Community Mental Health Association of Michigan study shows integrated care is growing

The Community Mental Health Association of Michigan (CMHA) is the state association representing and advocating for Michigan's public mental health system and those served by this system.
A research arm of the Community Mental Health Association of Michigan (CMHA), the Center for Healthcare Integration and Innovation released its Healthcare Integration and Coordination – 2022/2023 Update: Survey of Initiatives of Michigan’s Public Mental Health System in March. Around 40 organizations participated in the study, showcasing about 800 healthcare integration initiatives operating across the state. Integrated health care joins mental health, substance abuse, and primary health care to create more effective care for people in need.

The study shows that integrated care in Michigan’s public mental health system has not only grown in the last six years, but that the initiatives are diverse and available in rural, suburban, and urban committees.

According to CMHA Executive Director Robert Sheehan, these results for the average person show integrated care “is really good care” and that there are several ways to get integrated care. Also, public mental health systems are innovating to provide numerous integrated care initiatives, which currently are not available in private sector facilities where most of the public seeks care. 

“The average person, who’s a voter and might care about public policy, might say, ‘Wow, I want more of that leading edge, behavioral health system integration,” Sheehan says.

The report detailed hundreds of integration efforts taking place across Michigan’s public mental healthcare system that increased behavioral health consumers' access to primary care services; improved access to behavioral health services for people seen in primary care settings without ready access to the full array of behavioral health services; improved prevention and interventions that reduced serious physical illnesses; and improved health status for health care consumers overall . 

St. Clair County Community Mental Health hosting a vaccination clinic.

Among the many healthcare integration efforts, three seemed to be used the most.

• Coordination of care. A patient’s care activities are organized and information is shared among all of the providers concerned with that parent’s care. The goal is to achieve safer and more effective care. The study found 157 initiatives using coordination of care.
   
• High utilizer initiatives. These provide patients with comprehensive case management. A patient utilizes a lot of services, health services as well as human services such as public safety or housing support. The study found 147 joint efforts in high- and super-utilizer initiatives.
   
• Co-location of care. Behavioral health and intellectual/developmental disability services or protocols are provided by a behavioral health staff to a primary care site or hospital emergency department via face-to-face or via telehealth psychiatric consultations. The study identified 115 efforts to co-locate physical and mental health services.
   

Overcoming the challenge to integrate

“[Integrated care] sounds like a no-brainer, right? Let’s just work together,” Sheehan says. “Except the record keeping is really different. The primary care is short appointments and mental health care tends to be longer ones. Usually, physical health care is often based on coming into the doctor’s office and a lot of our [mental health] care is going out to people's schools and workplaces.”

To overcome those challenges, the study found public mental health organizations are utilizing several integrated care methods based on patient needs, the geography, the health care practitioner’s skill set, or even considerations like is a bus line nearby. The evolution of integration initiatives, which are becoming more concentrated, is efficient and advanced in meeting the demands of Michigan residents.Uswa Ali Memon, policy analyst for Community Mental Health Association of Michigan

“I was really intrigued that so much of the stuff that’s happening is not documented as much as it should be because these are big things,” says CMHAM policy analyst Uswa Ali Memon.

For that reason, she decided to include case studies in the survey report to make it easier to understand what integrated care is, encourage CMHs to showcase their work, and to highlight the complexity of the cases. 

By looking at the case studies, Memon says, “You actually understand how complex things are, which is not the sense you get when you follow the processes. You think if you follow a, b, and c, you will get the output, but it’s not always as simple as that.” 

“Our system gets better every year.”

Through the study, existing projects demonstrated more maturity than prior integration initiatives and deeper involvement from health integration partners. 

“Our system gets better every year,” Sheehan says. “What we have learned is that if you stay with it, this is a live organic process. It's not just an initiative or a project that changes the way you do behavioral and physical health care. That's the biggest thing. This is a live thing that every year gets more sophisticated. We learn from our errors, we back away, and we drive forward. I've been impressed with the results.”

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. 

Robert Sheehan photo by Roxanne Frith. Uswa Ali Memon photo and CMHAM logo courtesy Community Mental Health Association of Michigan. Other photos courtesy St. Clair County Community Mental Health and Genesee Health System.


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.