Mental health professionals disagree over a bill that would expand who can perform mental health assessments while requiring them to be done within 3 hours, saying the effort merely codifies what that community mental health service programs are already contractually required to do.
House Bill 6355, sponsored by Rep. Graham Filler of R-Greenbush Township, was introduced before the House Health Policy Committee for testimony only.
The bill would change Michigan’s mental health code to require a Community Mental Health Services Program – also known as CMHSP – pre-admission screening unit to assess a person being considered for hospitalization within three hours of being notified by a hospital of the need for an assessment.
The bill would also allow for the assessment to be performed by a clinically qualified person if the pre-admission screening unit could not complete the assessment within the three-hour time frame.
“I just think having a patient wait for hours or days can be extremely detrimental,” Filler said during his testimony. “We’ve seen in the state of Michigan some of these huge issues with people just waiting – waiting for an assessment, waiting for a bed. And people with mental health, mental illness, need immediate care in the same way as people with other injuries or illnesses.
Part of the state mental health code already requires each CMHSP to establish one or more pre-admission screening units within 24 hours to provide assessment and screening services to people whose admission to mental health programs inpatient or outpatient treatment is considered. The address and telephone number of pre-admission screening units should be provided by CMHSPs to law enforcement agencies, hospital emergency rooms, and the Department of Health and Human Services.
A pre-admission screening unit is needed to then assess a person who is being considered for admission to a hospital run by DHHS or under contract with a CMHSP. If the person is clinically fit for hospitalization, the pre-admission screening unit is required to authorize voluntary admission to hospital.
Filler’s bill would reduce the window for a pre-admission screening unit assessment to be completed within 3 hours of being notified for an assessment by a hospital, which is defined in Michigan’s mental health code as an “inpatient program operated by DHHS for the treatment of persons with severe mental illness or severe emotional disturbance or a psychiatric hospital or psychiatric unit licensed under the … code.
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If a pre-admission screening unit is unable to complete the assessment within 3 hours of notification from a hospital, a clinically qualified person may perform an assessment for the CMHSP, Crisis Stabilization Unit, the hospital or other entity contracted to perform assessment and screening services.
There is no penalty if this need to respect a 3 hour window is not respected.
The bill defines such a person as someone who, at a minimum, has a master’s degree in a specific behavioral health profession. The pre-admission screening unit would also be responsible for the costs of performing any assessment under this provision.
Nicole Knight, a pediatric nurse and founder of Michigan Parents for Mental Health Reform, said the impetus for the bill came from a conversation she had with Filler regarding her son’s own experience with a psychiatric crisis. .
Knight, who described her son as having significant mental health issues, said her family had already experienced wait times ranging from a week to 43 days for care that “as a single mother is a significant financial burden on our family”.
“Also, it’s a significant mental stress for my son who isn’t used to being housed in a 10 by 10 room. It leads to restraint and sedation and other trauma that doesn’t only compound the trauma he has already suffered,” she said. “Urgent psychiatric needs really should be given the same priority as physical medical needs.”
House Fiscal Agency analysts predict the bill would have negligible fiscal impact on the state, but could increase local CMHSP fiscal costs. CMSHPs, on average, have traditionally completed pre-admission screenings within three hours 97.6% of the time.
Several questions have arisen that Michigan faces an underlying shortage of behavioral health professionals overall and inpatient beds — a fact that would undermine this legislation.
Filler, however, countered that this was not intended to address a shortage of medical professionals, but to allow others in the field to help fill in where a shortage is seen. Knight added that the sooner screening is completed, referring to the 3-hour window, the sooner a patient can get care, which “makes a big difference.”
Marianne Huff, president and CEO of the Mental Health Association of Michigan, spoke in support of the bill and the intent behind it. She said community mental health service providers, as well as prepaid inpatient health plans, are already required, as outlined in a contract with DHHS, to complete assessments and evaluations within 3 hours.
But Huff also expressed concerns that a properly licensed mental health clinician could only step in to help if a CMHSP was unable to conduct an assessment. Also concerned about the legislation, Allen Bolter, associate director of the Community Mental Health Association of Michigan, called the legislation “a hassle-free solution.”
“We consider that this bill merely codifies this contractual requirement into law. … All of this is extremely tragic, but this legislation does not – from our point of view – solve this problem,” Bolter said.
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