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.

When state budget cuts gutted community mental health budgets in 2014 and 2015, four Michigan counties looked to their own residents for help. Voters in Ottawa, Jackson, Hillsdale, and Washtenaw counties all approved millages to support mental health services, which have since expanded significantly as a result.

Lynne Doyle.

In Ottawa County, County Commissioner Al Vandenberg first suggested a mental health millage. When the county's annual citizens' survey reported a 72% positive response to the idea, the board of commissioners put it on the ballot.

"We definitely did it out of desperation," says Lynne Doyle, executive director of Community Mental Health of Ottawa County (CMHOC). "Before we got the millage, we had a waiting list for services for people who did not have insurance. … At one point over 250 people were on that waiting list."

Anna Bednarek, program and community development coordinator for CMHOC, says CMHOC staff picked the March 2016 election for the millage because they'd anticipated not as many people would go to the polls. Interest in the 2016 presidential primary drove high voter turnout nonetheless, but 59% of voters still ended up approving the millage.

"It was really cool to see how the community supported our millage," Bednarek says.

As the first county to bring the issue to the polls, Ottawa County has seen its mental health programs blossom with the influx of flexible dollars.

"We have been able to get rid of that waiting list and provide services for people who might come to us with no insurance," Doyle says. "We help them get on Medicaid, and if they cannot, we'll pay for their services through other funding mechanisms."

Ottawa County's millage assessment brings in roughly $3.2 million annually for mental health services. Since 2017, millage programming has served 3,317 Ottawa County residents, including the uninsured, underinsured, and those with Medicaid benefits, with essential safety-net services.

"We truly reach more people, more individuals, than we ever could have served just with Medicaid," Doyle says. "We try to be a place where people can get information about mental health services and mental illness in general. Our millage dollars have allowed us to branch out to more collaborative community efforts."

Recipients of services have included elders in the county's Senior Reach Program, incarcerated people with mental health issues in Ottawa County Jail, and adults diagnosed with mental health issues at the county's drop-in center. The millage has funded clubhouses for people living with mental illness, and social recreation programs for people with a range of disabilities. In 2019, $2,264 of those millage dollars were used as a required matching contribution that brought in $572,091 from the U.S. Department of Housing and Urban Development to house residents with disabilities and those experiencing homelessness.

In partnership with Ottawa Community Schools Network, CMHOC coordinated mental health resources and support for K-12 schools. CMHOC dollars also funded summer camps that provided respite for underserved families while supporting their children's mental health.

"These millage dollars really allow us to gauge what our community needs, and at least partly fulfill those needs with our own response, and that's truly amazing," Doyle says. "A lot of our programs are really prevention. Now we are catching things at a mild to moderate level and lining up services so we can manage it at that level, as opposed to people going without services and winding up at our doors with a more severe issue."

Following Ottawa's lead

Jackson County's mental health services millage proposal passed in 2017, providing about $2 million a year for county residents' mental health from 2018 to 2026. Hillsdale County voters approved a mental health millage in 2018, as did Washtenaw County, where voters approved a combined public safety and mental health preservation millage.

"We worked with both Washtenaw County Community Mental Health (WCCMH) and Lifeways [Community Mental Health in Jackson and Hillsdale County] to help them with resources, literature we have pulled together, and language for their ballots," Doyle says. "We've also offered to consult and make presentations to other community mental health services that might be interested in passing a millage."

Gregory Powers is a senior analyst at the Center for Health and Research Transformation (CHRT) at the University of Michigan, which supports WCCMH with project management, grant writing, and communications support. He notes that Washtenaw County's millage passed by a two-to-one margin, showing "overwhelming support."

Gregory Powers.

"The community recognized the problem and put their money where their mouth is," Powers says.

In the past, WCCMH services were concentrated in Ypsilanti and Ann Arbor. But Washtenaw County's millage has also allowed WCCMH to set up partnerships with community organizations and walk-in clinics to offer services in rural communities like Manchester, Chelsea, Dexter, and Whitmore Lake.

"Transportation is a barrier, and hesitancy. There is great stigma around mental health. It's not always talked about, and less so [in rural communities]," Powers says.

Like Ottawa County, WCCMH had a huge waiting list of people in need of services before millage-funded programming kicked in. WCCMH Executive Director Trish Cortes notes that residents don't need to be in crisis to seek services, which are available around the clock every day of the year.

Trish Cortes, executive director of Washtenaw County Community Mental Health.

"This is a really huge benefit for individuals regardless of their socioeconomic status, regardless of insurance coverage, age, et cetera," Cortes says. "Now everyone has access to mental health services."

Treatment, not incarceration

County jails are one of the areas where the influx of millage funding has made a particularly large impact. State budget cuts in the mid-2010s forced many Michigan counties to reduce mental health services to inmates in their jails, but millage dollars have restored and increased those services.

WCCMH's partnership with the Washtenaw County Sheriff's Office on the Mental Health Criminal Justice Diversion Advisory Council helps divert low-level, low-risk criminal offenders who live with severe mental health or substance use disorders from serving jail time.

"That kind of work can't be done in a community unless the sheriff and community mental health can work well together," says Nancy Baum, CHRT's health policy director. "There are plenty of communities where community mental health and law enforcement are fighting all the time. In Washtenaw County, they are asking, 'Who are our joint clients?' The diversion council seeks to reduce the number of people in jail who have mental health or substance abuse disorder needs and to stop them from coming back. [It gets] them connected to community-based treatment that has been shown to be a lot more effective."

Nancy Baum.

A 2017 U.S. Department of Justice report found that 44% of people incarcerated in county jails had a mental disorder.

"Through partnerships with the sheriff's office, we are able to reverse those numbers," says Lisa Gentz, WCCMH millage program administrator. "We are constantly trying to look at how we can ensure individuals get access to psychiatric care. If law enforcement does need to follow up, then they have the tools to be able to do so and know how to navigate individuals through the mental health system."

Across Jackson and Hillsdale counties' 2020 millage-funded mental health programs, more than 3,000 individuals received more than 6,600 mental health services. Jail programming has also been one of the main emphases in these two counties' millage expenditures.

"There was a critical need in our community," says Maribeth Leonard, CEO of LifeWays Community Mental Health. "We've been able to put supports in both Jackson County and Hillsdale County jails around crisis response, individual therapy, psychiatric services, and care coordination that has been able to reduce the number of inmates being put into suicide watch."

One of five bedrooms in the crisis residential services unit at Jackson's new mental health crisis service center, funded by the county's mental health millage.

In 2021, LifeWays plans to use millage dollars to initiate a 24/7 mental health crisis service center that will serve people who end up in emergency rooms with mental health crises, aiming to divert them from jail. The center has been constructed and is currently awaiting its certificate of occupancy.

Leonard notes that millages allow community mental health service providers to send funds where they're needed most in the community. While Medicaid and the Healthy Michigan Plan have very strict criteria for use, she says "millage dollars are the most flexible."

"Millage dollars allow us to serve anybody, and allow us to be very flexible to be partners in our community around what is the local need and how can we utilize and maximize that benefit in the community as a whole," Leonard says. "At the end of the day, these millages have been a catalyst for communities to reduce stigma, to meet the unmet need, to provide hope, and expand mental health services — especially at a time, right now, when it is needed more than ever."

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.

Photos by Doug Coombe except photos of Trish Cortes and Lynne Doyle courtesy of the subjects.