In April 2014, Michigan expanded Medicaid, allowing more Michiganders access to health care — those with incomes up to 133% of the federal poverty level — through a program called Healthy Michigan. The plan simultaneously ensures low-income residents receive health care and saves Michigan money to improve care for all citizens. However, the expansion cut non-Medicaid state funds for Michigan community mental health agencies (CMHs) by 60%, which decreased access to needed mental health services for  Michiganders without Medicaid. 
 
This prompted four Michigan counties to spring into action and look to their residents to help by passing mental health millages, a tax that funds mental health services for residents. Ottawa County was the first to pass its 10-year mental health millage in 2017. Jackson, Hillsdale, and Washtenaw counties followed suit, passing 10-year mental health millages in 2017 and 2018. Since the millages passed, all four counties have seen positive impacts such as expanded access to care to their residents, increased service capacity, improved crisis response, and more.
 
Maribeth Leonard
Mental health care for all 
 
“I went from a budget of $5.4 million down to $2.4 million, and I had to cut services that supported the jails because they weren’t mandated,” says LifeWays CEO, Maribeth Leonard. “Our jails and our schools were in a crisis, and we had to look at the options we had. When Ottawa County was successful, I took it to my board who then took it to the county because mental health needs weren’t being met in the community.” 
 
The millage has helped all Jackson and Hillsdale county residents, insured, underinsured and non-Medicaid, to meet their health care needs. The millage brings in $2.7 million annually to the two counties. Those funds have provided community‐based mental health safety-net services as well as mental health clinicians in the jails to offer crisis support, individual therapy, and group therapy. 
 
The funding also has been used for school-based mental health services and expanded Crisis Intervention Training (CIT), a 40-hour training program taught by specialists from LifeWays, local law enforcement, and consumer/advocates to help prevent tragedies. Millage funds have also supported social enrichment programs for youth with developmental disabilities that include art and music therapy among peers to prevent isolation and loneliness. Millage funds have also helped LifeWays enhance its services as a Certified Community Behavioral Health Clinic (CCBHC). 
 
“Without the millage, we wouldn’t have been able to do it,” says Leonard. “We have a call center and a crisis center people can walk into. We can dispatch mobile services to the community, both adult and children’s teams, and we have an on-site crisis residential unit where someone can stay up to 14 days instead of going to a jail or an emergency department.” 
 
As a direct result of the millage, LifeWays provided 5800 services in Jackson County and 6800 services in Hillsdale County in fiscal year 2023.

“The millage has been critical in making mental health services accessible to everyone," Leonard says. "We have been able to look at those areas where there were gaps in care and say, 'How can we partner with the community to address that?'” 
 
Keeping the “community” in community mental health
 
Community Mental Health of Ottawa County (CMHOC) staff were not only concerned with non-Medicaid residents with serious mental health concerns having access to mental health services, but also that residents with mild-to-moderate conditions had access.
Dr. Michael Brashears
“The millage has allowed us to provide crisis services and other types of services that Medicaid hasn’t been able to support,” says Dr. Michael Brashears, CEO, CMHOC. “We have been able to offer services to the non-Medicaid population. It has allowed us to be a community mental health organization. We ask the community the type of mental health programs that they want, and, if it's not covered by Medicaid, we create them.”
 
The millage brings about $4 million a year to Ottawa County and has supplemented close to $15 million dollars of mental health services such as Ottawa Pathways to Better Health; the Momentum Center and other social and recreational programs for residents with intellectual or developmental disabilities; outpatient therapy for residents with moderate mental health needs; client assistance programs; psychiatric services in the jail, and the Ottawa Community Schools Network..  
 
“The millage has prevented probably the layoff of 30% of the staff. It helped with our turnover rate and keeping people intact,” says Brashears. “The cost of delivering a basic service in a residential setting has gone up 200% in the last three years. Our funding hasn’t increased enough to make up the pay for the cost of direct care workers. The millage has helped subsidize the gap.” 
 
The funding has also enhanced collaborations with the health department and other stakeholder groups. 
 
“For Ottawa County as a CMH organization, the millage has allowed us to be a true community partner and to extend services away from our buildings to other organizations to help,” says Brashears.   
 
Because of the millage, Ottawa County has witnessed a decrease in crisis contacts and hospitalizations for mental health conditions, an increase in quality of life, and fewer residents requiring services from more costly programs, for example, 68% of crisis contacts have been diverted from hospitalizations.
 
Lisa Gentz
Service expansion increases residents served
 
Washtenaw County voters approved a Community Mental Health and Public Safety Preservation Millage, generating $5 to $7 million a year. Thirty-eight percent of these dollars fund Washtenaw County Community Mental Health (WCCMH) services; 38% fund Washtenaw County Sheriff’s Office (WCSO); and 24% fund cities and townships with their own public safety services. In November 2024, 70% of Washtenaw County voters approved an eight-year renewal of the millage.
 
“We spent 2018 planning and hosting numerous community conversations” says Lisa Gentz, program administrator, WCCMH Millage Initiatives. "What they wanted was to expand access to behavioral health care and behavioral health care that was agnostic of insurance, so that people could get rapid access to care."
 
Washtenaw County has seen substantial increases in mental health calls since 2018, when 4,500 calls a month were received. In 2023, 8,500 calls were received. The millage has greatly expanded services to all residents regardless of ability to pay or insurance status, positively impacting resident safety and well-being through youth services, housing, mental health prevention services, education, and criminal justice reform.
 
“I would say 91% of all of the millage funds are invested directly into expanding access to care and removing barriers to care,,” Gentz says. "A large portion of our dollars are also invested in supportive housing initiatives and helping to reduce homelessness locally."
 
One program, the millage-funded CARES team provides 24/7 access to mental health and substance use stabilization services and service-navigation assistance to all county residents as well as individual therapy, group therapy, peer support, psychiatry, and nursing. Millage dollars have increased adults served by 147% and youths served by 104%. 
 
“We have been able to increase our workforce to provide more care in the community, which has been really helpful,” says Gentz. “To have tools to respond when people need us is really fantastic.”

Maribeth Leonard photo by Victoria Reackoff.
Lisa Gentz photo by Doug Coombe.
Masthead photo by Edmond Dantes via Pexels.com.
Other photos by courtesy subjects. 

The MI Mental Health series highlights the opportunities that Michigan's children, teens, and adults of all ages have to find the mental health help they need, when and where they need it. It is made possible with funding from the Community Mental Health Association of Michigan, Center for Health and Research Transformation, LifeWays, Michigan Health and Hospital Association, Northern Lakes Community Mental Health Authority, OnPoint, Sanilac County Community Mental Health, Summit Pointe, and Washtenaw County Community Mental Health and Public Safety Preservation Millage.