CCBHCs extend mental health care to more Michiganders despite challenges

OnPoint is the CCBHC serving Allegan County.
Michigan was added to the country's list of certified community behavioral health clinic (CCBHC) demonstration states back in the summer of 2020, with 29 counties throughout the lower peninsula operating CCBHCs through their community mental health (CMH) centers according to the MDHHS website. 

Wil Morris, CEO, Sanilac County Community Mental Health (CMH) and Mark Witte,  executive director of OnPoint, Allegan County’s CMH, say that overall having this CCBHC demonstration site certification has allowed for more rural county CMHs to expand services to their communities greatly. Morris explains that prior to this certification, residents in Sanilac county had to leave the county entirely to find certain kinds of specialty care such as child psychiatry. The requirements for CCBHC certification allowed Sanilac County CMH to provide additional services and ability to recommend patients more effectively.

Wil Morris“We knew a lot of our citizens couldn’t receive certain kinds of care because it just wasn’t available in their backyard,” says Morris. “This has allowed us to open up resources that are not available within 50 miles of the Sanilac county seat.”

Morris also says that Sanilac County CMH has been able to provide services to more patients, whether they require consistent care or simply need a referral for their child to receive an ADHD diagnosis. This expansion has allowed the CMH to provide services to 23% more patients than in previous years and mediate crises more quickly and more effectively.

“Historically, we’ve provided services to folks with severe conditions,” says Morris. “Now, we can serve more people with mild-to-moderate conditions, as well, and provide preventative care to improve patient outcomes sooner.”

Witte has similar stories about OnPoint seeing success since receiving CCBHC designation. He says that while OnPoint was already working diligently in the community to provide behavioral health and substance abuse services, becoming a CCBHC has allowed them to put more emphasis on these services as well as other programs such as homelessness services and furthering OnPoint’s relationships with other local care providers.

“CCBHC designation has really opened a lot of doors for On Point,” says Witte. “We’ve been able to put more emphasis on what already existed through expanding the services available for crisis access and addiction treatment, as well as emphasize health care integration to refer patients to other health services they need in addition to their mental health care.”
Mark Witte
Like Sanilac County CMH, OnPoint has also seen a significant jump in the amount of patients served since applying for CCBHC designation. Witte says that because OnPoint now has the ability to provide outpatient services as well as more flexibility in how patients pay for services, OnPoint has seen increases in patients both seeking traditional behavioral healthcare and substance abuse services.

“The total number of people served in our behavioral health and substance abuse programs in 2023 was 2,259. Six months into this year we’re at 2,175,” says Witte. “We’ve had many more people come to our door than ever before. Now we need more staff to accommodate them.”

Witte and Morris agree that CCBHCs in Michigan are the way to move behavioral health care and substance abuse programs forward throughout the state, but say eligibility requirements need to be flexible so more communities can apply. They also believe that CMHs need to continue building strong relationships with local providers and other community partners such as schools and local law enforcement to both find creative ways around some of the requirements and offer their communities as much variety in services as possible without sacrificing quality of care. 

“We need to strive to be the best we can be to support our community,” says Witte. “Seeking CCBHC designation is part of our commitment to the community — to be good at what we do and meet community needs for essential behavioral health services.”

As a CCBHC, Sanilac County CMH can better serve all ages.
Challenges persist for CMHs serving rural areas

Because of some current CCBHC requirements at both the federal and state level, some Michigan counties have had to find unique ways to offer additional services to the communities they serve to retain their CCBHC status — and some have been ineligible for CCBHC status at all.

Federal guidelines require all providers who seek CCBHC demonstration site status to provide nine different comprehensive services, such as 24 hour mobile crisis teams, outpatient mental health and substance services, and psychiatric rehabilitation services. Each state has its own specific set of requirements as well. The Michigan CCBHC handbook is updated each year in order to provide accurate and up to date guidance for providers seeking to apply as a CCBHC demonstration site. The state expands on the federal requirements to include things such as ensuring “no individuals are denied behavioral healthcare services [...] because of an individual’s inability to pay for services,” as well as providing care services to all patients regardless of their place of residence or lack of permanent address. 

Other state requirements, such as expanded hours of operation and having fully staffed clinical and non-clinical CMH teams, have been challenging for CMHs in more rural areas of the state. MDHHS associate public information officer Chelsea Wuth explains that Michigan’s handbook has “built-in flexibilities to support success at rural clinics,” but some of these clinics are still unable to meet the requirements. Despite these challenges, facilities currently operating as CCBHCs in these more rural counties have been exploring unique ways to meet the requirements to the best of their ability. 

Morris explains that Sanilac County CMH applied for CCBHC-related integrated care grants through SAMHSA twice before finally receiving funding on the third time applying. He says that the process was “arduous” given the small size of their facility.

“We have a small staff as far as data management and finances, so we put a lot of responsibility on just a few people to put together grant applications,” says Morris. “I would imagine that’s something that’s daunting for some of our smaller neighbors as well.”

However, once Sanilac County CMH received their CCBHC designation, Morris says that they were able to expand their services greatly to support more of the community. Sanilac County CMH has seen an overall increase in the amount of patients served in the first six months of this year, while expecting that number to continue to rise as the year goes on. The increase in patients, though, has also required more staff to continue meeting community needs. Morris worries about Sanilac County CMH continuing to be eligible for CCBHC status when the time comes to reapply next year.

“We’re being creative,” says Morris. “Every year the state changes the CCBHC criteria. We have been very blessed at addressing some of the requirements uniquely, but next year’s handbook may make things difficult because of our size.”

Being a CCBHC allows OnPoint to better succeed in its mission, vision, and values.
Staffing isn’t an issue exclusive to Sanilac County CMH. Allegan County’s CMH, OnPoint also has seen challenges in regards to its CCBHC designation due to staffing issues. OnPoint executive director Mark Witte says that expanded access and funding to mental health care services has been a net-positive for the community, but has also caused CMHs challenges in retaining staff.

“CMHs have had a hard time competing with other entities that also received enhanced funding for mental health services these days,” says Witte. “Schools have been given funding to provide mental health services within the schools, which is wonderful. But we have lost some staff due to folks moving into the schools instead, or clinicians entering private practice arrangements that are 100% virtual.”

Staffing is only one issue that rural CMHs like Sanilac County CMH and OnPoint have faced while applying for CCBHC status. Some of these issues are out of CMH control to change, like the overall number of community members who want to utilize CMH resources. Morris says that because of Sanilac’s population, the possibility of Sanilac County CMH being required to offer 24-hour crisis services, for example, would be too costly and not used frequently enough to be an effective use of financial resources.

“Sanilac has under 40,000 residents, and if I was required to open a 24-hour crisis center, I could go a month without a single person in it,” says Morris. “Rural communities struggle with these types of things because our transportation systems aren’t as robust, and the number of patients we have interested in these services is smaller because there are fewer of them overall.”

Witte also says that the state CCHBC requirements have posed challenges for rural CMHs such as OnPoint more so than the federal requirements, due to state certification being “much more rigorous” and requiring CMHs to reapply annually.

“State and federal CCBHC requirements differ with each state having a different emphasis,” says Witte. “There is a lot more documentation about meeting every element of the standard at the state level whereas the federal level is much more general.”

Washtenaw County CMH, LifeWays, Summit Pointe, and Genesee Health System are four more of the CCBHCs serving 29 Michigan counties.
Despite the challenges, both Witte and Morris see CCBHCs as crucial to mental health care in the state of Michigan.

“I believe that a CCBHC system is necessary to move mental health care forward especially in rural communities,” says Morris. “It’s going to require a high level of collaboration and compromise so that rural communities are able to do those types of adjustments without putting their whole system at jeopardy.”

To learn more about the Michigan CCBHC Demonstration Program and its associated requirements, visit MDHHS’s website.

Rylee Barnsdale is a Michigan native and longtime Washtenaw County resident. She wants to use her journalistic experience from her time at Eastern Michigan University writing for the Eastern Echo to tell the stories of Washtenaw County residents that need to be heard.

OnPoint and Summit Pointe photos by John Grap.
Washtenaw County Community Mental Health and LifeWays photo by Doug Coombe.
Sanilac County Community Mental Health photos and Genesee Health System photo courtesy the agencies.

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, LifeWays, Mental Health Foundation of West Michigan, Northern Lakes CMH Authority, OnPoint, Sanilac County CMH, St. Clair County CMH, Summit Pointe, and Washtenaw County CMH.