GRAND RAPIDS, Mich.
The 911 call came from a restaurant.
A customer was yelling and throwing things, the caller said. Inexplicably, the man had set his hair on fire.
Sgt. John Wittkowski, who heads the Grand Rapids Police Department’s mental health crisis response team, headed to the scene.
By the time he arrived, the man had fled. Wittkowski caught up with him three blocks away and began teasing out the man’s story.
His name was Devon. He was 29 years old and from out of town. He mentioned issues with schizophrenia, substance abuse and “he had some complex trauma as well,” Wittkowski said. “He was clearly distraught.”
Traditionally, police would have had two options on what to do next: Take Devon to jail, based on the destructive outburst in the restaurant, or go to the nearest hospital emergency department to address the apparent mental breakdown.
Instead, Wittkowski took Devon to a county-run crisis access center in downtown Grand Rapids. There, Devon was able to see a clinician and get plugged into the system to help people with serious mental health issues.
It was a small victory in a major effort to fundamentally reform behavioral health services in metro Grand Rapids. It’s a model that Wichita and Sedgwick County might seek to learn from as they work to create a more coordinated approach to addressing mental health, substance abuse and homelessness. Such an approach requires collaboration across a swath of government agencies and nonprofits.
Grand Rapids appears to be creating a more seamless system even though it lacks a more centralized single location for social services that cities such as San Antonio have become widely regarded for. Officials in Wichita and Sedgwick County have been considering building a similar hub here.
For the past five years, leaders in metro Grand Rapids have been brainstorming about how to improve services for individuals experiencing a mental-health crisis. Those talks – involving local hospitals, nonprofits that provide behavioral health services, law enforcement, city and county officials and even insurers – have led to new initiatives and expansions of existing programs.
Grand Rapids now has a new psychiatric urgent care center. A mobile crisis team can go to an individual’s home. Social workers are paired with police to help respond to 911 calls. A 24/7 behavioral health crisis center, which will serve as an alternative emergency department for psychiatric patients, is expected to open in November 2023.
The talks also have led to a broader mission: Creating a more seamless, robust system for people with behavioral health issues.
The efforts are a work in progress. But it’s made enough impact that other communities are looking at Grand Rapids as a potential model.
Participants define the Grand Rapids model as a collaboration of public and private entities to create a “continuum of care” in behavioral health services. And for the homeless population in particular, those services take a holistic approach, addressing basic needs such as shelter, food and employment.
It’s all about identifying gaps in the system and figuring out how best to fill them.
“Right now, people are truly less worried about who gets credit and who gets to run things, and more about who’s got the resources to get it done, and get it done quicker, and saying, OK, everybody get behind that. That’s the model,” said Bob Nykamp, chief operating officer of Pine Rent Christian Mental Health Services, based in suburban Grand Rapids.
At present, Grand Rapids has two teams of social workers and police responding to 911 calls, providing coverage six days a week. They triage calls as they come in, assigning top priorities to the most serious situations, such as suicide attempts. During their first seven months, the teams responded to 837 calls, reporting 192 emergency department diversions, 281 EMS diversions and 65 jail diversions.
Three teams of social workers and police and fire personnel, working six days a week, also split their time answering calls related to homelessness and engaging in outreach. For 2021 and 2022, the teams reported a total of 2,443 engagements, with 130 jail diversions, 78 emergency room diversions, 84 mental health referrals and 62 substance abuse calls.
Wichita already has some of the same programs as Grand Rapids, such as pairing police with mental-health clinicians to respond to 911 calls or reach out to homeless individuals in need of behavioral health services
The ICT-1 unit that responds to mental health emergencies operated four days a week in 2022, with more than 500 field responses. But expanded services are being rolled out following investigations into the death of teenager Cedric Lofton, who was fatally restrained by county corrections staff in 2021.
A mobile mental health team will be available to respond and provide on-scene treatment for people in crisis between 8 a.m. and 3 a.m., The Eagle reported last year. A social worker is being embedded in the county’s 911 center to screen calls and direct emergency responses to reports of people struggling with mental illness. Four teams of mental health workers can be dispatched with or without law enforcement.
The city will also pay to hire an additional clinician and two integrated care specialists, ensuring a mobile mental health response team will be on call 17 hours a day, supplementing ICT-1 and providing staffing from 8 a.m. to 6 p.m. Monday through Thursday.
The region also has formed the Mental Health and Substance Abuse Coalition, an effort two years younger than the Grand Rapids task force.
Compared to Grand Rapids, the Wichita coalition is still in the beginning stages. The latter’s biggest successes to date involve individuals who are heavy users of various social services. One is a pilot project to improve their access to public transit. The other is creation of a database to track their use of various social service programs. But the transit project only involves 15 individuals for far, as the coalition seeks funding to expand it, and the database has yet to officially launch.
The Wichita coalition’s most ambitious proposal is creating a social services hub, most likely downtown. But those plans are developing and have yet to come to fruition.
Dawn Shepler, executive director of the Wichita coalition, said it’s useful to look at communities about the size of Wichita who also are working to improve their behavioral health networks.
“We use other states and cities as examples to help guide us to the right fit for our community and how to service our community members,” Shepler said.
A booming region
Despite standing nearly 900 miles apart in very different states, Grand Rapids and Wichita have more than a few things in common and some noteworthy differences.
Grand Rapids, the seat of Kent County, is Michigan’s second-largest city, 160 miles and a world away from rough-and-tumble Detroit.
Located on the west side of the state, metro Grand Rapids is still defined by Dutch immigrants who started arriving in the mid-1800s, conservative Calvinists focused on church, family and a strong work ethic. Those roots explain why Grand Rapids has long been the center of the Michigan Republican Party.
But against that backdrop, Grand Rapids is changing.
The city has shed its stodgy reputation and now has a downtown known for its craft breweries and vibrant arts scene. That downtown, along with the area’s strong economy and proximity to Lake Michigan, has made it Michigan’s fastest-growing metro area, attracting 20-somethings seeking a hip urban environment and college-educated professionals wanting a place to raise a family.
The demographics of Kent and Sedgwick counties are similar. Kent County has about 660,000 residents; Sedgwick, 524,000, according to the 2020 Census. Kent County has a little more non-Hispanic Whites (73% of the population, compared to 67% in Sedgwick); is a little more affluent (median household income of $70,000 vs. $61,000); a lower poverty rate (10% vs. 13%) and has more college graduates (38% of adults vs. 31%).
Kent County’s growing prosperity has its downsides, particularly for low-income residents.
The median monthly rent is now $1,417 in Grand Rapids, with virtually no rentals below $700 a month, according to RentCare, an online real estate site.
Grand Rapids has the hottest rental market in the Midwest, according to July 2022 study by RentCafe, with a 97% occupancy rate and 18 applicants for every rental that opens up.
By comparison, the median rent in the Wichita market is $811, according to RentCafe.
In addition to housing costs, there’s another significant difference between Grand Rapids and Wichita: Unlike Kansas, Michigan expanded its Medicaid program under the Affordable Care Act. For Grand Rapids, that largely reduces the issues around funding behavioral health services for the uninsured, since Michigan’s low-income adults are Medicaid eligible, according to Nykamp and other health experts.
“I would say the lack of Medicaid funding is one of our biggest gaps,” Shepler said about the Wichita area. She added that it’s particularly problematic for agencies working with the homeless population, most of whom are uninsured, leaving agencies scrambling to find ways to fund behavioral health services.
“It’s a financial hardship on those agencies, and the county can’t pay for it all and the city can’t pay for it all, so we’re trying to the best way to adapt and adjust for that if the Medicaid expansion doesn’t happen” in Kansas, she said.
Birth of a crisis
Long before Grand Rapids faced an affordable housing crisis, it was grappling with fallout from the deinstitutionalization movement.
As Michigan began phasing out its state psychiatric hospitals in the 1980s and 90s, the state created community mental health authorities to fund and coordinate services for Medicaid and uninsured residents. The Kent County Community Mental Health authority is called Network 180.
But people with severe and persistent mental illness are not always able to follow an outpatient treatment plan. That’s contributed to rising homelessness; the likelihood people with mental illness will end up incarcerated, and pressure on hospital emergency departments when those in a mental-health crisis have nowhere else to go.
By 2017, 10% of emergency department visits to Grand Rapids’ downtown hospitals involved a behavioral health crisis, and 20% of inmates in the Kent County Jail were prescribed psychotropic drugs.
Another issue: Network 180 was spending more and more of its budget on inpatient care for their clientele, eating into money available for outpatient services.
In 2017, Grand Rapids area leaders formed a task force to consider these issues. They agreed quicker access to treatment and more effective outpatient interventions would benefit patients, ease the burden on jails and emergency departments and reduce the need for costly psychiatric hospitalizations.
The task force also agreed no one program would solve the issue; no one agency could solve it alone, and people in crisis must also have access to longer-term treatment.
It’s all about collaboration, with Network 180 taking the lead.
Among the new initiatives in recent years: Pairing social workers with police to answer 911 calls; pairing social workers with police and fire officials to visit homeless encampments; opening an urgent care; creating a separate space for psychiatric patients at a downtown hospital emergency department; opening a peer respite center, in which those with behavioral health disorders can get a break from family or housemates for a few days.
There’s also been expansions of the mobile crisis teams, local substance abuse treatment programs, outreach services for homeless individuals, and a day program that’s an alternative to inpatient treatment.
The coalition’s two biggest projects are still in the works.
The first is a 24/7 behavioral health crisis center that will essentially serve as a regional psychiatric emergency department for adults.
The center will be located at Trinity Health St. Mary’s downtown hospital, and it is expected to open in November 2023.
“We can give them rapid access to psychiatric medications, peer support services, recovery coaches, therapy, interventions, nursing, labs, all of those types of things within this setting,” said Kristen Spykerman, chief clinical officer for Network 180.
The expectation is the center should substantially reduce admissions to inpatient psychiatric hospitals – perhaps by as much as 60% to 70%, based on national data for similar centers.
That could result in huge savings for Network 180, freeing up money for outpatient programs. Between 2016 and 2020, an average of 2,420 Kent County residents a year were admitted to a psychiatric hospital, at an average cost of $8,490 per stay, according to a Network 180 report. By comparison, the average bill for an eight- to 24-hour stay in the Crisis Stabilization Center is expected to be $1,400.
The other big project in the works: A $62 million pediatric behavioral health center, tentatively scheduled to open in spring 2025 on the Pine Rest campus in suburban Grand Rapids.
The center will include outpatient and inpatient services, including a pediatric psychiatric hospital, eating disorder program and specialty clinics for depression and autistic spectrum disorders.
The biggest lesson learned from Grand Rapids is the importance of getting top leaders of stakeholders to the table, said Dr. Subodh Jain, a Corewell Health psychiatrist who has worked with the task force.
“Second, the advocacy at the state and federal level needs to be aggressive to get all the resources needed,” Jain said.
Providers also need to put aside turf wars, which shouldn’t be an issue since the demand for behavioral health services is so huge, Jain said. “Market share is not a problem.
“The Grand Rapids model is an excellent model,” he added. “It works.”
Still, coordinating all these initiatives hasn’t been easy, acknowledged Kate Berens, Grand Rapids deputy city manager. It means identifying all the key providers and “creating some formality around how you work together and how you share information and what you do to make sure your system is evolving together instead of one organization at a time.”
The collaboration has had its share of other challenges.
The biggest frustration said Nykamp of Pine Rest: There are still many individuals in need of mental health services who aren’t accessing them. And if all those individuals did seek help, “the system would be overwhelmed,” he said.
The obvious solution is to expand capacity. But that’s easier said than done.
Mental health worker shortage, funding
A major barrier is a shortage of workers, an issue throughout the behavioral-health system – from psychiatrists to therapists to nurses to psychiatric aides. Working with psychiatric patients can be difficult, and especially in a competitive job market, workers have other options that can pay more for a lot less stress.
“One of the lessons learned – which everybody nationally is recognizing and especially in our part of the Great Lakes area – is workforce shortage,” Jain said. “We do not attract workforce. We have to grow our own because we don’t necessarily have a ton of people who are looking to work in Grand Rapids.”
That’s forced the partners in the Grand Rapids collaborative to get creative, Nykamp said, including partnering with local colleges for internship programs and funding scholarships to recruit future workers. Pine Rise also has started a psychiatric residency program to lure doctors to Grand Rapids for training, in hopes they’ll stay long term.
Another issue is funding.
Grand Rapids officials found it important to have Medicaid gatekeepers and private insurers at the table to make sure they’re willing to pay for behavioral health urgent care visit or having a patient go to a crisis stabilization unit vs. an emergency department, Nykamp said.
Another lesson learned has been the importance of communication, not just within the collaboration partners but also for the general public – particularly in regard to programs for homeless residents.
Last year, the Grand Rapids Area Chamber of Commerce and downtown business owners confronted the Grand Rapids City Commission about disturbances involving homeless persons, a growing issue as the pandemic ebbed and people began returning downtown. The chamber proposed new ordinances that some perceived as criminalizing homelessness.
“I think there’s difficulty communicating about the unhoused community, and the fears, concerns, assumptions that people on the outside make about what’s happening on the streets,” Berens said.
The city’s response has been two-pronged: First, pointing out police are “enforcing ordinances for misdemeanor, violent and other illegal behavior,” Berens said, while also stressing the need to “work on system failures so that we have fewer and fewer people in crisis, and in that crisis moment, violating ordinances.”
“So we need to be clear about how we bring criminal enforcement to bear and then what we’re also doing to help the system serve people better, especially people with mental health and drug addiction crises,” she said.
Yet another frustration: Even as metro Grand Rapids improves its behavioral health system, it’s not clear that hospital emergency departments have seen a drop in behavioral-health cases or that the number of homeless people has declined.
Indeed, in the wake of the pandemic, more and more people are reporting mental-health problems and those issues seem to be more severe. That’s compounded by inflation and a housing crisis that exacerbates the conditions that fuel homelessness.
While more people are getting help, Berens said, there are constantly “new people who have fallen through the cracks.”
“I think the data shows we’re continually improving,” she added. “But it also shows we still have more work to do, particularly in regard to homelessness. Anyone in the homelessness response space will tell you, the No. 1 solution is to have more affordable housing” – and that’s a huge challenge in a community growing faster than the number of new housing units coming online.
All that said, “the task force has been very successful,” said Spykerman, of Network 180. “It’s helped move initiatives forward” and has created a much more collaborative environment between the various entities.
“The other thing is that collaboration just leads to, I think, a better product,” with each agency sharing their insights and expertise, Spykerman added. “So when we come together and share those ideas, it leads to a better result for the individuals we are going to be serving.”
This story was produced by the Wichita Journalism Collaborative, of which The Eagle is a member, in partnership with the Southwest Michigan Journalism Collaborative.