MDHHS & Adequacy Of Mental Health Treatment For Potential School Shooters

CBS Detroit is following the mental health treatment of a child in the Fruitport Middle School. An adoptive single mother in the Muskegon area is deeply concerned about one of her four children who has developed an obsession with school shootings.  The mother believes that MDHHS is giving her the bureaucratic runaround and should be providing more mental health support to her child:

https://www.cbsnews.com/detroit/news/mother-fears-school-shooting-could-happen-again/

Michigan mother of child in mental health crisis fears school shooting could happen again
By Amyre Makupson - July 27, 2023

(CBS DETROIT) - As much of the state listens in about the psyche of the Oxford High School shooter, for Cam Romanelli, the descriptions are all too familiar, explained here in a previous interview with CBS Detroit.

"He's talked about school shootings, he's talked about shooting up the neighborhood. The school had to implement a safety plan that they pat search him daily. So when I relayed all of this to the school and said I have concerns, he has said, he's been obsessed with school shootings. It's documented. The vice principal called me and told me he's talking to other kids about school shootings," said Cam Romanelli, the mother of a teen in crisis.

Since the last interview, her son was placed in a mental health facility that she says will send him home within seven to 14 days after arrival. Friday, July 28 marks day number seven.

"This Friday will be seven days. We have no safety plan created yet. Regarding the release, we are still looking for placement for him. But to date to every placement, I've applied at has denied him based on his significant behaviors. There has been no family therapy, nothing in conjunction with him and I, since he's been in treatment there. And that was part of the plan <facility name omitted> was doing coordinating family therapy and individual therapy and group therapy for him. So none of that has happened to date," said Romanelli.

Michelle Massey Barnes is an administrator with Advocates for Mental Health of Michigan Youth, featured before on CBS Detroit. When asked if Romanelli should be looking for a placement or if it's something the state should do, she said it depends on who the payer is.

"It's seems like there should be a lot more help from the state level at the state or the county to have that kind of help for the family. One of the challenges families have really across the country right now is they're so few residential beds available that these facilities don't even call parents back that call and leave messages. There's a concern that if Cam doesn't find placement, the option will be then he comes home. And if he comes home and there are not home and community based services to stabilize the needs, then what I mean you have to understand we're talking about residential placement. But we're also talking about a youth and a family that can't access home and community based services at the frequency, duration and scope that is needed for the individual and for the family," said Barnes.

"My current plan is to refuse to pick him up. We don't have a safety plan in place and I don't feel he would be safe to come home for himself for the community and for my family," said Romanelli.

So what are the consequences if Romanelli refuses to pick him up?

"The court has made it very clear if I refuse to pick them up a 3200 would be filed against me, which is a CPS case for neglect and abuse, said Romanelli.

"The neglect and abuse is what's called medical abandonment. So, it would be refusing to pick him up from a facility. Refusing to pick him up from a facility does not seem to be directly tied to the availability of services in the home and in the community. For the safety of the home and in the community," said Massey-Barnes/Mental Health Advocate

Once again, CBS News Detroit reached out to HealthWest and the Michigan Department of Health and Human Services to ask about the safety plan. The state's public information office responded with some general information about community mental health.

The following is the full email response:

Hi Amyre,

Here is the information I promised you. I saw your latest questions. I believe Health West will need to respond to those, but I will check with my team if we can provide general input.

Every child deserves access to behavioral health care where and when they need it. When a youth needs treatment services in a residential facility, it is very important that they have services and support for a healthy and successful transition back to the community, including planning for community-based services and supports. Medicaid-funded behavioral health specialty services and supports are managed by a public system through 10 locally operated Prepaid Inpatient Health Plans (PIHP). The residential care facility and the family work with their local Community Mental Health (CMH) to determine a personalized treatment plan tailored to the specific needs of the youth and family. In that plan a longer-term community placement may be needed, or the youth may be able to be treated at home with services coordinated through their local CMH.

If a family believes that services are not being delivered appropriately, they can take the following actions:

Request a Person-Centered Planning (PCP) meeting with the CMH.

Request mediation through the CMH - A recipient or his or her individual representative must be offered an opportunity to request mediation to resolve a dispute between the recipient or his or her individual representative and the community mental health services program or other service provider under contract with the community mental health services program related to planning and providing services or supports to the recipient.

Contact CMH Customer Service for local dispute resolution

Request dispute resolution at the PIHP level or file for a Medicaid fair hearing.

Medicaid consumer requests a State Fair Hearing with the Michigan Office of Administrative Hearings and Rules (MOAHR) after receiving notice that an adverse benefit determination (ABD) was upheld by the Local Dispute Resolution Committee.

A Medicaid consumer initiates a State Fair Hearing with the MOAHR, because the PIHP/CMHSP failed to adhere to the notice and timing requirements. (When this occurs, a consumer is deemed to have exhausted the internal appeals processes).

A non-Medicaid consumer completes the Local Dispute Resolution Process and requests a Michigan Department of Health and Human Services Alternative Dispute Resolution Hearing.
File a recipient rights complaint. Contact Information for Local Rights Officers by County. (michigan.gov)
Background: Public behavioral health services in Michigan are delivered through county-based Community Mental Health Services Programs (CMHSPs), which are public entities that are created by county governments to provide a comprehensive array of mental health services to meet local needs regardless of an individual's ability to pay. CMHSPs provide Medicaid, state, block grant, and locally funded services to children with serious emotional disturbances, adults with serious mental illness, and children and adults with intellectual/developmental disabilities. These services are either provided directly by the CMHSP or through contracts with providers in the community. Some CMHSPs also contract for direct provision of outpatient and other substance use disorder treatment services (residential, detoxification, and inpatient rehabilitation).

Prepaid Inpatient Health Plans (PIHPs) contract with CMHSPs, which on behalf of MDHHS, serve as the state's publicly operated managed behavioral health system for Medicaid-funded behavioral health specialty services and supports. PIHPs are also the responsible entities for directly managing Substance Use Block Grant funding and local substance abuse funding. Ten regionalized PIHPs operate throughout the state and contract directly with MDHHS.

Services for individuals with mild to moderate mental illness are covered by Michigan's Medicaid Health Plans (MHPs) separate from the PIHPs. MHPs have developed a network of private providers to serve the needs of those with mild to moderate behavioral health problems. Mild to moderate behavioral health services are a benefit that is provided as part of the contracting process for Medicaid health services, including physical health services, by MDHHS."

As a follow-up to the join e-mail, a meeting was requested with both MDHHS and HealthWest, Romanelli, Massey-Barnes, and myself. Romanelli was sent a waiver by the state granting permission for us all to speak, which she signed. We're now waiting for that meeting to be scheduled.

"It's setting him up to fail. It's a very unsettling, terrible feeling, not to know from day to day, like what's happening, what our future looks like, what's going to happen to my other children? What's going to happen to me, when all of this comes to an end? So I, my job, I'm tasked with finding a placement by myself, while caring for all of the other children, and dealing with all of these meetings, and everything else. And then if I don't, they're going to force me to take him home, which creates an unsafe environment, for my family and for him and for the community. And if I don't, I've been threatened with the removal of my children. I don't think that's fair," said Romanelli.

Lynn Suftin from MDHHS issued the following statement:

MDHHS is committed to ensuring every child has access to behavioral health care where and when they need it. (Redacted) Romanelli is currently receiving services provided by (redacted). His mother has located a potential program that will best serve his needs and is working on the admissions process. MDHHS staff, the facility and his mother are reviewing program requirements to assist in coordinating the services as the family sees fit for (redacted). MDHHS has been able to confirm that a safety plan is in place and MDHHS is working to ensure the safety of this family and youth.

MDHHS has a number of resources to help families in crisis. While the authorization provided allows MDHHS to share information about (redacted) behavioral health services, it does not allow the department to discuss other services that may be subject to a different set of confidentiality laws.

As soon as MDHHS was made aware of the issues the family was having in getting services for (redacted), MDHHS reached out to Lakeshore Regional Entity (LRE) which is the managed care entity responsible to ensure its contracted providers are complying with its expectations, standards and requirements outlined in the MDHHS/PIHP contract. Through its contract with the LRE, MDHHS requires all medically necessary services be provided to children in the amount, scope and duration necessary to allow children to remain safely and successfully in the community. MDHHS requested documentation from the PIHP and CMH outlining the services and supports they were providing. MDHHS has requested further information and is awaiting documentation to assure compliance with contracts and policies. MDHHS is committed to holding its system partners accountable to the high standards outlined in their contracts.

Apologies for using bold type to set off the responses in the original text.  It is the only method available in this board format.