In January 2021,Ottawa County Community Mental Health (CMHOC) applied for the Certified Community Behavioral Health Clinic (CCBHC) grant from the Substance Abuse and Mental Health Services Administration (SAMHSA) of the Federal Government. The two-year $3.8 million grant began August 30, 2021 and expired on August 29, 2023.
The intent of the CCBHC grant was to treat patients, become a certified clinic, and to “improve and expand coordination of care” and improve clinical pathways for individuals with health conditions by analyzing data based on risk-factors and high-risk health behaviors. Clinical pathways is a term that represents the way treatment plans are formed based on statistical data. Therefore, the idea is that data collection will show the links between risk factors and mental and emotional illness, leading to more efficient and effective treatment plans. The theory is that, by reducing risk factors, the rates of mental and emotional illness will also decrease.
The goals in implementing the grant included serving 700 patients, reducing the rate of obesity, reducing the prevalence of tobacco use, improving the care of those with diabetes, training staff in assessing substance use disorder, reaching the Hispanic community, and helping current youth receiving county mental health services to transition to adult mental health services. Methods for achieving these goals included providing those at risk with information about health and wellness fairs, classes that provide information on dieting, exercise, and smoking cessation, and training staff. Surprisingly, individuals with intellectual and developmental disabilities (I/DD) were not eligible for CCBHC services without an additional diagnosis such as mental illness, severe emotional disturbance, or substance use disorder.
According to the grant application project summary included below, “CCBHC expansion will improve and expand coordination of care and whole person wellness for individuals in Ottawa County who are living with or at risk of developing severe mental illness, severe emotional disorders, and/or substance use disorders.”
Referring to Ottawa County residents, it also states, “Individuals living in this area have numerous social and economic factors impacting their health and well-being including poverty, poor general health status, chronic health conditions, health risk behaviors, and difficulties accessing adequate and coordinated primary care and behavioral health services.”
This is a very misleading statement as during the April 24, 2023, CMHOC meeting, it was announced that Ottawa County is the second healthiest county in Michigan. In addition, the same slide stated 94.21% of residents have primary care physicians.
According to the grant application, Ottawa County needed this grant because the Community Health Needs Assessments surveys found people in Ottawa County believe mental health treatment for the uninsured has worsened and that there is a stigma in Ottawa County against seeking services. One-third of stakeholders indicated people are “not caring and sympathetic to mental illness”. In addition, the ratio of mental health providers to population in Ottawa County is much lower than in the state of Michigan; Ottawa County 1:640, Michigan is 1:330. Therefore, the data shows that Ottawa County is one of the healthiest counties in Michigan, but the perception of the residents shows they believe mental health is a significant issue.
According to the grant application, Ottawa County intended to focus their efforts on reaching those under age 35 that live in urban areas, have household incomes less than $35,000, and the Hispanic population, because those characteristics are the most common in leading to pre-diabetes, obesity, tobacco use, alcoholism, and drug addiction. The plan was to serve 350 people the first year and an additional 650 people the second year resulting in 700 unique people served.
To execute the grant, it was necessary for Ottawa County to expand its infrastructure for data collection and hire additional staff. The grant required staff trained in outpatient primary care screening, assessment and monitoring of key health indicators and risks, and a health educator to provide health and wellness classes. It also required the creation and distribution of marketing materials. According to the grant application, the following staff members were required.
One project director to provide oversight
One project evaluator to measure efficacy through data collection
Three medical assistants to perform health assessments, screenings, and care coordination
Three community health workers to link consumers to programs
One claims/billing specialist to track grant spending
One on-call crisis clinician to provides services
One health educator to create and provide health and wellness programming
Two peer support specialists
Three support staff for data entry
This grant requires lots of support personnel, but lacks individuals that hold medical degrees. Out of 16 staff members, it appears only one (on-call crisis clinician) will provide medical services directly to patients. It appears all other staff perform functions such as patient assessments, screenings, care coordination, linking consumers to programs, tracking grant spending, designing wellness education programs, and performing data entry.
So, the CMHOC received $3.8 million to collect data, improve treatment plans, educate vulnerable residents on dieting, the dangers of tobacco use, drug use, and alcohol use, and reach out to the Hispanic population with the goal of serving 700 people. The goal was to improve the treatment for patients with severe mental illness, severe emotional illness, and substance use disorder by focusing efforts on reducing obesity, diabetes, smoking, and alcoholism. To me this seems backwards. Severe mental illness including issues such as anxiety, depression, and psychotic disorders are not caused by obesity, tobacco use, substance use, or being Hispanic. Rather, obesity, tobacco, and substance use can happen as a result of the mental illness conditions which are more likely caused by the inability to control life events and traumatic past experiences.