In-patient pediatric psychiatric facilities in Metro Detroit

[Orthophonic]

I'm not asking for any personal stories here, but can somebody give me some input on the state of inpatient psychiatric hospitals here in Detroit, in particular pediatric? Children's does not seem to have anything. There is a place called BCA Stonecrest on Gratiot. Beyond that you need to start going out to Auburn Hills, Ann Arbor, Grand Rapids, etc. I fully recognize that mental health treatment is [[unjustifiably) an afterthought in most insurance plans, typically lumped in with "substance abuse" and other stigmatized "behavioral" issues.And for background, anybody have some non-politicized history on the Lafayette Clinic and its Englerized closure? Did I just politicize this by calling it "Englerized"? Answer: No, it was his administration's idea and action.Rather than just trying to stir the pot I am really interested in this. With a family member recently hospitalized it is puzzling to me why there seem to be so few local facilities to treat this. Perhaps Detroit is average in this respect? Or do we devalue mental health more than other places? Perhaps knee replacements are more lucrative. I fully support incorporating the mentally ill into the community - we are all somewhere on the spectrum of relative mental health. But how do we help the people, particularly the children, who can't handle daily life due to their own inner turmoil? I do not support suicide by police. Clearly this is a ripe opportunity for smart-ass remarks. But please work with me, people!

[Blueidone]

I'm sorry that I cannot speak to any facility within the City of Detroit. I have some experience with one in Macomb County and one in Oakland County, neither one of which impressed me very much. I did talk to the folks at U of M a few times, but never used their facilities. My young grandson had some issues a couple of years ago and treatment was, to put it mildly, lacking. Everyone just wants to throw pills at the the problem and that's it.

I can tell you for sure that no one in the State of Michigan cares very much for the mental health of its residents regardless of age.

[Slim]

In the course of my work [[private service EMT), I've been in pretty much all of the psychiatric facilities in the metro area, and most of them have both adult and adolescent units. The exceptions to this are in-patient wards at the traditional hospitals, most of those tend to be adult only.

In addition to BCA Stonecrest on Gratiot, there is Henry Ford Kingswood hospital on Mendota just north of 8 Mile in Royal Oak Twp. Also, within a reasonable distance of the city are Behavioral Center of Michigan at 12 Mile & Ryan in Warren, and the Hawthorne Center at 7 Mile & Haggerty out in Northville [[across from Schoolcraft College). Getting a little farther out, there are Havenwyck Hospital in Auburn Hills, St. Joe's Mt Clemens, and Harbor Oaks Hospital at 23 Mile & Jefferson in New Baltimore.

Unfortunately, we have to take people where the beds are. My company is based in Pontiac, and it's not uncommon for us to take patients all over the metro area.

I'll concede that most of them aren't very nice places, but I only see a small microcosm of them. On the other hand, I used to take patients in and out of the old Clinton Valley Center, and most of these places now are like comparing the Motel 6 to the Westin.

[Lt. Dan Bassett]

my info may be dated because the institutionalization of family members goes back almost 10 years to start. behavioral or chemical imbalance -- they all are lumped together [[learn bad habits and exposed to all kinds of disfunction and very real crazyiness). medications can and do really change who the person is. not necessarily a good thing if they come out the other side to be integrated back into the community [[memory and concentration issues). We've had experience with Havenwyck, St. Joe [[A2), over on Mendota, and Hawthorne. St. Joe was very caring. Havenwyck very clean and structured. Mendota, a little rough around the edges [[old facility) but caring and structured [[lots of bad boys though). Hawthorne, can be end of the line where you find out if your minor is looking at lifetime institutionalization or finds the will to move away from destructive bahavior [[a very sobering experience). Finding med balance is like trying to scratch your butt with a boxing glove.
Hawthorne is very structured and caring. If humanly and spiritually possible, the "client" has to want to work out the issues. Fortunately, ours is. Some states [[like PA) do better jobs of providing services. We did lose one to suicide two years ago. I miss her every day.

[Scottathew]

Everyone just wants to throw pills at the the problem and that's it.

My dad's side of the family has a lot of mental disease, and I most certainly agree with your statement. Not only do they just want to throw pills at it, they also don't even want to take time to get the medication mixture correct.

[Barbara Nadel]

I can't speak for any facility in Detroit or even in the USA. Here in the UK, we have free health care as I expect you know [[if you can live long enough to get it). But mental health is still the Cinderella service even here and stigma remains a problem. Community solutions can work very well provided enough money is spent by the authorities and provided the community are educated to understand what mental illness really is. I worked in mental health services for many years, still have contact with them and believe passionately that education and putting the patient first is the key. A relative of mine was seriously ill for 10 years before he found a psychiatrist who was willing to take the time [[and spend the money) to get his medication right. But it has paid off because he can now live in the world. As you can see this is my 'pet' subject. I absolutely hate it when people with mental health problems can't get the treatment that they need. Apart from anything else, if someone is ill and untreated eventually it costs nations more in lost working days and emergency medical care.

[Jimaz]

There was a related story in yesterday's Free Press:

After closing psychiatric hospitals, Michigan incarcerates mentally ill

[Mikeg]

De-institutionalization of the mentally ill in Michigan

Note: I pieced this brief history together from the linked sources noted below. The number of institutions in 1974 and 1981 are my best reconstructed guesses because some sources provide conflicting data for the number of institutions closed over a period of time. My focus is strictly on what drove the de-institutionalization and when it happened over the past half-century - not how well the community-based approach has worked, whether it has been sufficiently funded, impact on the corrections system, etc. If you want to make this into a partisan issue, it's best to know the full history behind Michigan's de-institutionalization of the mentally ill and which political parties were in control of the executive and legislative agendas during that period.
.
State hospitals and centers originally were the main means of treating and caring for the mentally ill and developmentally disabled. In the first half of the 1900s, the capacity of state institutions grew dramatically. However, by the 1960s there had evolved a general consensus among mental health professionals and the public that the needs of most mental health patients could best be met in community programs located as close to a patient's family as possible.

In 1963,
a) the Michigan Legislature passed Public Act 54, authorizing the creation of Community Mental Health Boards [[CHMBs) to stimulate the formation of community care programs.
b) the US Congress passed the Community Mental Health Centers Act, which provided funding aimed at developing community-based care centers in order to reduce hospital populations by 50 percent within ten years

In 1974 the Michigan Mental Health Code [[Public Act 258) transferred the authority and funding for the care and treatment of adults and children with mental illness and developmental disabilities from the state to the former CHMBs, now designated Community Mental Health Services Programs.

The decline in the mental health institution population in the second half of the twentieth century occurred not because fewer people were being afflicted or diagnosed but because of court rulings that limited involuntary commitments, dramatic improvements in treatment, and a significant change in how and where society believed people with these illnesses and conditions should be treated. Scientific developments in pharmaceuticals greatly facilitated the movement of people out of institutions and into the community by providing methods to control chronic, serious mental illnesses. The introduction of psychotropic drugs as an element of treatment proved successful for many persons with mental illness.

How much of this de-institutionalization happened on which governor's watch?

Below are the numbers of Michigan's publicly-operated mental health institutions and their patient populations at various points in time over the past 60 years.

Mid 1950s: 20,000
1965: 17,000
1974: 5,000, 45 institutions
1981: 41 institutions
1990: 24 institutions
1992: 2,700
1997: 1,400, 7 institutions [[50 CMHSPs)
2001: 1,330, 6 institutions [[48 CMHSPs)
2010: 818, 5 institutions [[46 CMHSPs)

Below are the governors during this period and the number of years during their administration during which each party controlled both the Michigan House and Senate.

George Romney [[R) was Michigan's governor during 1963-1968; [[R) - 4 yrs., [[D) - 2 years, [[split) - 0 years
William Milliken [[R) was governor during 1969-1982; [[R) - 0 yrs., [[D) - 8 years, [[split) - 6 years
James Blanchard [[D) was governor during 1983-1990; [[R) - 0 yrs., [[D) - 1 year, [[split) - 7 years
John Engler was [[R) governor during 1991-2002; [[R) - 4 yrs., [[D) - 0 years, [[split) - 4 years
Jennifer Granholm [[D) was governor during 2003-2010; [[R) - 4 yrs., [[D) - 0 years, [[split) - 4 years

sources:

http://www.rosehillcenter.org/wp-con...-July-2010.pdf [[pp. 7-9 of this PDF)
http://www.michiganinbrief.org/editi...ntalHealth.htm
http://www.michiganinbrief.org/editi...s/issue-46.htm
2009-2010 Michigan Manual

[compn]

like a few have said upthread, most psych wards just put the patients on the pills and call it a day.

the social worker at one facility was actually fooled by the patient that they were well enough to leave after only the first week of hospitalization. i spent an hour in a family interview with the worker until he realized that the patient was in no way ready to be released.

the doctors [[hospitals and private practices) have not cared enough to give the family tips, support group information, or even called to ask if things are going better / worse on different medications.

i always thought the decrease in mental institutions was due in part to ronald reagan. heres an article from 1984 on the subject.
http://www.nytimes.com/1984/10/30/sc...tml?sec=health

and then if all else fails, theres always the idea of giving your kid medical marijuana:
http://www.youtube.com/watch?v=lWYqzWDIJa8

good luck!

[vetalalumni]

Here is a book I recently purchased which came to mind while reading this thread. Though not pediatrics oriented, this insightful book relates historical information specific to Detroit [[metro). I'm a bit of social history buff .

How Schizophrenia Became a Black Disease: An Interview with Jonathan Metzl
In the late-1960s, schizophrenia's profile as a disease changed dramatically
Published on May 5, 2010 by Christopher Lane, Ph.D. in Side Effects

...

Ionia State Hospital for the Criminally Insane was, for much of the twentieth century, one of the nation's more notorious mental asylums, occupying an incredible 529 acres, and its annual census hovered above 2,000 patients. But, like many American asylums, Ionia suffered a rapid fall from grace in the late 1960s and early 70s, during the so-called era of deinstitutionalization. By 1974, the census was a paltry 300, and in 1975 the facility closed, then quickly reopened—as a prison.

...

When did you first suspect that diagnostic patterns with schizophrenia had become heavily racialized?

I found dramatic racial and gender shifts in persons diagnosed with schizophrenia at Ionia during the 1960s—so much so that schizophrenia's racial and gendered transformation became the central narrative of my book. This shift became apparent very early in my research. Before the 60s, Ionia doctors viewed schizophrenia as an illness that afflicted nonviolent, white, petty criminals, including the hospital's considerable population of women from rural Michigan. Charts emphasized the negative impact of "schizophrenogenic styles" on these women's abilities to perform their duties as mothers and wives.

To say the least, these patients were not seen as threatening. This patient wasn't able to take care of her family as she should, read one chart; another, This patient is not well adjusted and can't do her housework; and another, She got confused and talked too loudly and embarrassed her husband.

By the mid- to late-1960s, however, schizophrenia was a diagnosis disproportionately applied to the hospital's growing population of African American men from urban Detroit. Perhaps the most shocking evidence I uncovered was that hospital charts "diagnosed" these men in part because of their symptoms, but also because of their connections to the civil rights movement. Many of the men were sent to Ionia after convictions for crimes that ranged from armed robbery to participation in civil-rights protests, to property destruction during periods of civil unrest, such as the Detroit riots of 1968. Charts stressed how hallucinations and delusions rendered these men as threats not only to other patients, but also to clinicians, ward attendants, and to society itself. You'd see comments like Paranoid against his doctors and the police. Or, Would be a danger to society were he not in an institution.

...

Jonathan M. Metzl is associate professor of psychiatry and women's studies and director of the Culture, Health, and Medicine Program at the University of Michigan. A 2008 Guggenheim Fellowship recipient, Metzl has written extensively for medical, psychiatry, and popular publications. His books include Prozac on the Couch and Difference and Identity in Medicine. He lives in Ann Arbor, Michigan. ~ Amazon Bio

Bio at UMich http://www2.med.umich.edu/psychiatry...ink_name=Metzl

[vetalalumni]

There was a related story in yesterday's Free Press:

After closing psychiatric hospitals, Michigan incarcerates mentally ill

Thanks Jimaz for adding this thread sub-topic. Here is a compelling book related to the Free Press article.



The New Jim Crow: Mass Incarceration in the Age of Colorblindness
By Michelle Alexander

A longtime civil rights advocate and litigator, Michelle Alexander won a 2005 Soros Justice Fellowship and now holds a joint appointment at the Moritz College of Law and the Kirwan Institute for the Study of Race and Ethnicity at Ohio State University. Alexander served for several years as the director of the Racial Justice Project at the ACLU of Northern California, which spearheaded the national campaign against racial profiling. At the beginning of her career she served as a law clerk on the United States Supreme Court for Justice Harry Blackmun. She lives outside Columbus, Ohio. ~ Amazon Bio

[jtw]

At inpatient facilities, the goal is discharge as soon as possible. In an emergent situation, pills and injections are far more effective in the very short term. Dosing children is difficult as well since age and development are not always well-correlated, and there isn't a good history of allergies, responses, and contraindications. They need to be stabilized and released to a proper level of care [[most outpatient and residential facilities have Hospital Liaison services to help with this). From there, hopefully they progress to a stable combination of therapy/case management and medication. In the short term, they go where the beds are.

"Throwing pills at them" is kind of a jaded half-explanation of what happens at psychiatric facilities. Keep in mind also that many mental health patients are only interested in their meds and willingly skip appointments with their clinicians and therapists after they've seen their psychiatrist.

Also remember that both drugs AND psychiatrists/therapists are expensive. Some injections to treat schizophrenia and other severe illnesses can run into the thousands of dollars per dose.

[compn]

"Throwing pills at them" is kind of a jaded half-explanation of what happens at psychiatric facilities. Keep in mind also that many mental health patients are only interested in their meds and willingly skip appointments with their clinicians and therapists after they've seen their psychiatrist.

this is absolutely true. the patient i talk about would love to just get the prescriptions and not have to sit in a room with a psych for an hour each month. there isnt much reason for a psychiatrist/therapist to talk to the patient if the patient actually has some kind of chemical imbalance. talking about family or life issues with the patient will not help or cure the patient's phsyical problems.

of course this is more of a general problem with doctors wanting to get paid each month for diseases that are life-long and require daily medication. a friend of mine with epilepsy is tired of seeing neurologists for his needed prescriptions every few months. its a waste of doctor time, his time, insurance/medicare and money.