When mental health care for a child must be chased rather than requested, the labor is often done on borrowed time.
It happens in hours taken from sleep and in the narrow spaces between work and dinner. At kitchen tables after bedtime, laptops glow blue with open patient-portal tabs. Inboxes crowd with unanswered messages. Ten quiet minutes in a parked car become enough time to call one more number and explain, again, why a child needs help.
A recent Detroit News story followed two Michigan families trying to obtain more intensive mental health treatment for their children after doctors determined it was necessary. They challenged denials and searched for ways to pay for care the public mental health system would not provide. The distance between knowing what a child needs and getting it can be measured in appeals, hours and miles.
Along the way, they became fluent in the language of medical necessity and least restrictive settings, repeating painful details of their children’s lives to strangers with the power to decide what happened next.
“They think I’m going to give up,” one mother said.
There is an entire mental health system hidden inside that sentence.
Seeking help can require an extraordinary amount from people who may have little to spare. They must find the right person, understand the process and make the call. They must describe something frightening clearly enough for a stranger to understand, then begin again when the first person cannot help.
Michigan’s public mental health network passes through the state, regional health plans and local agencies. Medicaid rules govern medical necessity. Providers say reimbursement can make services difficult to sustain, and even the first appeal of a denial may return to the same structure that said no.
Authority is often divided among several offices, each explaining the limits of its obligations to families who have to live with the consequences. In the Detroit News story, four professionals recommended residential treatment for one child. But the local community mental health agency, which decides whether certain Medicaid-funded services will be approved, disagreed. Whatever rules govern that decision, the consequence does not remain in a file. It goes home with the family.
These are adoptive parents. They took in children whose lives had already been shaped by circumstances they did not choose. Now they must make the case for treatment again and again.
The state asks families to take in vulnerable children. It should not make them repeatedly prove those children are vulnerable enough to help.
One child was sent hundreds of miles from home for treatment. Another’s parents appealed and lost. The therapy helping that child is funded through sponsorships and money raised online — money that is now running out.
I admire the parents who go to these lengths to get treatment for their children, and I also think about the families we never hear from.
There is no newspaper quote from all the mothers who accepted the first no. We do not know about the parent who meant to call again after work, then came home to dinner and a child who still needed watching. No one can count the appeals never filed because a family did not know the decision could be challenged.
No one knows how many children have fallen through the cracks.
Some parents are managing health issues of their own. Some have jobs that do not allow hours on the phone. Some may assume the person saying no knows something they do not.
And not everyone can make distress sound reasonable to a stranger. People in crisis do not always communicate in the calm, measured language institutions tend to reward. Concern for a child is rarely orderly. It does not always arrive in complete sentences or observe the conventions of professional correspondence.
A system should not require parents to become professional advocates or translate their child’s suffering into precisely the right words. None of those abilities is a measure of a child’s need, nor is the endurance to keep fighting.
Michigan cannot untangle its mental health system overnight. But families should not be left carrying the consequences of a structure so fragmented that accountability can disappear between its parts. Appeals should be meaningfully independent, and someone must remain answerable for whether a child actually gets treatment.
We tell parents to notice when their children are struggling and seek help before a problem becomes a crisis.
These mothers did, and they are still fighting.
But a closed door does not always make a person knock harder.
Sometimes it makes them walk away.
Lindsay Kalter is an independent journalist covering health, science and technology. Her work has appeared in The Washington Post, National Geographic, Columbia Journalism Review and other publications. She was a 2022–2023 Knight-Wallace Fellow at the University of Michigan.
This article originally appeared on The Holland Sentinel: Michigan’s mental health system expects too much of parents | Opinion
Reporting by Holland Sentinel / The Holland Sentinel
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By Holland Sentinel | USA TODAY Network
