October 6, 2022

Unwell Up North: Northern Michigan's Mental Health Crisis

Support and services lacking for all but especially for the group most in need: our youth
By Craig Manning | Nov. 13, 2021

If you’ve tried finding a therapist for yourself or your child lately, you’ve probably had a hard time. That’s because northern Michigan doesn’t have the capacity to handle the huge spike in demand for mental health care services that COVID-19 triggered, local mental health professionals say.

Even before the pandemic, the region was bound for trouble. National statistics show that demand and need for mental health care among kids and teens have been on a steady rise for years — a precarious powder keg growing more dangerous year after year.

COVID-19 lit that powder keg on fire, and now northwest Lower Michigan’s youth mental health situation is in crisis mode. What happens next will depend on a variety of factors: political will, the ability for local players to build bridges and collaborate with one another, and how much empathy parents, teachers, coaches, and other local residents can muster to help destigmatize mental health struggles among youths.

THE NUMBERS
In March 2020, a study published in the Journal of the American Medical Association (JAMA) examined how “mental health problems for which adolescents received care and the service settings where they received care” changed from 2005 to 2018. Across the survey years, more than 230,000 adolescents were surveyed, and 47,090 of them (19.7 percent) received some form of mental health care.

First, the good news: The JAMA study actually concluded that “the overall prevalence of mental health care did not change appreciably” from the start of the survey window to the end of it. The bad news is that, even before the pandemic, adolescents were already seeking care for more severe mental health situations than they did back in 2005.

At the start of the research window, for instance, struggles with “suicidal ideation and depressive symptoms” made up less than half (48.3 percent) of the visits that youths were making to inpatient or outpatient mental health care settings. By 2017­–18, that percentage was up to 57.8 percent.

Mental health struggles are especially common among girls, the JAMA study found. Female adolescents accounted for 57.5 percent of mental health care visits across the survey period, with incidence rates rising steadily between 2005 and 2018.

Researchers ultimately concluded that the increasing severity of mental health problems among adolescents ­— combined with an uptick in “use of outpatient mental health services” over time — were “placing new demands on specialty adolescent mental health treatment resources.”

The arrival of the COVID-19 pandemic — which was only just picking up steam when the JAMA study was published — has only made matters worse. According to the CDC, the summer of 2020 saw “a 22.3 percent spike in ER trips for potential suicides by children aged 12–18,” compared to the previous summer. The numbers looked even worse during the winter of 2020­–21, when ER visits for potential suicides increased a whopping 39.1 percent year-over-year.

Again, the data suggests that girls are particularly at risk. Between February 21 and March 20 of this year, ER visits for potential suicides were up 50.6 percent for girls aged 12–17, compared to the same one-month stretch in 2019.

LOCAL FOCUS
These national trends are borne out by local data, too. For instance, North Country Community Mental Health (NCCMH) — which serves the six-county region of Antrim, Charlevoix, Cheboygan, Emmet, Kalkaska, and Otsego counties — tracked a 24.6 percent increase in “crisis assessments” at its region’s five hospital emergency departments over the course of its 2021 fiscal year, which ran from Oct. 1, 2020, to Sept. 30, 2021. (That number reflects mental health crises for both children and adults.)

The National Alliance on Mental Illness (NAMI) defines a mental health crisis as “any situation in which a person's behavior puts them at risk of hurting themselves or others and/or prevents them from being able to care for themselves or function effectively in the community.”

“The stats [regarding youth mental health needs] are troubling, even pre-pandemic,” says Gina Aranki, executive director of Child and Family Services of Northwestern Michigan (CFS). “One stat I heard recently is that the number of children meeting criteria for Severely Emotionally Disturbed (SED) has been rising steadily in the past few years. In all of 2018 there were 34 children within the region of Crawford, Grand Traverse, Leelanau, Missaukee, Roscommon, and Wexford Counties that were admitted to an inpatient psychiatric children’s unit. In 2021, only three years later, 39 children were admitted in one quarter— between the months of June and September 2021.”

THE CAUSES
The pandemic is the easy scapegoat to blame for local and national spikes in the need for youth mental health.

Certainly, Aranki feels that “the isolation and uncertainty children and adults have felt since the pandemic have exposed the areas in which our current system is lacking, including access for many and not enough professionals in relevant fields to staff needed increases in services.” From health insurance policies that don’t cover mental health services, to insufficient numbers of therapists able to take on new patients, the system was never set up to respond to the sea change that COVID-19 brought. 

But local experts also say that blaming the pandemic for the problem is too easy — and doesn’t account for the full scope of the crisis.

“I think social media has driven a lot of it,” says Kate Dahlstrom, a Traverse City woman who embraced youth mental health advocacy after her son went through a series of mental health struggles in college. “I think the pressure that kids put on themselves when they're sharing on social media — or that kids put on each other — is really significant. I can't even imagine if I was a young person now with social media, and with all the criticism that comes with that, or with the pressure that comes from looking at others who pretend to be so perfect. It’s hard, especially for girls.”

Social media, texting, cyberbullying, even video games: These outlets are commonplace among today’s kids and teens that their parents either didn’t have to deal with growing up or experienced in fundamentally different ways. As a result, Aranki says parents and adults don’t always understand the need for youth mental health.

A common narrative Aranki sees among many grown-ups is that, since they didn’t need mental health services to get through their school days, surely their kids can muddle through the stressors and emotions of growing up, too. What adults with this mindset miss is that the world is a very different place than it was 30, 20, or even 10 years ago.

“It's funny,” Aranki says. “In my experience, the mindset is like a pendulum that swings back and forth between ‘Everyone gets a medal for participating’ to ‘Grow a backbone’ — both of which are simplistic and miss the mark. The elephant in the room is the internet, and the way children and youth are plugged in 24/7. There's no way to get a break from the bullies; no way to escape the images of others either looking a certain way or living a fabulous life. Kids — and all of us who participate — end up wondering why our own lives and selves don't look like those others. There are pressures on youth today that are different than previous generations, and the way they seem to be manifesting is in mental health struggles.

 “As adults, we're all trying to navigate those challenges alongside our kids. It requires space to have good conversations with them about what they're experiencing, and good outlets for their minds, hearts, and bodies [that are] unplugged from the pressures of social media.”

THE NEEDS
So, what does northern Michigan need to respond to the growing youth mental health crisis — and to resolve its existing insufficiencies in serving kids and teens who are struggling?

“NAMI — of which there is an active and growing chapter here in northwest Michigan — says that a good menu of mental health programming in any community needs to include three things: 24/7 local hotline access, or ‘someone to talk to’; a mobile response team, or ‘someone to respond’; and a crisis stabilization center, or ‘somewhere to go,’” says Aranki.

Currently, Aranki says northern Michigan is lagging behind in two of those three categories. The community does have a strong mobile response team, she notes, provided in partnership between CFS and local CMH offices. While Aranki would like to see those teams “expanded and publicized more widely,” they are mobilized around the region to respond to situations where children are “experiencing behavioral or mental health crises.”

But there are gaps elsewhere. On the subject of 24/7 local hotline access, Aranki mentions the Third Level Crisis Intervention Center — a fixture in northern Michigan since 1971, and now part of CFS thanks to a 2014 merger. The merger was intended to consolidate the resources of the two entities and streamline their shared missions of “supporting children and families during moments of crisis.” While Third Level is still a component of CFS, though, Aranki says that “funding [for the hotline] went to a West Coast provider that I presume was less costly.”

Translation: CFS still has a 24/7 hotline that kids, teens, or families can call for help — it just isn’t staffed locally. “So ideally, we'd bring back that local component,” she says. 

As for northern Michigan’s single biggest youth mental health care, most local experts seem to be united in the belief that the region needs significantly more inpatient mental health services.

PROGRESS
Last December, NCCMH and Northern Lakes Community Mental Health (NLCMH, which serves Crawford, Grand Traverse, Leelanau, Missaukee, Roscommon, and Wexford counties) contracted with a consulting firm called TBD Solutions “to assess the behavioral health crisis system in their shared 12-county region in northern lower Michigan.” That process, which ran from December to June, involved Munson Healthcare and McLaren Health Care as “active and collaborative partners.”

The resulting “Northern Michigan Crisis System Assessment” provided four key recommendations. At the top of the list? “Develop and/or expand crisis services to include a crisis stabilization unit, psychiatric urgent care, adult crisis residential, and additional child and adult psychiatric inpatient beds.”

According to Christine Gebhard, CEO of North Country Community Mental Health, there is currently “no inpatient facility in northern Michigan or in the Upper Peninsula” that offers long-term beds for youths experiencing mental health crises.

One of the problems, in Dahlstrom’s opinion, is that many people don’t think of mental health care as something that even needs to happen in a long-term inpatient facility. The image of mental health services that most people have in their heads is of the outpatient 45-minute therapy appointment. Even if there were enough therapists and counselors in the region to respond to the area’s mental health needs, though, outpatient therapy wouldn’t always be the ideal mechanism to help a youth in crisis. 

“There are waitlists [with local therapists], and a lot of providers aren't even taking new patients,” Dahlstrom explains. “So, if you're on a waitlist for a month, and then you have a crisis, and you're really in trouble, but you can't even get your 45-minutes-every-two weeks meeting [with a therapist], how do you expect to really improve it all?” 

By Dahlstrom’s count, Munson Medical Center in Traverse City currently has just 17 inpatient mental health care beds, and those are intended only “for very severe adult mental health crises, with stays often between 3–8 days.” It’s something, but it’s too narrow to respond effectively to the growing numbers of patients in need. 

“The range of services in Traverse City should be broad enough to meet the diverse needs of persons struggling with varying forms of mental illness,” Dahlstrom says. “Inpatient stays should range from 23 hours to 90 days. Obviously, if a person needs 60 days to stabilize and get immersed into a lifelong treatment plan, but only receives three days, the result is a continuous revolving door, as we see now.”

These types of longer-term inpatient facilities do exist in Michigan, but Dahlstrom says most of them are downstate. She recalls a time several years ago when a friend’s daughter needed to seek treatment for an eating disorder. Local health care providers referred the patient and her family to a long-term inpatient facility at the University of Michigan.

Dahlstrom sees that kind of solution — sending patients to other parts of the state to receive the care they need — as a mixed bag. On the one hand, patients are at least able to get the care they need. On the other hand, non-local facilities add other challenges to the equation. Many youth mental health treatment programs, for instance, require or strongly encourage the engagement of parents and family members for at least part of the treatment timeline — a challenge for parents trying to hold down jobs in Traverse City while their child receives treatment in Ann Arbor. 

Distance between home and treatment facility can also cause challenges once patients have concluded their stint in inpatient care.

“If [the patient] is downstate, and they've been doing this one thing and doing it really well, but then they come up here … then there’s a total detachment from what they were doing [in inpatient care],” Dahlstrom says. “It makes it extremely difficult to continue on with a good plan.”

Fortunately, there are signs of progress. Aranki says that “a number of individuals and organizations are currently working together on the inception of a crisis stabilization center.” Those efforts hit a setback when the region was turned down for a federal grant that would have helped finance the project. Still, local stakeholders are aware of the need and are actively working on ways to address it.

Just this week, the Northern Michigan Community Health Innovation Region (NMCHIR) hosted a behavioral health summit, with the idea of bringing together community mental health stakeholders and drafting an aligned set of goals and a comprehensive roadmap for providing and improving behavioral health services in the region.

“Youth inpatient will be a part of [that roadmap],” Gebhard says.

Whatever the roadmap ends up looking like, the stakes could hardly be higher.

“If we don't help our kids now, they will be less able to function successfully as adults, meaning more pressure on the adult mental health system, jails, and prisons — and increased medical health problems, as mental health and physical health are so intertwined and connected,” Aranki says. “There will be increases in suicidal ideation and suicide. This scenario also bodes badly for a labor force that is already shrinking across nearly every field and profession, including human services. Pay now, as the old saying goes, or pay later.”

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