Welcome to Why Not Me, embracing autism and mental health worldwide. Hosted by Tony Mietour, broadcasting from the heart of Music City, USA, Nashville, Tennessee. Join us as our guest share their raw, howlful stories. Our song will spark laughter, others will move you to tears. These real life journeys inspire, connect and remind you that you're never alone. We're igniting a global movement to empower everyone to make a lasting difference by fostering deep awareness, unwavering acceptance and profound understanding of autism and mental health. Tune in, be inspired, and join us in transforming the world one story at a time. Hi, I'm Tony Mietour. Welcome to Why Not Me, embracing autism and mental health worldwide. We're taking a brief holiday break so we'd like to wish you a Merry Christmas and Happy holidays. We also want to take the time to share one of our favorite episodes from the past six months for you to enjoy. So before we dive into our episode, we'll be back with an uninterrupted show right after a word from our sponsors. Today with Rill, to be joined by a truly remarkable guest, Judge Milton Mack. Judge Mack brings a wealth of experience to the conversation, having served as a state court administrative for the Michigan Supreme Court and as chair of the Governor's Mental Health Diversion Council. He's also held the role of Chief Judge of the Wayne County Pro-Bate Court and worked as a consultant and advisor for numerous advocacy groups. In 2017, his groundbreaking policy paper decriminalization of mental illness, fixing a broken system, played a pivotal role in the creation of the National Justice Task Force to examine state courts' response to mental illness, where he served as co-chair from 2019 to 2020, with his deep expertise and passion for reform, it's an absolute honor to have Judge Mack with us today. Thanks for coming on. Well, I spent a passion on for some years now, so we're making progress. Yes, it's a great passion. Can you tell us why it became a passion of yours? Well, when I became a pro-bate judge, that's when I started hearing these mental cases, and I had no familiarity with them at all. But it did take me long to say, I don't think this is working. I'm seeing the same people over and over and over again. This person's been hospitalized by every pro-bate judge who served as 1970 and multiple hospitalizations and just seeing me that things weren't working. We weren't accomplishing anything that we were just in this revolving door. I started to agitate for change, by the way. This led to my being appointed to the Governor's Mental Health Commission in 2004. When I was appointed, the point I wanted to make was the mental health system was an inpatient model in an outpatient world. It was focused on hospitalization and preventing hospitalization, but not promoting that, not focusing on getting people well. So I advocated a number of changes, which the Commission adopted, but I really got nowhere. I had a blog on R, and then one day, a channel seven came in and wanted to fill the mental health case. Earlier in my career, I probably would have done that. I thought, you know, the public should see this. They should see what's going on. So I'm televised in mental health trial. Added to the bus ticket reporter coming to the sink, he wanted to do a series, filming cases, talking to the family members, talking to the person to the mental illness, and so forth. The series was called Waiting for Disaster. I said, the way the mental health system works is you just imagine a train going down the tracks and then bridges out. So we have two choices. We can dial up the engineer and say, did bridges out without the train or we can park ambulances at the bottom of the ravine and pick up the dead and won't it? Well, that's how the mental health system was working. We wait for crisis and then we intervene. Now, the 2000 for a mental health commission report said we live in the recovery era, where mental illness is treatable, recovery is possible. People with mental illness can lead productive, satisfied lives, if they can't re-treatment. But the system was not designed to permit early treatment. It was designed to wait till a magic moment just before someone actually killed themselves or killed someone else or did something terrible. Yes, I've heard that from several people. What approach did you take that you thought might work for change? My effort has been trying to change the system. Ironically, I had time running to a brick wall with Michigan. I've been a pro major at 25 years and Chief Justice asking to be state or administrator. So I agreed to do it. And when I became a state court administrator, this made me a member of the Compton State Court administrators. They drew a paper over here on a topic of some short. So I volunteered to a paper on the mental health system and how we can change the system so, underneath early, reduce hospitalization and incarceration and improve people's lives. They actually chose to pay for the paper for that year and led to creation of a national task force. And in the meantime, all of a sudden, while Jambroke, Russo, and Lansing, I was able to get a series of bills passed in 2016 and 2018 that changed the way the process for Michigan. We're seeing real differences now. Are there other things that you do as well? One of the things I do is I do CIT training for law enforcement. And I tell them about the new mental health code in Michigan, how it's now in inpatients, now an outpatient model in an outpatient world. And when I say that, it's because over 90% of all in the treatment for mental illness is on an outpatient basis. So the system should reflect that. We should find a way to help people get help when they need it. I mean, if you go back to 1963, the community mental health act, the bill was designed to do two things. Significantly reduced number of people in hospital and provide an outpatient system of care and an alternative. The outpatient treatment system didn't happen. So what happened? We got two million people in America, a serious mental illness in jail every year. We have well over 300,000 in our state prison system, serious mental illness because we're left untreated. And people think that guardian ship is for adults. Now, over half of our guardianships harbor people, serious mental illness, who never got the treatment they needed when it would have made a difference. So my objection has been to treat a system or be intervenerally and it will be the use of hospitals as well as jails and prisons. It's hospital, so they're not therapeutic environments, number one. They're more than jails and prisons, but they're designed to stabilize someone. Not to get the mental recovery, not to get them well, but stable. So just for example, Wayne County, which is where the Christ Lockhaden, we did a study over a five year period, we had 15,000 petitions for mental health treatment or 9,000 individuals, 600 of those 9,000 people accounted for 36% of all the petitions file. There was a less than 1% of the population, but 36% of the petitions. They are all from the faces that rotate in and out of the system. Caffeine, we looked at the top as users of the system. We had 79 people, at least 10 petitions in the previous five years. Those individuals in the prior fiscal year, we spent $3.3 million on hospital evasion, $1.6 million on incarceration, we're told with $4.9 million. And for the $4.9 million, we got nothing. We went in the eventual at 46% of the ER. So what point in time do we say this is now working? Pretty much not working. Well, that's amazing. So what was the next step to make a change? So we have changed the standard for intervention. We don't wait till some is dangerous to solve, rather, we want to know, do you have a mental illness? Do you understand your need for treatment? Are you faced with decapensation, deterioration, and does this create a risk of harm? The harm doesn't have to be immediate. So for example, we had a case in Michigan at the trial, the mental health trial, the doctor testified that the individual was now presently at risk of harm. However, he had a history of stopping taking his medicine. And the doctor testified that he could be expected to stop taking his medicine in three to six months, and he would then be at risk of harm, harm in the form of drug abuse, suicide, increased risk of dementia, and so forth. And the court of appeal said, yeah, that's good enough. We're having a look at the total circumstances to ask which is some of the end of treatment. What we've done in Michigan is we actually have a system of mediation for mental health cases, which I think is kind of unique, or it's best for additions where we ask for outpatient treatment only. Now, we have a system in Michigan now where you're going to file a petition with the Pro-Vate Court, don't go to the hospital, don't go to the police department, the person may put it this way. When I'm hearing cases with Pro-Vate Court and I have family members, I wonder if you stop taking his medication. And they say six months ago, eight months ago, we all know where this is going. We're just waiting for the magic moment. Well, no, we don't have to wait anymore. So you can file a petition with Pro-Vate Court and get a hearing on whether to order out patient treatment. And then as an extra tool, instead of going to a full hearing, you're saying, let's go to mediation. So we have mediation centers for process date. We have about 100 mediators were trained in mental health issues to mediate these disputes. If you're going to mediate an agreement with someone who has a mental illness, you have engagement, you have the likelihood of compliance. I have four bills pending in lunchtime, so right now they have passed the Senate around the four of the house. As we speak, I might get a 10 spending minute out from the Senate or her tells, I mean, we've got them all done. The bills I've had introduced expand mediation so that providers of care will have a better option. The providers of care don't like to petition their clients for treatment. They'll certainly take advantage of mediation. And they'll see if their client has been getting to decompensate and before it gets too bad, it's going to get mediation. We are trying to make the process work better. These all sound like they are great ideas that you've been able to accomplish. Have you had any bumps in the road in doing some of these things that you're trying to do? So we still have some blockages. For example, if I want someone to get out of the patient's treatment only, I have to have a psychiatrist tested by. I went in to be hospitalized, a psychologist's tested by. To me, it was seen that the higher ranking, none of the person ought to be taught about hospitalization and a lower echelon person talking about outpatient treatment. There's been tremendous resistance to these outpatient treatment orders. What to do? Think what's going to happen when you impede the hospitals, what are you going to do with individuals who had to be hospitalized before? You just give me a comparison. The New York State is where Kendrislah was adopted. And that's where in 1999 they started the idea of assisted outpatient treatment. The New York State right now has about 2,500 people on AOT, with a population of 20 million in Michigan, Tennessee County, with a population of 400,000, has about 800 people on AOT orders. So New York City, or New York State, rather, used AOT the way Jesse County does here in Michigan. They have 20,000 people on AOT. It's a preferred option to hospitalization. When we go off the hospitalization road, what that involves is the police go to someone's home like the parents, and they go down and they effectively arrest the parents' son, and then take them out into a spot car in front of the neighbors and transport them to the hospital, and where he's held a guest's will for a few days, depending on the trial in front of a judge in a black road. Now that experience is pretty traumatic. Yes, that's what everyone says. Why do we have to do it that way, and we don't have to do it that way? We inflict trauma, and then the rate of hospitalization is a few days. In fact, we measure length of stay by hundreds of a day. So we say, okay, the average length of stay in Wayne County is 6.25 days. What's length of stay is now there's typically less than seven days. I've talked with a few judges that are just like you. They want to make change. How do we get this across through other judges around the country? There's a couple of things I think that are very important. One is, of course, you're helping people. Two, along with helping them, you're saving taxpayers millions of dollars by keeping them out of the judicial system. What's our best pathway forward to get this across the country? Well, you know, judicial leadership really does matter. And after front the Myers-Briggs pro-Snowdeg profile, basically I sighed a paper on this by judges. And judges tend to be introverts, and they tend to be reluctant to engage directly with the legislature. But you have to find the judicial leadership in each level. Now, when we formed the National Task Force, one of the recommendations by the National Task Force was every state administrative, like the Ministry of Level, the State Department of Level, every state should have the behavioral health administrator at that level. And Michigan now has one Illinois, has one, Pennsylvania has one. And this provides leadership at the state level. Michigan and Wayne County, Judge Freddie Burton, formed a behavioral health unit within the pro-Bate court to monitor this process from beginning to end, to create accountability by the hospital, the community, the treatment system, and so forth. And then the person who hired to run it has now been hired by the state to run the behavioral health unit for the state of Michigan. And part of her mission is to find champions across the state. We don't need a lot of them, but we need one for Regent, for example. This can be happy across the country by each state court of Michigan office having someone who's charged with that responsibility to find these individuals who are willing to do this. So I'm seeing progress. I wouldn't have, well, the first 20 years, I wasn't seeing much progress, but things really started to change when that series came out. I had a clock in the 10th of Congress office, one 12th, I would help fix the statute. I thought that to my experience with the Mental Health Commission in 2004, or we made 70-some recommendations, it got nothing. So that's not a wild goose chase. I was assured it wasn't. So I went up and did that, and things were improving. There isn't a challenge, though. Implementation is a big deal. So in the 50s, it was one shock shopping. The person was admitted to a facility, that facility provided all the sugars that the person could possibly need. Well, now that's not the case. Now either in the community. So now we have stakeholders that all have an interest. Law enforcement is a stakeholder, the hospital emergency department, the community treatment system, the core families, and other schools and so forth. All these stakeholders, and we have all the makings of a mental health system, but the stakeholders don't communicate with one another. They don't work together. They don't have warm hand-tocht, one place to the next. And so it just doesn't, it hasn't been working. So in Michigan, what we found was after these laws were adapted, a lot of the hospitals weren't complying with the laws, and needed one of the community treatment agencies, and needed one of the courts. So we're changing the culture, and that's huge. It's the culture where organizations are hard to do. But the culture has been, we don't give people treatment, they don't want. Even if they don't have the ability to make that decision. So we're changing that. So the idea is, you've probably heard the term of anesthet nausea. Yes, I've heard that term many times in my travels with this topic. People who have a mental illness, who start a process or are compromised, they're not the ones exercising choice, but the illness is exercising the choice. Well, we want to do this free people so they can make their own choice, free them from the effects of mental illness, good thing they have recovery. Aside from the economic sense, avoiding incarceration, which is expensive, especially with people with mental illness, we have to have extensive drugs. We spend a ton of money providing mental health treatment and our jails and prisons, and what are not therapeutic environments. If we can get people that kind of care to need in the community, not only can they get well, but you can save a lot of money. In the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, in the United States, what happens is, when I ordered all patient treatment, a former sent to the patient saying, a treatment team is going to guide you treatment, and you're on the treatment team. They're within the can to engage the individual to participate in the planning of their own treatment plan. An individual's not situation to life they've been listened to, and they respond. So I think it's a great opportunity to help people recover from mental illness, become a doctorate citizens, substantially reduce hospitalization or virtual room costs, and substantially reduce incarceration. Yeah. Now, you were a part of the mental health diversion council, correct? I share the mental health diversion council in Michigan. How does that approach some of these issues? I think it goes in line to what you've been talking about. Does it give a bigger audience to the issues that we've been talking about? Yes. Because we have stakeholders. All the stakeholders are in these meetings. even had the Michigan Hospital Association, I suggested they be a part of the diversion council. They were kind of curious why they were there. They didn't think they were part of the issue. I said, actually, you have a big part of the issue, is if your system is working, nothing's working. With the diversion council, we've been developing these statutory changes in 2016 and 18 and 19. So I've kind of expanded the notion of what diversion is. So in my view, a diversion is a healthy mental health system that keeps people from evolving themselves, that criminal justice system at all. It's a form of diversion, but it's rather expansive. I mean, the Dursary Council in the beginning was focused on people who are in jail and what could do for them. I want to focus on people before they end up in jail. You think about it in Michigan, on an average year, between 150,000 and 200,000 people that show up on hospital and emergency rooms. On the other hand, now, health courts, do we have in Michigan, which we have a lot? We have over 200 courts that do this sort of work. But only about 3% of the people who have a mental illness in our case, jails are in a treatment court. The treatment courts are expensive and you can't scale them up. So if you really want to make a difference, go upstream, help people stay well, so they don't get in trouble with the law. Now, does the council work with the legal system, like lawyers, DAs, that type of people, so that they can get more information about what needs to be done to help these people? Yeah. It's my understanding that once a person gets in front of a judge, that's when the legal system judges lawyers, DAs, even some defense don't understand the mental health situation. Oh, that's just true. But we're having one of our bills to create a diversion process for those who are charged up lift to meters. So currently in Michigan and most states, when you charge of the crime, you have mental illness, they send you to the forensic center for an evaluation. And they have to assert if you're a combat of the state trial or not. If you're not a combat of the state trial, they have to make your combat of the state trial so they can get in. Now, or misdemeanors, sending those individuals to the forensic center as an enormous waste of time, talent, money, resources, because at the end of the day, all you need to do is a conviction for an estimator for an individual who's going to reaffirm. So to be much smarter, so instead of staying this person to the forensic center, you send them into a cesspool of patient treatment and drop the criminal charges. Now, when we put together that legislation, we have the support of the Michigan Poscillus Association, as well as the defense payer. We had the support of the disability rights people. So they all saw this is a better option because if we can take someone who's mentally ill committing misdemeanors and get them well, they were not going to have to deal with them again in the criminal justice system. So let's see if we go out extreme and take care of people before they get trouble, the criminal justice system, and you're just going to significantly reduce the impact of that level. Have you had situations where you sit down with some people, tell them what you're trying to do, yet they're just still not getting behind you? While you're talking with them, you think it's going to be an upward battle, they're just not getting what you're trying to put across. Then the more you get into it, the more you show them the facts, how they can save money. Most importantly, how they can make it a better system for everyone involved. Oh yeah, it's been very enlightening. It's been enlightening for stakeholders to find out how they are victims of a bad system. So for example, how spur emergency rooms are trying for the fact that their emergency rooms are crowded with people at mental illness. Nine point out, well, you know, if we take care of that properly, they will become into your emergency rooms or law enforcement. Yeah, one third of all the people in this country with the serious mental illness, they're pathway to care with sidewalk enforcement, which is a staggering. So people in law enforcement are not in the front line. There's not a police officer around who won't tell you that you know with people behavioral health issues is a big partner job. If we can take care of that at the mental health treatment level, we help them out. And we even help out community treatment because it gives people on their entertainment and in recovery, it puts less pressure on everybody all the way around. People eventually see it. You are so correct there. The police officer is the first one most times that they come in contact with. The unfortunate part is sometimes the officer has only seconds to make a decision on what to do. The more we can get them to understand the better situations we can have. So when they do come in contact with someone that has a mental illness, they might be able to have a better outcome. Right, well, you know, in China, I think you spoke with Judge Tevlett-Steele life run, I believe, already. Yes. And he's a master of that. He's an amazing what he's done. Florida's not an Medicaid expansion state and they don't have a good civil system or mental health issues. Like we do in Michigan. So to that extent, Michigan really is an advantageous position. And the other thing we should be doing better than what Judge Leifman is doing. But Judge Leifman is about a head start on us. So we're still trying to catch up. But we're trying to, we're moving into, we're in line with crisis centers inside of hospitals. And, you know, if we ride outpatient treatment, crisis centers and so forth. And the hospital emergency room is going to look a lot different. Yeah, I think he's got a 218,000 square foot facility that he's opening up. I've been down there and checked it out. It's quite an operation. Yeah, it's great. I think that's what we need is more people like him, yourself, to show people that change can be made. Not only does that change help loss of people, it also saves tremendous amount of money and time within the legal system that can be better put to use for other things. And eliminate some kinds of risk as a danger. And I mean, you're still going to have situations, but you can reduce the number. You can manage it better. Absolutely. Now, what would you like to leave with our listeners that you think is very important for them to understand on what it is that you're trying to do to help people? Well, we need to intervene early. We don't wait to treat someone. We wouldn't wait to treat someone with cancer in the stage four. Would you just as much damage by waiting to treat mental illness? And it is no... You've had to private people of their freedom when you're freeing them from the impact of mental illness which you've left untreated. And assisted on facial treatment is the most humane treatment possible. It's better than being treated in the hospital, far better than being treated in jail, and far better than homelessness. And we should do this, and it's good for everyone. Absolutely. Well, I definitely appreciate you coming on. Great information, great conversation. All right. Thanks a lot. I appreciate you doing this. It's been my pleasure. Thanks again. Thanks for taking time out of your busy schedule to listen to our show today. We hope you enjoyed it as much as we enjoyed bringing it to you. If you know someone who has a story to share, tell them to contact us at whynotme.world. One last thing, spread the word about why not me. Our conversations, our inspiring guests, that show you are not alone in this world.
