Mental health professionals mixed on bill to shorten evaluation window

Mental health professionals are at odds over a bill which would expand who can perform mental health evaluations while mandating it be done within a 3-hour window, saying the effort only codifies what community mental health services programs are already contractually obligated to do.

Up before the House Health Policy Committee for testimony only was House Bill 6355, sponsored by Rep. Graham Filler, R-Greenbush Township.

The bill would amend Michigan’s mental health code to require a community mental health services program – also referred to as CMHSP – preadmission screening unit to assess an individual being considered for hospitalization within three hours after being notified by a hospital of a need for an assessment.

The bill would also allow the assessment to be performed by a clinically qualified individual if the preadmission screening unit could not complete the assessment within the three-hour timeframe.

“I just think that having a patient wait for hours or days can be extremely detrimental,” Filler said during testimony. “We’ve seen in the state of Michigan some of those massive issues with individuals just waiting – waiting for an evaluation, waiting for a bed. And people with mental health, mental illness, need immediate care the same way that people with other injuries or illnesses do.”

A portion of the state’s mental health code already requires each CMHSP to establish one or more preadmission screening units within 24-hour availability to provide assessment and screening services for individuals being considered for admission into in-patient or outpatient treatment programs. The address and phone number for the preadmission screening units must be provided by the CMHSPs to law enforcement agencies, hospital emergency rooms and the Department of Health and Human Services.

A preadmission screening unit is required to then assess an individual being considered for admission into a hospital operated by the DHHS or is under contract with a CMHSP. If the individual is clinically suitable for hospitalization, then the preadmission screening unit is required to authorize voluntary admission to the hospital.

Filler’s bill would narrow the window for an assessment by the preadmission screening unit to be performed within 3 hours after 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 individuals with serious mental illness or serious emotional disturbance or a psychiatric hospital or psychiatric unit licensed under … the code.”

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Should a preadmission screening unit be unable to complete the assessment within 3 hours of being notified by a hospital, a clinically qualified individual could perform an assessment for the CMHSP, crisis stabilization unit, hospital or any other entity contracted to perform assessment and screening services.

There is no penalty should that need to meet a 3-hour window go unmet.

The bill defines such a person as being an individual who, at minimum, has a master’s level degree in a behavioral health specific profession. The preadmission screening unit would also be responsible for the costs of performing any assessment under this provision.

Nicole Knight, a pediatrics nurse and founder for Michigan Parents for Mental Health Reform, said 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 concerns, said her family has previously experienced wait times of anywhere between a week to 43 days to receive care which “as a single mother bares a significant financial burden on our family.”

“In addition, that’s significant mental health stress on my son who is not used to being housed in a 10-by-10 room. That leads to restraint and sedation and further trauma that just deepens the trauma he already experienced,” she said. “Urgent psychiatric needs really need to be given the same priority as physical medical needs.”

Analysts at the House Fiscal Agency anticipate the bill would have a negligible fiscal impact on the state but could increase local CMHSP fiscal costs. CMSHP’s, on average, have traditionally completed preadmission screenings within three hours 97.6% of the time.

Several questions did arise around the fact that Michigan is facing an underlying shortage of behavioral health professionals overall and inpatient beds – a fact which would undercut this legislation.

Filler, however, countered that this wasn’t meant to solve a shortage of health care professionals but to allow others in the field to help supplement where a shortage is found. Knight added that the sooner the screening is completed, referencing the 3 hour window , the quicker 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 as well as the intention behind it. She said community mental health services providers, as well as prepaid in-patient health plans, are already required as written in a contract with the DHHS to complete evaluations and assessments within a 3-hour timeframe.

But Huff also expressed concerns that an appropriately licensed mental health clinician could only step in to assist if a CMHSP was unable to complete an assessment. Also concerned about the legislation was Allen Bolter, associate director of the Community Mental Health Association of Michigan, who called the legislation “a solution without a problem.”

“We see this bill as only codifying that contractual requirement in the statute. … All of this is extremely tragic, however this legislation does not – from our perspective – solve that problem,” Bolter said.

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