Change isn’t the problem—Profitizing Michigan’s mental health system is

Originally published on https://michiganadvance.com/2026/01/09/change-isnt-the-problem-profitizing-michigans-mental-health-system-is/, republished here with permission.

Change is inevitable, progress should not be optional.

This old saying comes to mind as the State of Michigan, now going back decades, has threatened to privatize or what I call the “profitization” of public community-based behavioral health, better known to many as mental health and addiction services.

These vital community resources have been provided at the local level going back to President John F. Kennedy’s administration and are desperately needed to bring a semblance of help and human decency to individuals and their families who are combating serious mental illness, intellectual and developmental disabilities and substance use disorders.

Using the euphemism of “bidding out or redesigning the system of care” the state under the direction of the Department of Health and Human Services, going back to Governor Engler’s administration, have attempted to give the insurance companies control of billions of our tax dollars to “manage” these services.

The courts slowed down the state’s action and a recent court pronouncement resulted in a “kissing your sister ruling,” as a long-time watcher said, not fully satisfying either the department or advocates fighting the state move.

The ball appears to be back in Governor  Whitmer and State Department of Health and Human Services Director Hertel’s hands on how they wish to proceed.

They should follow the railway warning: Stop, look and listen.

Those advocating for the “redesign” believe it will modernize the system of care and provide better outcomes than the current system. Those advocating for the change provide no evidence or data that the changes will add any additional value or make a difference to persons in need and their families’ lives.

To the contrary these proposed changes would result in a loss of local control, increase administrative costs, replace a publicly managed care system that has a 2% overhead with a privately managed profit care system that has up to a 20% overhead.

In a strongly worded open letter to Michigan’s Governor and the State Legislature, the National Alliance of Mental Illness (NAMI-MI) made it abundantly clear they oppose the “redesign” process saying: “The RFP/bid out process represents a significant and damaging shift in the structure and delivery of behavioral health services in our state with far-reaching harm to the ability of Michiganders to receive needed mental health care and to the locally driven system upon which 300,000 Michiganders (and the 1 million family members) have come to rely.”

The Community Mental Health Association of Michigan which is opposed to the redesign process says it provides, “serious risks without addressing the system’s core challenges.”  The organization goes on to say, “Other states that have pursued similar restructuring have experienced higher costs, workforce losses, fragmented services and diminished access for those most in need. Michigan must not repeat those mistakes.”

Debbie Stabenow, who has spent her professional career of over a half century serving as a county commissioner, state Representative, state Senator, U.S. House member and U.S. senator, has been a staunch advocate and supporter of a strong community based public mental health system. She has been a vocal critic of the Michigan Department of Health and Human Services plan to privatize the state’s public mental health system.

Stabenow retired from the U.S. Senate in January 2025 but has continued to voice her opposition against the Whitmer’s administration’s effort to the state’s proposal since it was introduced in 2024.

Tenacious Debbie has ferociously argued that the state’s privatization proposal would be detrimental to patients and the public system as a whole by increasing costs, decreasing access, reduce transparency and accountability and concluded saying that Michigan’s mental health system is in need of greater public investment — not being put up for private management.

The former senator has earned the respect and admiration of  behavioral health consumers, their families and community based providers across Michigan and deserves to be listened to, and more importantly, followed.

Wishful thinking by state government is neither a strategy nor a plan. Consumers and their families fear these changes and don’t believe the state with their mantra, “We are from the government and we are here to help you.”

In her final year in office Gov. Gretchen Whitmer and the Legislature must pull together to enhance and improve public mental health access and integration of care in the new year. “Profitizing” it by turning it over to profit-driven insurance companies is not the answer.

Period- full stop!

This is not a side issue that impacts “those people.” Mental health and substance use disorders impact every ZIP code and one in four people across this great nation of ours. Dr. Vivek Murthy, former U.S. Surgeon General, says the mental health crisis is the biggest health concern facing the country because it impacts so many people and different facets of life.

This fact was recently bought home by the death of the iconic actor and film producer, Rob Reiner, and his wife Michelle, by their son Nick Reiner, who has been charged with their murders. Nick has struggled with mental health and addiction issues since his adolescence.

We need to listen to those most directly impacted by these threatened changes. There is a palpable fear among parents, consumers and advocates that the public mental health safety net will be ripped to shreds. Family members worry about losing long-term relationships with trusted providers and new rules that limit service. Given the struggles to get what they have, their worries are not without merit.

The voices of county sheriffs, boards of county commissioners, police officer associations, local hospitals, the Community Mental Health Association of Michigan, National Alliance of Mental Illness, Michigan Mental Health Association and other advocacy organizations are opposing this false promise that would place profits before people.

The so called “redesign” is not truly about solutions to the real issues facing a system of care that does need additional support and sensible consumer-focused reforms. We must do better by serving not profiting from persons with behavioral health needs.

Here’s how we continue the pursuit of an integrated health care system that maximizes public resources, is consumer and community-focused and is data-driven and evidence-based:

• Eliminate the separation of physical health care services from behavioral health care. Integrate care at the consumer level where no person is turned away. Treat the whole person; the mind is connected to the body;
• Shut down services that continually abuse taxpayers’ resources while enriching themselves at the expense of those most vulnerable;
• Create crisis intervention teams for law enforcement agencies throughout the state. Such partnerships between law enforcement and behavioral health care providers considerably improve care while reducing police officer injuries and costs when responding to mental health crisis calls. Sadly, our jails and prisons have become 21st-century psychiatric holding cells;
• Significantly step up audits on Medicare/Medicaid providers to identify and prevent fraud and abuse;
• Pay livable wages to direct-care staff. Stop the rhetoric about “supporting ‘essential’ workers” while paying invaluable staffers a pittance, often with no benefits.
• Fund advocacy organizations adequately to enable them to hold the system accountable. Without their watchdog eyes and ears the system will slip off track with devastating consequences to people’s lives;
• End the stigma of mental illness. Channel funds toward researching the causes of serious mental illness and developing responses to these disorders;
• Utilize digital technologies and artificial intelligence which have the potential to profoundly impact behavioral health services. We need to use predictive analytics to design programs that help people engage with behavioral health services. Smart analytics could help educate people about behavioral health services;
• Continue insurance reimbursement for virtual mental health services after the COVID-19 crisis subsides. It works;
• Address shortages of certain specialty providers, including psychiatrists as well as eating disorder and autism specialists;
• Fund local community mental health agencies to work with schools to address psychosocial issues students face that were exacerbated by the pandemic;
• Create partnerships between behavioral health services and employers to boost awareness, acceptance, prevention and recovery within the workplace;
• Move nonviolent persons with serious mental health issues currently in our prison system to appropriate behavioral health programs;
• Hold hospitals accountable for serving people with serious mental illness. Michigan needs to get serious about using all the tools at its disposal, including certificates of need, licensing and tax policy forcing hospitals to accept public money to serve patients. Finding a psychiatric bed for someone with serious mental illness can often feel like their name is Mary or Joseph and it is Dec. 24 in Bethlehem. It is unconscionable that people with mental illness in need of hospital settings are denied service.

Decisions that benefit consumers and taxpayers instead of the “system” will lead us to a path that adds value and makes a difference. Without a shift in emphasis from profit to quality care, future policymakers will be confronted with an unfathomable mess to clean up.

Let’s work together to enhance care, support and opportunities for strangers, friends and family members with an illness or disability. A friend with cerebral palsy once called me a TAB: temporarily able-bodied. He explained that we are all one life-changing event away from needing some level of assistance. There, but for the grace of God, go I.

Everything we do should create a life of dignity and self-determination for our fellow citizens. We ought to proceed as though our actions will impact someone’s mother, father, sister, brother or son or daughter – because ultimately it will.

Let’s move forward, getting past the turf protection and place our focus on integrating care for our families and neighbors in need of quality mental health and substance use services.

People over profits.