CMH 101: Who we serve and why

By Betsy Reed

Special Projects Coordinator

In the past 5-plus years, I hope you, dear reader, have enjoyed the many personal stories and informative pieces that have been shared here. It’s come to my attention that I and my guest writers have said a lot about mental health, but not much at all about West Michigan Community Mental Health and the services it provides.

Folks in the community who interact with WMCMH — including physician’s offices and their staff, human service agency workers, school personnel, other social workers and individuals and their families who seek care at WMCMH — have commented that it’s difficult to understand who WMCMH serves and why.

Well, no wonder. It’s complicated. Those of us deeply familiar with the Community Mental Health system may not realize how difficult it is for an outsider to understand. Case in point, I thought this column would be easy to write. Nope. Explaining this issue accurately without overloading you with industry jargon and historical context was certainly a challenge. I have done my best.

The simple explanation is that WMCMH serves individuals who meet its admission criteria. In short, we serve people who have severe mental illness and/or developmental disability, and whose diagnoses affect multiple aspects of their lives. Community Mental Health services are comprehensive and intense, designed for people with many challenges.

Here’s a little more detail. WMCMH’s first priority and responsibility is to serve people who meet the admission criteria AND have Medicaid as their insurance. Medicaid is the state’s health insurance program for low-income children and families and some adults with disabilities. The Community Mental Health system is the state’s means of serving the serious mental health needs of its Medicaid enrollees. Our contract with the State of Michigan provides the large majority of our funding and makes us responsible to serve this specific group of people.

For those who meet our severity criteria, do not have Medicaid, have no other insurance, and no ability to pay, WMCMH is responsible by contract to provide emergency services only. WMCMH receives a much smaller portion of funding for this group of people. Via careful management of funds, and because we think it’s the right thing to do, WMCMH currently provides comprehensive services (not just emergency services) to people in this group. However, funding for this is not a sure thing going forward, especially if Michigan’s Senate does not pass the Medicaid expansion.

Those who do not meet our severity criteria may be referred to our new therapy-only program (more on this in a bit), or other providers in the community as needed. Referrals are not just a hand-off. WMCMH follows up to make sure the referral worked out; if it didn’t, we do our best to find another provider.

A few years ago WMCMH took on an additional contract to provide substance abuse treatment services. We serve people who have substance abuse disorders and have Medicaid or limited ability to pay. We also accept private pay and a few private insurances.

Even more recently, we added our new therapy-only program. This allows us to serve individuals who don’t meet our severity criteria and would be best served by a few sessions of therapy. WMCMH cannot prescribe medications for people receiving this service. We fund this program not with the state Medicaid dollars mentioned above, but by billing insurances. We accept some Medicaid health plans, some private insurances and private pay.

Hopefully this information has added clarity to the subject. If anyone would like to know more, WMCMH is happy to provide educational presentations to interested community groups. Please contact me at (231) 843-7285 or at betsyr@wmcmhs.org to set up a presentation.

Betsy Reed is the special projects coordinator for West Michigan Community Mental Health System