This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

A new 24/7 mental health crisis support line is now available in Oakland County and Michigan's Upper Peninsula – and it's just the first step of a larger plan to roll out improved mental health crisis services across the state.

The new Michigan Crisis and Access Line (MiCAL) provides phone, chat, and text support for Oakland County and U.P. residents experiencing mental health or substance abuse crises. A statewide, regional rollout is planned by fall of 2022. Trained crisis specialists serve as mental health first responders, answering calls or texts to 844-44MICAL (844-446-4225) and chats via MiCAL's website.

"[MiCAL] is a coordinated crisis system for all Michiganders, regardless of the severity of issues or payment type," says Krista Hausermann, strategic initiative specialist at the Michigan Department of Health and Human Services (MDHHS) Behavioral Health and Developmental Disability Administration. "The federal government encouraged us to set up a crisis service for everyone that coordinates with other behavioral health services in the state. MiCAL is the first component that we are developing as part of a coordinated crisis system – a public good, like fire departments or the police, for everyone in the state."

MiCAL is the first part of a three-part plan that also includes setting up brick-and-mortar crisis stabilization units and mobile crisis first response. The crisis stabilization units will provide a location where people experiencing urgent mental health or substance abuse crises can go. Like a hospital emergency room, they will be open 24 hours a day, seven days a week. Unlike a hospital ER, the care will be trauma-focused and tailored to people with behavioral health needs.

"They will also allow time for a crisis to unfold naturally," Hausermann says. "In a hospital emergency room, people want to get in and out [and] get things resolved quickly. With a mental health issue, oftentimes people need a safe, quiet place where other service professionals can come in, touch base, assess them, and take the time for the crisis to unfold in order to see what's going on. It's a very different environment."

Like paramedics, the mobile crisis units will take action when people experiencing a mental health crisis are unable to get to a place where help is available.

First steps: Crisis lines

In April 2020, MDHHS launched a mental health warmline in response to COVID-19's impact on Michiganders with mental health needs. Since then, the warmline and MiCAL have collectively taken 14,000 calls. Callers to either line can choose to remain anonymous. Certified peer support specialists staff the warmline, and MiCAL callers speak to similarly trained crisis specialists. The 96-hour certification process covers various scenarios that callers may need help with: human trafficking, domestic violence, substance use, and a full range of potential mental health crises, including how to respond to people contemplating suicide or homicide. Each MiCAL shift is supervised by a licensed social worker.  

"MiCAL treats every call initially as a crisis. For a lot of callers, it's the first time they are reaching out or being in crisis. We explore what's going on with callers, ask open-ended questions, and get information," says Brian Nicholson, MiCAL program director for Common Ground, an Oakland County 24-hour crisis services agency contracted to operate MiCAL. "Many callers just need a listening ear."
Brian Nicholson.
Operators ask callers questions and input their answers into a computer program that develops a color-coded risk assessment of the caller, ranging from green to orange to red depending on the severity of the crisis. When danger seems evident, the supervisor steps in to help.

"The people [answering the calls] make these questions into a conversation," says Rosa Thomas, Common Ground clinical director. "The supervisor … determines if crisis resources or an active rescue is needed. All of this is done with listening in a way that eases the caller really quickly. They feel safe talking to us."

Ongoing care

When the call ends, the care continues. During the call, the crisis specialists share resources that callers can utilize within their own communities. If continued care is warranted, MiCAL initiates a warm hand-off to mental health providers located within the caller's community.
Rosa Thomas.
"It's really important that people know there is a place they can call that will help them navigate the system, get them where they need to be, and get them the help they need," Thomas says. "MiCAL is a safety net that catches people before it gets so bad, and explores what is needed."

If social determinants of health, like food insecurity, unpaid utility bills, lack of housing, unemployment, or lack of access to medical care are part of the picture, callers are linked to community resources that can help. MiCAL crisis specialists also schedule a follow-up call to make sure individuals have been able to successfully connect with the resources that they need.

"If we connect you with resource A, we call you back to ask, 'Did you connect?' If not, we ask, 'What were the barriers?' Then we find out if we can remove those barriers to ensure they get connected," Nicholson says. "If there is suicidal ideation, we develop a safety plan and follow up as needed. We might call back a couple times throughout the night, in an hour, in three hours. We're moving people from crisis to hope."

Specialists fill a range of needs

MiCAL's crisis specialist staff comprises people with a wide variety of life experiences that can strengthen the rapport they build with callers. Nicholson shares an example of a military veteran who called MiCAL because he was experiencing depression. When the caller said, "I'm a vet and want to talk to a vet," the MiCAL specialist answering his call was able to transfer him to a veteran serving on the staff.

"We get a lot of calls from veterans of the Army, Navy, and Marines. There's a brotherhood that goes with that. On this call, that brother built rapport very quickly," Nicholson says. "The conversation let him know that somebody was there for support and encouragement, somebody that had been there and done that. During the call, there never seemed to be an escalating crisis. He just seemed to be having a day-to-day struggle, not suicidal. At end of the call, the vet told the specialist, 'You saved a life today, brother.'"
Brian Nicholson takes calls for MiCAL.
Because MiCAL makes a point to coordinate with other services, it is connected with the Michigan Veterans Affairs Agency and MDHHS Veteran Navigators. When veterans call in, any of the crisis specialists they talk to can, with the caller's consent, help them access all of the veterans' services that they are entitled to. Similarly, operators help callers of all backgrounds connect to community services that are best suited to their unique experiences and needs.

"MiCAL is based on the air traffic control model. MiCAL holds on to them until they get to the next point and are safely connected," Hausermann says. "It also will connect at the state level with two big databases, 211 and the open beds registry. These will provide those resources easily when accessed through MiCAL."         

In the wake of COVID-19, more Michiganders than ever are at risk for mental health issues and substance abuse disorders. But MiCAL, the mental health warmline, and other local and national crisis lines are stepping up to weave a safety net that catches residents in crisis before they fall too far. Hausermann says MiCAL "is for any Michigander to call, and call earlier."

"It plays an important role in diversion and early intervention," she says. "We're hoping people will call earlier so they don't have to reach a certain level of crisis. Maybe their only option was to wait until things were severe enough for an emergency room visit."

Nicholson agrees, saying that MiCAL allows people to "get help in the simplest way possible."

"We create rapport and they are not going to be judged," he says. "It's that first baby step that people take."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

All photos by Steve Koss except photo of Krista Hausermann courtesy of MDHHS.