By TYLER SCHNEIDER
Westside Lansing resident Emily Smith has run the gamut of inpatient psychiatric care in Michigan.
“I have been in inpatient treatment several times since 2017. I’ve gone to Sparrow’s St. Lawrence campus in Lansing, Cedar Creek Hospital in St. Johns and more recently was at StoneCrest Center in Detroit,” she explained.
If a future mental health crisis required another inpatient stay, Smith (at her request, her real last name is not being used) said she’d prefer to remain in the area, if possible. However, with UM-Sparrow’s psychiatric beds frequently at capacity, that’s far from a sure thing. Smith recalled experiencing precipitous wait periods ranging from a few days to more than a week before a suitable bed opened up.
“I waited at Sparrow for up to 14 days once, and I was miserable. It was just me and the voices in my head with nothing to do besides sleep,” Smith said.
Smith’s experience is hardly an outlier. For years, a shortage of inpatient psychiatric beds has loomed over a state healthcare system that’s still recovering from crucial staffing shortages spurred by the pandemic. And even when there are fully staffed beds available, they may be several counties away or at smaller facilities that aren’t equipped to accommodate more extreme cases.
University of Michigan Health-Sparrow has proposed building a 120-bed psychiatric hospital in Lansing. The plan has generated a controversy because UM-Sparrow wants to tear down the landmark old Eastern High School to make room for it. But no one seems to dispute the need for such a facility — in fact, to the contrary.
Clinical social worker Marianne Huff has seen Michigan’s mental health landscape expand exponentially over the course of her nearly three decades in the field. Today, she serves as the president and CEO of the Mental Health Association in Michigan, an 87-year-old Lansing-based nonprofit working to expand mental health services statewide.
Increased state funding has been huge, Huff said. In 1990, the state spent $626.7 million on community mental health services. Thirty years later, that number ballooned to $3.5 billion.
Still, Huff noted that the increase hasn’t yet eliminated the pressing need for more psychiatric beds.
“One of the problems is that when somebody needs an inpatient psych bed, it’s not like when you have a physical health need where you’ll have a lot of choice,” Huff said. “You’re really just kind of at the mercy of what’s available, and because there aren’t a lot of options right now, people can end up in other parts of the state to get treatment.”
The issue became more easily quantifiable in 2022, when the Michigan Department of Health and Human Services began regularly tracking the state’s total number of inpatient psychiatric beds. Its July 2024 Psychiatric Bed Inventory report listed 2,453 beds for adults and 385 for children and adolescents statewide — a shortage of 19 and an excess of 36, respectively.
The MDHHS reports break Michigan down into eight subregions, one of which comprises Clinton, Eaton, Ingham, Jackson, Hillsdale and Lenawee counties. Together, those counties offer 189 non-specialized psychiatric beds for adults, or eight beds short of what’s needed by MDHHS’ standards. Just over half of those are in Greater Lansing, including 59 at UM-Sparrow, 34 at Brightwell Behavioral Health in East Lansing and 15 at McLaren Greater Lansing.
Robert Sheehan, executive director of the Community Mental Association of Michigan, called the bed shortage “deep and prolonged.”
“There really is a lack of psychiatric beds, not only in Lansing, but across the state. Kids, young adults and adults have been waiting in emergency rooms, police stations and communal health centers for hours or days for an inpatient bed to open up,” Sheehan said.
Numbers are misleading
Though Sheehan cited the MDHHS inventory as a key resource, he noted those figures don’t necessarily reflect the true number of beds that are actually available at any given time.
“The need here is determined based on the assumption that, if you had every bed online and available, then you would only need to add eight more,” he said of the shortage in Greater Lansing. “Once you untangle that demand, though, you realize that eight beds doesn’t quite describe it.”
In some cases, he said, beds will go offline because of staffing shortages. In others, patients with acute needs may require an isolated environment, which can sometimes force hospitals to close down multiple beds to accommodate that one individual.
“What we see happening now is, when you’re trying to put somebody in a hospital bed because of behaviors that are quite extraordinary and hard to manage, sometimes you can’t put them in a ward with any other patients. So, if I have a four-person ward and I put one person like that there, I’m also putting those three other beds offline,” Sheehan said.
The number of beds needed for children and adolescents can be similarly underrepresented, according to both Sheehan and Huff. While Greater Lansing’s MDHHS subregion has a surplus of 11 youth beds in the latest state inventory, all 37 of them are at Cedar Creek Hospital in St. Johns.
“Multiple families that have reached out to me when their child clearly needs to be in the hospital. Some had been stuck in emergency rooms for weeks on end waiting for an inpatient psych bed. Sometimes, they’ll be forced to take their child back home, even though the child is obviously not psychiatrically stable,” Huff said.
Sara Lurie, chief executive officer of the Community Mental Health Authority of Clinton, Eaton and Ingham Counties, also noted that the MDHHS’ count of standard adult and youth beds doesn’t include specialty beds reserved for “high acuity individuals and those with intellectual or developmental disabilities.”
Due to the higher intensity of care required for these individuals, the MDHHS inventory tracks these kinds of beds as separate categories. One of those categories, which covers beds designed for patients with developmental disabilities, had a shortage of 189 adult and 30 youth beds. Of those that are available, none are in or near Lansing.
Another specialty category tracks “medical psychiatric units,” or beds for patients who need concurrent medical and psychiatric treatments. To meet that demand, Michigan would need to add 132 more of these beds for adults and 38 for minors. At present, the only options for adults are in Garden City, Flint and Warren. Just 12 of those hybrid beds are equipped for children, and all of them can be found at Spectrum Health Butterworth in Grand Rapids.
“High acuity units,” or beds for individuals who are actively suicidal or at risk of otherwise harming themselves or others, represent the most urgent need of all. Among Bridgeport Behavioral, Macomb Behavioral and Trillium Behavioral in Warren, Michigan has just 69 of the 261 high acuity beds it needs for adult patients. For youth who need this care, there isn’t a single high acuity bed in the mix anywhere in Michigan, despite the MDHHS listing a need for at least 50.
Across the board, Huff said the overall lack of youth and specialty beds often heaps additional burdens on the shoulders of patients and their families during what is already a high-stress situation.
“When somebody is in a psychiatric crisis, they want their family and friends to be able to visit and support them. But what do you do when your loved one is a couple hundred miles away? Sometimes, we even have to place people in other states like Ohio, Indiana and Wisconsin if they can’t be seen anywhere else,” Huff said.
Sheehan said this issue is especially prevalent for younger patients.
“Typically, most places have fewer kids’ units than adult units, and you can’t have family involvement if the closest available bed is four counties away,” he said. “A family might decide that they’re willing to wait to see if something closer opens up, but that isn’t always in the kid’s best interest, either.”
Lurie’s work frequently involves tracking down beds for Greater Lansing residents of all needs and ages. Like Huff, she’s also had to send some clients out of state, though she said the majority are sent to hospitals in Ann Arbor, Detroit or Grand Rapids.
“As you can imagine, sending people far away from our community creates all kinds of burdens for that individual and their family. It can also be really difficult to even find ambulance transport, which makes discharge planning all the more complex,” she said.
Staffing shortages an issue
Even if Michigan is able to bolster its bed counts to meet the needs of all of those subgroups in a timely manner, there’s still the issue of lingering, widespread staffing shortages that began during the COVID pandemic years.
“Going through the pandemic has reduced stigmas, made people more aware of the importance of behavioral health care and created more opportunities for funding. At the same time, we are in a big workforce crisis, so we can’t realize all the potential that’s brought,” Lurie explained
As Sheehan put it, “Folks just aren’t getting into the field like they used to.”
“A lot of hospitals have taken beds offline because they just can’t staff them. What we’re finding is that we have to pay people a lot more than we have been, because, frankly, it’s hard work. On top of that, we also lost a lot of boomers who retired who aren’t going to unretire,” Sheehan said.
One way to curb that issue, Sheehan said, is to offer more incentives designed to bring more young people into fold.
“There are loan repayment programs and other programs designed to encourage more people to enter the field, but that pipeline will take a couple of years to solidify,” he said.
In Greater Lansing, organizations like Lurie’s have also taken advantage of their proximity to Michigan State University to help fortify that pipeline.
“As we try to sort of grow our own a little bit more, we’re super lucky to be right in the shadow of a huge university with a school of social work. That’s been a great help as we’ve expanded our internship program, and we’ve also funded a pilot cohort of nine of our bachelor-level staff to help them pursue their master’s in social work,” Lurie said.
As a result of these healthcare staffing shortages, 70 of Michigan’s psychiatric beds went offline in 2022, including 50 at the 165-year-old Kalamazoo Psychiatric Hospital. The 119-bed facility is one of four state-operated public psychiatric hospitals, along with the Caro Psychiatric Hospital, Saline’s Center for Forensic Psychiatry and the Walter Reuther Psychiatric Hospital in Westland.
Sheehan stressed the importance of having a diverse mix of public and private psychiatric hospitals at the ready.
“I think we need several dozen more state hospitals, because it’s a lot harder for them to turn patients away. Currently, private hospitals can reject people who have unique behavioral or healthcare challenges due to the needs of their other patients.”
However, Sheehan added that this doesn’t necessarily mean it’s time to go on a public hospital “building spree,” either.
“People forget state hospitals are still short-term stays, where someone will typically be there for seven to 10 days,” he said. “To meet our longer-term needs, you also want a stronger network of private hospitals.”
Running a private psychiatric facility is in itself a unique challenge, however. For one, it’s not usually a revenue driver.
“A lot of psych units go out of business because it is costly and the rates of reimbursement aren’t high enough,” Huff said.
This can be crippling for private hospitals that are already experiencing staffing shortages.
“If a hospital has to take care of somebody experiencing a lot of psychosis, or someone who is what we call ‘combative,’ you’ll need more staff to help care for that person. That’s a unique challenge that can cost a lot more money,” Huff said.
Even when a hospital is fully staffed, Sheehan said another set of issues can emerge when that facility inevitably “becomes a magnet” for patients throughout the state.
“While that’s a good thing, that can also start to make it look like you have a lot of beds open elsewhere. But that’s only because the other beds may not be built or staffed in a way that can handle that kind of challenge, so it can be somewhat misleading,” he said.
Similarly, if a local hospital knows it doesn’t have the staff or beds needed to accommodate patients with complex needs, “they may not be willing to admit them.”
“But if a hospital four counties away doesn’t know that patient, they might be willing to take him or her the first time before they realize they weren’t ready for it,” Sheehan said.
Ancillary services also needed
These disparities are just one of many considerations in the larger effort to bolster Michigan’s mental health care infrastructure. While the need for inpatient psychiatric beds will remain a chief concern for years to come, there’s also a growing list of ancillary services designed to prevent and mitigate mental health challenges before they require hospitalization.
Colleen Donaldson, who grew up in Lansing, is a Milwaukee-based mental health counselor and dance therapy instructor. Before she opened her own practice in Wisconsin, she spent nine years working in psychiatric hospitals in New Hampshire and Oregon.
Donaldson’s time in Oregon ended when she was diagnosed with PTSD after she experienced eight suicides, including seven in the same facility. Two were co-workers, she said, while another three clients took their own lives shortly after being discharged.
These experiences led Donaldson to leave the psychiatric hospital field for good in favor of opening her own private practice in Wisconsin. Since then, she’s become a staunch advocate of alternatives to psychiatric hospitalization.
“For a client who’s in a crisis and needs a place to stay outside of their home, I recommend something called a peer respite house,” Donaldson said. “These are non-clinical, which means that people called peer support specialists work there who have lived experience getting through their own mental health crises. They’re there 24/7 for support, but guests can come and go as they please and are in charge of their own medications, if they choose to take any.”
Donaldson would also like to see a Wisconsin mental health voucher program spread to her home state.
“There’s a really neat program here where farmers that are experiencing mental health issues can get vouchers. Counselors can sign up and offer their services, and they’ll get paid through those vouchers,” she explained.
Back in Greater Lansing, Huff, Lurie and Sheehan all touted the emerging popularity of another ancillary service known as a crisis stabilization unit.
“It’s basically a mini emergency room that’s equipped to stabilize and hold people for up to 72 hours,” Huff explained. “The idea is to get some treatment started and potentially avoid the need for inpatient hospitalization.”
Lurie’s team is working on bringing one of these units to Lansing by fall 2025. She said there are a handful of them in the works throughout Michigan, while two are already up and running in Detroit and Grand Rapids.
All in all, these outpatient and ancillary mental health services help alleviate pressures on psychiatric hospital staff by gradually reducing the number of people who would otherwise need long-term psychiatric boarding, she said.
According to a May 2020 report by the Community Mental Health Association of Michigan, this emphasis on providing more funding for a wider variety of psychiatric care options has resulted in a “staggering” increase in the number of Michiganders served through state-backed mental health programs.
“If the dollars currently spent by Michigan’s community-based public mental system, $3.46 billion, were spent solely on the provision of traditionally long-term inpatient care at the state’s psychiatric hospital and developmental disability centers, those dollars would serve 9,500 persons per year,” the report read. “In contrast, those dollars, used to fund community-based services and supports, as they are now used, allows the public system to serve over 350,000 persons per year.”
Despite this upward trend, the need for additional inpatient psychiatric beds isn’t going to just disappear. According to a 2023 needs assessment prepared by the Community Mental Health Authority of Clinton, Eaton and Ingham Counties, the number of inpatient hospitalizations in the tri-county region increased by 17% for adults and 13% for children between 2018 and 2022. In that same span, the average length of stay per patient increased by 20% for adults and 30% for children.
Sheehan cited UM-Sparrow’s recent proposal to build a $97.2 million, 120-bed psychiatric hospital on the site of old Eastern High School in Lansing as a “substantial” step forward in meeting this growing need.
“UM-Sparrow’s proposal would qualify as a separate facility, but it’s still close enough to the ER that if you had a medically compromised person, they can get to the ER or be transferred to the main unit quickly,” Sheehan said.
The proposal, which includes at least 10 beds for adults, 24 for children and 37 specialty beds, would be large enough in scale to where it could easily flex to accommodate a variety of long term psychiatric patients in the future, Sheehan added.
“The reason you need that many beds is, for example, you may take someone in who needs to detox from opioids or alcohol. That has to be a separate unit from a kids’ unit, and you’d have the space to do that there. You could also have specific sections for people with psychosis, bipolar disorder and so forth,” he said.
Mandy Bolter, government relations director of U of M Medicine, cited the plan as paramount to efforts to minimize an ongoing emergency room overflow in Lansing.
“Lansing is in a mental health crisis. Our ER is built for 75 people, and we’re seeing 200 per day,” Bolter said. “Twenty to 30 of those people are mental health patients who are stuck there, and being a staff member working in an ER with emergency psych patients is not an easy thing to do.”
At one point, Smith was among those 20 to 30 people awaiting a psychiatric bed placement. She hopes to get to a point where she’ll never have to return.
Even if she’s successful, Smith added that she still hopes to see the bed shortage addressed sooner rather than later.
“I understand there are a limited amount of beds, but there are many places around Lansing that could be changed into another ward. It would bring in jobs and keep people local,” Smith said.
