlement agreement have not fixed the problem.

In the meantime, the state has racked up millions of dollars in fines, court cases are delayed, and people with mental illnesses are stuck in jail for months, at a cost to their own health and to local jails who care for them — potentially serving more time than they would if they were sentenced criminally.  

Dr. Danna Mauch, the court monitor for what’s known as the Trueblood Settlement, testified Monday that the current wait times are the longest she’s seen in the history of the case. In fact, wait times are worse than in 2015 when state officials faced initial litigation. 

Asked during cross-examination if she would describe the current wait times as “unprecedented,” Mauch said, “That’s one way to characterize it.” 

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The Mental Health Project team is listening. We’d like to know what questions you have about mental health and which stories you’d suggest we cover.

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This week’s court hearing was called after plaintiffs with Disability Rights Washington accused Washington state officials of being in breach of their 2018 settlement agreement, which states people need to be provided evaluations within two weeks, to determine whether they are competent to stand trial, and treatment within another week. 

According to the court monitor’s early data from April, people in jail are now waiting an average of 130 days before they’re admitted to a state facility for inpatient services. 

Under the settlement, people in jail can receive compensatory sanctions — money from the state to make up for the excessive wait times defendants face. In addition, DSHS has paid an estimated $98 million in contempt fines as of November, the most recent data immediately available. Millions more in fines are suspended due to the terms of the settlement agreement, but could potentially be leveraged by Pechman if she finds the state is not doing enough to keep wait times down. 

State officials argue that both inside and outside the settlement agreement they are making progress on a number of programs to help people with mental illnesses, including the 988 hotline that serves Washington residents in crisis, a crisis facility that opened in Spokane and mobile crisis response teams that de-escalate crisis situations. Coupled with a future hospital currently under construction on the Western State grounds, officials stress they are working to meet the demands of the settlement agreement but are just facing overwhelming demand for services. 

Officials with King, Pierce, and Snohomish counties who previously submitted amicus briefs in the case say their counties are left with the financial burden of taking care of some of the sickest defendants in their jails, while they await a bed at a state facility. 

“We are grouped at the bottom of the hill,” David Hackett with the King County Prosecuting Attorney’s Office testified Monday, referencing the public safety crisis local municipalities face when people are not able to get services at state facilities.  

“Everything runs downhill.” 

However, state officials say part of the reason for the delays is that local prosecutors are sending more and more people to competency services. At Monday’s hearing, Pechman echoed that thought, shooting back, “Let’s look at who has a choice at stuffing that pipeline.”

Another sticking point among the parties has been the growing population of a particular kind of patient known as a “civil conversion.” These patients switch from being detained within the criminal legal system to a separate, civil system where they receive involuntary treatment because they’re believed to be a danger to themselves or others. 

As local prosecutors push for civil conversions in order to keep defendants off the streets and in care, those patients are competing with Trueblood class members for a limited number of available beds at state facilities like Western State Hospital — and that’s been leading to backlogs. 

The Trueblood Settlement, named for Cassie Cordell Trueblood, a public defender and plaintiff in the original case, aimed to prevent detained people from being warehoused in jail before they’ve had a fair trial. In 2014, when the class action first started, the American Civil Liberties Union of Washington and Disability Rights Washington also joined to represent the class members.

A compromise with state officials came the following year, establishing timelines for people in jail to access services.

The last major settlement occurred in 2018, when officials at the Department of Social and Health Services agreed to provide competency evaluations within two weeks and restoration treatment within another week. 

Wait times improved slightly the following year, but the COVID-19 pandemic ravaged progress. State facilities were forced to quarantine patients to mitigate outbreaks, creating backlogs as fewer patients were admitted. At the same time, they lost staff to burnout and more competitive salaries elsewhere. 

In the coming days, officials with the Washington Health Care Authority and DSHS are expected to also testify, including describing how defendants are triaged and prioritized into state beds. 

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