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The price to privatize mental health care

Jack Lessenberry

Perhaps the most horrific story of the summer was the Detroit News’s revelations of unsanitary conditions at the now for-profit group of hospitals known as the Detroit Medical Center.

These included dirty instruments, old blood and bone fragments in tubes that were being used for a baby’s operation and other similar horrors.

That was more than bad enough. But a group of mental health advocates are now concerned that the Snyder Administration wants to partly or totally privatize mental health services.

Six months ago, an early version of the governor’s next budget had so-called “boilerplate” language that appeared to do just that. According to an analysis by Crain’s Detroit Business, the budget “calls for privatizing the $2.4 billion public mental health system by turning over state funding to Medicaid HMOs.”

This hasn’t happened yet. But a new policy is expected to be finalized this fall and presented to the legislature in January, and mental advocates are worried.

Dohn Hoyle is director of public policy for The Arc, an advocacy group for those with developmental disabilities. He told me yesterday that the DMC experience shows that “relying on an out-of-state, for-profit corporation to correctly or even safely serve a vulnerable population was clearly a mistake.”

Hoyle was one of a number of mental health professionals who walked out of a meeting with state health officials last week, a meeting that was convened to discuss how to coordinate Medicaid mental health payments and improve services.

Tom Watkins is president and CEO of the Detroit Wayne Mental Health Authority, the largest service provider of its kind in Michigan. “There’s tremendous fear among advocates,” he said.

These fears, he added, are not without reason. Private insurance companies, Watkins said, are in business to make a profit for their shareholders which, ideally, may mean running away from the most at-risk cases.

That’s exactly the opposite motivation from those who service those most at need. "Our job is to run towards them,” Watkins said.

Watkins doesn’t think the worst is inevitable. Over the spring, a group of mental health advocates calling themselves the 298 Workgroup had a series of meetings with Lt. Gov. Brian Calley, who initiated the discussions. They worked out a set of core values they said needed to be part of any new proposal on coordinating delivery of services.

Some folks, however, don’t trust the governor and especially the legislature to sufficiently recognize and respect their values which is why they walked out of that meeting.

Watkins himself isn’t necessarily opposed to privatization per se; much of the current community mental health system is private non-profit. He just gets the willies at the prospect “of a wholesale transfer of $2.4 billion taxpayer dollars for mental health services to the private, profit-making insurance companies.”

Watkins thinks integrating physical and mental health care is a good goal, but cautions “it must be done with the needs of the person served driving all decisions.”

He says what’s important is that any changes help, not hurt, “the over 300,000 vulnerable friends, family members and citizens who depend on us for support and care.” He wants lawmakers to eventually vote as though someone they personally know and love will be impacted by their decision.

More often than not, that’s likely to be true.

Jack Lessenberry is Michigan Radio's political analyst. Views expressed in his essays are his own and do not necessarily reflect those of Michigan Radio, its management or the station licensee, The University of Michigan.

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