Ok – there cannot be a debate anymore.  Matthew Stafford is a great quarterback!  Especially considering he plays for the Lions, with our lack of stability related to coaches, GMs, and front office vision.

According to Pro-Football-Reference.com, Stafford is tied for 4^th in NFL history with 30 Fourth Quarter Comebacks – only trailing Tom Brady, Drew Brees and Ben Roethlisberger.   The last-minute drive to win the game on Sunday was ridiculous.  And if Swift had caught the perfect pass Stafford laid on his hands at the end of the game vs the Bears on Week 1 this year, he would have another crazy comeback under his belt. 

I would prefer that the Lions win a game with some ease, but in the meantime my Idea to Consider is this…Matthew Stafford is the best quarterback never to play in a Super Bowl.  Have fun with that one. 

PS – Next week will be a post on local government revenue and taxation policy.  I attempt to limit these reads to between 5 and 10 minutes.  Right now my thoughts extend beyond that limit so I need more time to condense and edit.  Have a great week!

During the past six months, our country has witnessed multiple deaths of Black men and women on our media platforms.  One on a jog killed by a white father and son.  Another having his neck held down while in police custody with three other police officers watching.  A Black man was shot seven times in the back by a police officer and is paralyzed.  A Black woman was killed when officers entered her home with a no knock warrant. These are just three recent events, lest we forget Ferguson, Chicago, Baltimore, New York City, et cetera, et cetera.  In response, we have seen peaceful protests turn into riots across our nation from New York City all the way to Grand Rapids, Michigan.  

While I recognize that many white Americans are outraged about police violence against Black Americans, I also hear many white people criticizing the protests in response to the violence. Questions and comments such as: 

• I do not understand. Why are they protesting?  Why are there riots?  Most police officers are good people.
• Protests and riots do not accomplish anything.  It just destroys property and makes people mad. Things are better than they used to be. This does not help.

And most of us have heard what President Trump relayed to Governors across America earlier this year: ‘If you don’t dominate, you’re wasting your time.  They’re going to run over you.  You’re going to look like a bunch of jerks.  You have to dominate.’   And after Kenosha, the President also compared shooting a Black man seven times in the back to a professional golfer choking on a three-foot putt.

For me, these horrific events and comments are part of a much larger race relations problem in America beyond law enforcement, and makes me sympathize with the Black protesters.  Consider this data:  

• Birth outcomes are racialized.  White babies are more likely to survive to their first birthday.
• Educational outcomes are racialized.  White students do better on standardized tests.
• Health outcomes are racialized.  White people live longer and have less chronic disease.
• Incarceration rates are racialized.  White people do not go to prison as much and serve less time when they do.
• Wealth and income distribution are racialized.  White people have larger bank accounts and higher incomes.

My conclusion:  Systemic racism is alive and well in the United States because there is no way that birth, education, health, incarceration, wealth and income outcomes can be like they are without a system that perpetuates it.

I wrote in the ‘About’ section, that faith was important part of my life growing up.  So here is a bias…As a Christian, white guy who grew up in the traditional family, homogeneous, reformed church and attended multi-cultural public schools, who worked in public policy, I look around and think:  ‘My LORD, white America, and especially white evangelical Christian America are asking the wrong questions. Making the wrong comments.  We are doing the exact opposite of how to move toward peace and wholeness.’

Instead I wonder:

• How come it has taken so long to get to this point? 
• Why haven’t we heard and responded to the prophets of our generations…people like Martin Luther King or John Perkins? 
• When are we going to fulfill the Greatest Commandment to Love our Neighbor like ourselves?   When are we going to live like what is described in Acts with Christians sharing everything among themselves?  When are we going to live out the Old Testament Jubilee, and take care of those that do not have food and return property to original owners?  When oh LORD are we going to reconcile our sin and behavior like Paul describes? 
• Where are the leaders you are calling?  Where are your followers in all of this? 

I would ask my white friends and colleagues, especially those who claim to be brothers and sisters in Christ, to contemplate the following:

• If we knew that our children were less likely to have a first birthday; or were less likely to receive a quality education than their peers, how would we respond? 
• If we knew our parents were more likely to have heart disease and diabetes and/or die earlier what would we do (especially in this COVID-19 era)? 
• If we knew our sons and daughters were more likely to receive a longer prison term if they committed a crime, would we stand for that? 
• And what if we knew that our young adults were less likely to have a job, or a job that could sustain their family how would we cry out?  What would we do?

From our nation’s beginning, we have thought of ourselves as a Christian nation.  We celebrate the Pilgrims leaving Europe for religious freedom.  We call ourselves blessed by God because we are the richest nation in the world.  We remind ourselves that Christian abolitionists helped end slavery 150 years ago.  We hail the role of the church in the Civil Rights movement that led to the passage of the Fair Housing Act, the Voting Rights Act and many decisions of the Supreme Court that outlawed ‘separate but equal.’  Yet here we are in 2020, and the data tells me we are not progressing nearly as much as we might think we are.  We are not loving our neighbor as ourselves.  We are not creating heaven on earth.  Our Black brothers and sisters are suffering and have been for years.  Clearly, something is wrong. 

But how do we change this direction?  How do we move forward?  What is the next best move to help create a ‘good life’ (or some heaven on earth) in this pluralistic, multi-cultural, small ‘d’ American democracy we live in?   Let me try to offer some solutions or Ideas to Consider:

Learn history.  White America needs to learn about the history of Black America and its impact on today.  Look beyond the obvious sins of slavery, Jim Crow segregation laws, and the poll taxes. Learn about the connection between the Great Migration, the Depression, and the wealth of African Americans today.  Learn about the eruption of ‘local school districts’ and its correlation of funding schools by property tax after Brown vs Board of Education, and what that did to impact education outcomes.  Learn about the GI Bill, mortgage underwriting, red lining and local zoning laws impacts on wealth creation, and ensuring segregation at the same time. And then, consider the trauma and toxic stress these historical events, policies, and decisions have had on generation after generation of African Americans.  Pulling yourself up by the boot strap certainly gets harder with an extra 100 pounds of stones in your boot.

Dedicate ourselves to improved communication.  Most people would suggest that white America needs to listen to the stories and experiences of Black American in a new way so we can build our empathetic skills.  I would offer that white America needs to improve its communication skills with Black America.  Communication includes listening, but is so much more.  While we listen, we need to be aware that our body language, our tone of voice, our facial expressions and our words either begin to build trust or diminish it.  We cannot get away from it.  The small nod of the head. The raised eyebrow.  An inquisitive eye.  They can show our heart in a flash.  Are we leaning in, committed to learn and understand?  Or are we going through the motions?  Will we change our behavior or continue to accept what is? 

Practice empathy.  When you google ‘empathy definition’ this is what comes up first:  the ability to understand and share the feelings of another (Oxford).  Simple.  Straightforward.  And oh, so hard.  This is a journey that requires intentionality and commitment.  And it requires to step out of our comfort zones, visit new places, experience new things.  But so often we do not want to do that because we like it our way.

But just like when we are learning to play an instrument, shooting a basket, or hitting a ball, we need to practice empathy in order to become good at it.  And when we do get good at a new skill, it feels good and allows us to participate in the orchestra, band or game in a more impactful manner.  Changing the racialized outcomes throughout the United States does not seem possible unless we better understand and share the feelings of Black America.  We need to start practicing our empathy skills if we believe in the Great Commandment to love our neighbor as ourselves.  

Intervene at a community level, not an individual one.  Attempting to change one life at a time is futile in a country as large as ours.  Attempting to create uniform, national change is futile in a country as large as ours.  Local communities have different needs embedded within different cultures. 

As an example, health outcomes are unlikely to change in rural areas if a physician is not available to diagnose ailments.  Yet, an urban neighbor may be surrounded by physicians but unable to get a needed appointment because their insurance does not pay enough.  To address this type of problem and others, it is imperative that the interventions need to be tailored to local and state dynamics.  Large scale bureaucracies and one size fits all policies cannot improve racialized outcomes.  Finding community-based solutions that match local need allows local communities to own their future. 

In my view, Christian communities can play a significant role in this by living out Biblical commands in the workplace with Christian business owners creating policies such as paying higher wages or increased retirement match opportunities, granting post-secondary scholarships and/or down-payment assistance for homeownership options, creating equity options for all employees, et cetera. Churches can create non-profit organizations to meet basic needs. Christians can organize and work together to influence and/or create and pass local and state policies that reflect Biblical values rather than secular ones designed to benefit those in power.  This is but a short list of options and the ideas can be endless, only limited by one’s imagination.

Recognize that there is not a silver bullet to any social problem.  Too often, I hear people say, ‘If they just did this, everything would be better.’ Or ‘If we did this, that would solve the problem.’ People are too complex.  The economy and capitalism are too complex.  Government is too complex.  Also, we need to remember that small ‘d’ American democracy is not designed for quick change.  That is why the private sector – businesses, philanthropy, churches, healthcare and/or education – need to lead the way and engage government to change how it spends its resources. 

We also need to remember that there is hope because we have seen slavery end.  We have recently seen criminal justice and prison reform take center stage, with new laws passed that reduce sentences.  We have seen African American infant mortality rates drop in parts of the country.   Is there work to be done?  Of course – lots of it.  But we have hope because we know change is possible when we work hard to create it.

Reprioritize our labels.  Last – but so important.  We need to reprioritize our labels, and identify ourselves as humans first.  Not Republicans.  Not Democrats.  Not Conservative, progressive, and/or liberal.  Not White, Black, Asian, Latinx.  But people who care about our neighbors because it is good for us as individuals to see them prosper too.

_____________

Postscript – There is one last thing I want to share with my friends that identify as Christians, especially those who call themselves Evangelical Christians.

No single political party, philosophy, ethnicity and/or race has a hold on what the Bible says or how the Holy Spirit moves today.  No President has been or ever will be perfect.  Some of us would be wise to learn from how the Millennial generation seems to live out their understanding of Christian creation care which transcends any one political label.  If we identify ourselves as Christians first, we will be compelled to live out the Jubilee, the story of the Good Samaritan, the return of the prodigal son, the communal practices of the first Christian communities. 

I have attended, participated in, and observed the workings of many different types of protestant churches.  Large churches, multi-racial churches, medium-size churches, highly liturgical churches, charismatic churches, dying churches, leaderless churches, healthy churches.  All kinds of churches.  Church seems to work when people are willing to get in the trenches, to get dirty, be open to the moving of the Holy Spirit, and respond to the BIG issues of the day.  When churches look inward or try to maintain the status quo they struggle and disappear.

Today, there is not a bigger issue in my mind than the racialized outcomes within our country, the hurt they cause, and the fear demonstrated by those thinking they could lose power.  So much so they are willing to go as far as to kill unarmed people.  Yet, many Christians and the church in general seem to turn our back from standing up and addressing these systematic sins because solving them would require us to move beyond our comfort zones, challenge our conventional thinking, surrender some comforts and change our behavior. 

Friends, the reckoning is here.  Will Christians and churches stand up to influence our world and create the ‘good life’ for all of God’s children?  Will we help to create heaven on earth that brings God’s peace?  Or will we continue to stay in the background and see our nation continue its march toward the religious affiliation of ‘None.’  Time to decide.

For years individuals, community groups, education institutions, health systems, and elected officials have been crying out for expanding and improving mental health services.  But yet, there seems at best incremental improvements.  A crisis center comes online.  A new community-based center opens. Education systems create pilot efforts.  But broad access to therapists and support most often depends on one’s health insurance plan, whether it is a commercial plan provided by an employer, or a public one such as a Medicaid Managed Care Organization (MCO), including Healthy Michigan, or a Community Mental Health Service Provider (CMHSP).

One of the unique aspects of Michigan is the Michigan Mental Health Code (i.e. – the Code) which requires CMHSPs to provide emergency mental health services to those in need whether insured or not.  The Code also requires those on Medicaid (including Healthy Michigan) with Severe Emotional Disturbances (SEDs) to receive services from the CMHSP.  At the same time, Michigan has a mental health parity law that requires insurers to provide mental health care just like physical health care.  Therefore, individuals with mild and/or moderate mental health needs are served through their healthcare insurance…. commercial or public.  And those with commercial insurance also receive SED  benefits as described in their health insurance plan. (See Figure A)

These two public systems:  CMHSPs for emergency and SED care, and healthcare plans for mild/moderate care is a fundamental, systemic problem to improving mental health care in Michigan because mental health issues are chronic, meaning they are not resolved like an acute illness such as the flu or a torn ACL.  People are complex and may have a mild depression that grows into a severe one that needs robust services, only to achieve stability which may require moderate services. 

Insurance Type	Emergency	Mild/ Moderate	SED
None	CMHSP	–	–
Public	CMHSP	MCO	CMHSP
Commercial	Insurance Plan	Insurance Plan	Insurance Plan

Yet the current public healthcare system and billing procedures can bounce them between systems with insurers pointing responsibility at one another about who pays the bill.  Similarly, by having two discrete systems, insurers are unable to conduct robust utilization review to determine what services are or are not working.  One set of insurers has access to physical health claims with mild/moderate mental health claims, while another insurer has access to SED claims.  This systemic problem harms enrollees (and tax payers) especially when one considers that mental and physical health often go hand in hand, and integration of physical and mental health care shows positive treatment and cost containment results.   

Another problem within the current mental health model is that commercial insurance providers often have just two benefits:  an outpatient benefit (i.e. traditional outpatient therapy) and an inpatient benefit (i.e. mental health hospitalization).  Research suggests that many people need something in the middle.  Examples might be:  Traditional outpatient therapy along with peer recovery services; or An in-home therapy treatment along with case management to address social determinants of health affecting a family.  This type of customized package is not the norm in a commercial mental health environment, but often can be created by a CMHSP that is responsible for those with SEDs on Medicaid because they understand that hospitalization without needed follow up services is expensive and has poor outcomes, while a community based care model can yield better outcomes along with cost savings. 

So what to do?  First, we need to explain a little bit more about the CMHSP system.  Not only does it serve those with an SED.  It also provides:

• Long term services to individuals with intellectual disabilities (often those with Down’s Syndrome or a similar disease that live in some type of group home),
• Services for those with Autism (this is a relatively new benefit designed to provide early intervention), and
• Certain substance use services. 

These services are funded through a combination of sources including, but not limited to:  Capitated Medicaid formulas created by a state paid actuary firm, statewide Liquor Taxes generated by sales in a county (after first paying for TCF Convention Center Bonds), and limited State and local general funds. This service delivery combination occasionally creates challenging dynamics between CMHSP Boards and stakeholders that want funds directed to one group over another.   

Ok, so this is the Idea to Consider….a series of recommendations on how to improve Michigan’s Mental Health System:

1. Remove Intellectual Disability funding from the CMHSP model, and make it its own system.  Throughout Michigan, different CMHSPs provide different levels of financial support for these services.  It is time to streamline the system and create a more equitable state service model to ensure similar services are provided no matter where one lives in the state.
2. Remove Autism Services from the CMHSP system, and transfer the funding and responsibility for services to the Intermediate School Districts (ISD).  As a society, we are learning more and more about autism.  One thing that seems clear is that early intervention yields incredible results which can reduce long-term spending on special education services which are funded and/or services provided by ISDs.  Additionally, across Michigan, Intermediate School Districts are seen as the go-to body for early childhood education via the Great Start Collaboratives.  Therefore, moving autism funding and services to ISDs ensures that:
   • As Great Start Collaboratives design early childhood systems, they are creating models to identify potential delays, and then work with families to address needs.  Autism delays are often found through this process.
   • Those with the largest skin in the game related to special education services to support students with autism have an incentive to figure out an early intervention model that yields results because if they do not they will have to pay larger sums later.
3. Decide if the Medicaid/publicly funded Mild/Moderate Mental Health Services belong in the CMHSP System; or if Emergency/SED Services belong in the Medicaid MCO system.  The current dual system is untenable.  It creates a system that is not accountable to CMHSP Boards, the Michigan Department of Health & Human Services (MDHHS), the Legislature, or people of this State.  CMHSPs can blame the MCOs for having inaccessible mild/moderate services due to having few paneled providers and low payment rates, and therefore flood the CMHSP system with people that could be served with a mild/moderate benefit.  (A commercial Usual Customary Rate for outpatient mental health services is between $85 and $98 per session, while a Medicaid MCO rate is between $45 and $55 per session. Non-profit providers often lose money at this rate.)  Similarly, the Medicaid MCOs can blame CMHSPs for not serving clients effectively by claiming they need services greater than what is ‘mild/moderate’ or not providing emergency services.  This blame game serves no one and needs to be addressed systemically rather than on a case by case basis which takes too much time for patients, and costs too much in administrative inefficiency.
4. Align Substance Use Services with Decision #3.  There is something in the Mental Health/Substance Use Service literature called Co-Occurring Disorders.  Basically, it states that often mental health and substance use go hand-in-hand and therefore need to be treated together.  By aligning state substance use policy and funding with mental health services, Michigan can create a co-occurring model that meets national best practices for treatment of these diseases.
5. Expand Commercial Insurance to Include a Benefit Mix Beyond Traditional Outpatient/Inpatient Mix.  To assist Michigan residents that struggle with mental health diseases that require a different service bundle, we need to create a service delivery system that is flexible to meet unique, individual needs.  While it would be ideal for market pressures to push commercial insurers to provide this benefit, it may require legislative action to create this benefit. 

But what to do with Children’s Mental Health Services?

Listen to a teacher today, elementary, middle school or high school…it doesn’t matter, and they will share that children are struggling with emotions.  They need help in different ways, and schools are unsure how to respond since their core purpose is education, not mental health.

Michigan provides a variety of resources to local school districts to support children considered vulnerable.  Among them include:

• Title I – A federal program operated by states which provides additional funding to eligible Local Educational Agencies (LEAs) to ensure that all children meet challenging state academic standards.  Funding amounts are based on the number of children that receive free and reduced lunch.
• 31A – A Michigan program that provides additional financial resources to eligible LEAs and Public School Academies (PSAs) for programs focused on student outcomes such as:  attending school regularly, reading proficiently by the end of 3^rd grade, being proficient in mathematics by the end of 8^th grade, and being career and college ready by high school graduation.
• 31N – A recently created Michigan program to provide mental health services in schools through Child & Adolescent Health Center (CAHC), school mental health and support services, and behavioral health teams pilots.
• Caring 4 Students (C4S): An expansion of school-based services reimbursement program intended to support access to nursing and behavioral health services for all Medicaid eligible students.

Beyond these programs are commercial insurance as well as the Medicaid programs described earlier.  Additionally, several ISDs across Michigan have been able to work with their local districts and voters to pass what are called ‘Enhancement Millages.’  Proposal A allows ISDs to place a property tax question before voters in its service area to enhance the per pupil amount of funding received from the State.  Often these millages are used to provide additional programs and services, some of which often support vulnerable children. 

One of the largest challenges facing schools regarding needed student mental health service is that there is not a consistent way to braid the available resources into a coherent service model.  To meet this challenge, it will need all of us to think about changing the way we organize services. For me, the community school model (see http://www.kentssn.org or http://www.nccs.org) has proven successful in linking mainstream community services, like mental health therapy, to schools.  In my mind, just like with Autism Services, the Idea to Consider is this:

ISD throughout the state should be given the responsibility to organize and deliver mental health student services because they:

• Serve LEAs across Michigan and have direct access to students with needs
• Understand how to bill Medicaid for eligible special education services, which they can build upon regarding behavioral health service billings
• Can hire needed program and administrative staff with its economies of scale

Conclusion

To significantly improve the mental health needs of our friends, family, and neighbors, we need to come together and work on meaningful change that benefits the whole.  This means the Michigan Mental Health Code should be revisited by a specific bi-partisan task force that includes representatives from insurance companies, CMHSPs, advocacy organizations, counties, Probate Courts, the Legislature, MDHHS, ISDs, and the Governor’s Office to address:

• System reform.  We will not see improvements unless we change the system design.
• Data.  The current system does not allow for comprehensive Utilization Management through data review. 
• Change Management/Creativity.  Unless we welcome change and become more creative in system design and service delivery, we are not going to see large scale, community improvements.

Please remember that these Ideas to Consider are meant to serve as a catalyst to move a necessary discussion forward. We can do better than we are to meet the real, human needs facing our society. 

Coda:

• Feel free to forward this to anyone you think might be interested in reading or considering these ideas.
• If you have a column idea, forward it to me. Topics I’m working on now include: Taxation in Michigan. Equity and Racialized Outcomes. Land Use/Housing Policy. Government Size & Home Rule History. Child Welfare Reform. Substance Use Funding & TCF Convention Center Bonds. So I have plenty of room for more ideas and thoughts…..got 51 more to go.