State of shambles

Cuts to mental health services in the US state of Michigan and medical insurance are badly affecting provision for people on low incomes, writes Carole Katz. And it will become worse.   

In the past decade, 10 mental health hospitals in Michigan have closed. The state is currently closing the last full service facility. One small hospital is to be reserved for the criminally mentally ill in the greater Detroit area, the largest urban area in the state. Funding for out-patient services and treatment has also been consistently slashed.

During our last Senate election one of my clients who has schizophrenia contacted the Republican candidate and asked what would be provided for those currently in the process of hospital release. She was informed more group homes were being made available, including support services. But the Republican governor had just made more cuts in contracts with mental health service providers. Unless there are family members available these people end up in shelters or, even worse, in prison.

The people who come to our community mental health clinic are often without family supports or the ability to pay for their expensive medication. Even the national insurance for disabled and older people (Medicare) does not pay for any type of medication. Frequently, they are without any medical insurance and we must provide medication or try to link them with a medication programme through a drug company.

Last week I had two clients who ran out of medication and had to wait for two days until we were able to provide help. Some drug companies make it easy, a simple form to complete for free medication. They understand that our clients would not be in a community mental health agency if they had other options.

Some companies require legal documentation of a client’s income without considering housing or food as expenses, which affects an individual’s ability to pay for medication. Some drug companies do not offer any assistance or samples.

A woman with mental health problems in a woman’s group I run told me her medication costs were $1,000 a month. She qualifies for Medicaid, a state insurance for very poor people. She lives in her mother’s home, and has a college degree. She could work part-time but if she makes any money at all she will lose the Medicaid. If she works enough to pay for insurance or qualify for work-related insurance coverage she will lose her disability status. This could be disastrous if she is hospitalised again and unable to return to work in a reasonable time. She is caught in a catch 22 situation and shares her frustrations with the group, often weeping. She wants to be as much a member of society as she can but is caught up in the bureaucracy. What would she do if she could not live with her ageing mother?

The National Association of Social Workers’ newsletter recently portrayed the mental health system in the US as “in shambles”. I feel that “shambles” euphemistically describes a process of chaos that is affecting a population that is without voice or political advocacy. It is scary to think what will occur in the future as funds become more tightly controlled.

Carole Katz is a social worker in Redford, Michigan.


  • Ethnic groups: white 77.1 per cent, black 12.9 per cent, Asian 4.2 per cent, Amerindian and Alaskan 1.5 per cent, other 4.3 per cent.
  • Religions: Protestant 56 per cent, Roman Catholic 28 per cent, Jewish 2 per cent, other 4 per cent, none 10 per cent
  • Form Indian word “Michigana” meaning “great or large lake”, Michigan is known as the “Wolverine State”. It covers 147,122 sq km (about two-thirds of the size of the UK) with a  population of just over 10 million. Its largest city is Detroit with a population of about 950,000.

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