News Photo by Julie Riddle Phil Sinato, a South Carolina psychiatrist contracted to provide services to MidMichigan Medical Center-Alpena’s Behavioral Health center, talks with Nurse Manager Cami Misak via telemedicine equipment used to provide patients with quality care in a region that struggles with physician retention.

ALPENA — Cold winters, geographic isolation, high unemployment, and the influx of the nationwide opioid epidemic can take their toll on the mental health of Northeast Michigan residents, experts say.

While rural areas, especially, often feel the pinch of a nationwide shortage of trained mental health experts and funding for mental health treatment, a potentially surprising picture arises when looking at mental health care options in Alpena and surrounding areas.

Many area organizations and health care providers have overcome obstacles to provide a wide variety of care — if those residents know where to look.

Dion Giraud, of Lewiston, has received services from Northeast Michigan Community Mental Health and is a frequent visitor at the Light of Hope Clubhouse, an Alpena agency focused on providing a sense of worth and belonging to people battling mental illness.

Giraud has good days and bad days. But, with the help he’s been provided, he said there’s hope.

“Nothing’s a barrier for us,” he said. “It’s a challenge.”

A CHALLENGING ENVIRONMENT

In the 1980s and 90s, a national trend shut the doors of most mental hospitals, leaving to local communities the care of the roughly 20% of adults the National Institute of Mental Health estimates are struggling with mental illness.

Community hospitals such as MidMichigan Medical Center-Alpena have not been able to pick up the slack. Instead, the number of inpatient facilities has decreased in the past two decades.

In such a challenging environment, rural Michigan counties must be creative with the resources they have to meet the needs of area residents, officials say.

In Northeast Michigan, mental health services are offered through the Behavioral Health arm of the Alpena hospital, through Northeast Michigan Community Mental Health, through Catholic Human Services, and through private providers.

Reflecting a recent push toward care that combines physical and mental services into one comprehensive package, patients at Thunder Bay Community Health Service and Alcona Health Center can access counseling services in the same building as their primary care physician.

Any local provider can be a doorway to receiving services, according to Larry LaCross, clinical supervisor at Catholic Human Services.

The hospital offers the only inpatient facility in the area. The Pointe East Center is a 15-bed facility providing short-term, acute psychiatric care “for depression to schizophrenia and everything in between,” according to Cami Misak, nurse manager with Behavioral Health.

Outpatient and emergency services are also offered through Behavioral Health, with two adult psychiatrists and one child psychiatrist on staff via telemedicine, as well as therapists and nurse practitioners.

Community Mental Health provides services for severe and persistent cases, primarily for patients who receive Medicare or have no insurance. Catholic Human Services specializes in treatment for mental illness co-occurring with drug addiction, and also offers a range of other counseling options, including family and marriage counseling.

RURAL CHALLENGES

A nationwide shortage of mental health providers is reflected in Northeast Michigan, where agencies say they struggle to acquire and retain mental health workers. Presque Isle County’s population-to-health-care-provider ratio, among the highest in the state, is 10 times that of the state average, according to Amy Hepburn, program development director for Thunder Bay Community Health Service.

“There’s a severe shortage, we know that,” Hepburn said.

Behavioral Health has struggled to find staff willing to live in Alpena. Patients might have to wait two weeks to see a counselor, a professional who uses talk therapy to help clients learn better ways to manage their problems, or six weeks before seeing a psychiatrist, a medical doctor who can prescribe medications used to treat specific mental disorders.

Many area residents can’t afford to travel downstate for care, and shouldn’t have to, Misak, the nurse manager at Behavioral Health, said.

To counter that problem, Behavioral Services currently uses telemedicine exclusively, connecting patients to doctors via screens.

“It would be fabulous to be able to recruit more physicians, more psychiatrists, to be able to come to the area,” Misak said. “The number of patients we are seeing is not decreasing, by any means.”

While more specialists are needed to fully serve the community, the Alpena area is not bereft of advanced mental health treatment.

At Catholic Human Services, for example, several counselors are certified in specialty fields such as eye movement desensitization and reprocessing — used to move post-traumatic stress disorder and other trauma-impacted patients quickly through the healing process — and crossover mental health/addiction treatment.

CHILDREN AND MENTAL HEALTH

One of every seven children in Michigan are diagnosed with anxiety, depression, or attention deficit hyperactivity disorder, according to a 2019 study by the American Medical Association. With a severe nationwide shortage of child and adolescent psychiatrists, 65 of Michigan’s 83 counties — most of them rural — have no child or adolescent psychiatrist to meet those needs.

Since last fall, the Rogers City branch of Community Mental Health has been one of the few CMH organizations in the state with a child psychiatrists on staff.

Dr. Anastasia Hoffman, a former private practitioner in metro Detroit, has a caseload of 225 children and adolescents from the surrounding counties.

Area providers and schools have taken proactive steps to watch for signs of mental struggle and to offer in-school counseling services.

Local schools have OK2SAY signs in hallways, encouraging students to use the state program to confidentially report tips on potential harm or criminal activities.

Alpena High School Principal Tom Berriman said the school receives notifications from the Michigan State Police if a student submits a tip to OK2SAY, so the school can intervene and help, if necessary.

“It’s just another tool that’s out there for anybody to share concerns, so, if they’re out in the community and they walk by a group of kids and a kid talks about bringing a gun to school and shooting up the school, it gives them another avenue to immediately notify the law enforcement in the schools,” Berriman said.

Since September 2014, OK2SAY has received over 4,409 tips on suicide threats from kids statewide, over 1,500 on self-harm, and over 1,900 tips on other issues, like anxiety, stress, depression, and harassment.

Northeast Michigan schools have options for students when it comes to mental health.

Thunder Bay Community Health Service is located at Atlanta, Hillman, Onaway, Posen, and Rogers City schools to provide on-site counseling services to students from a therapist.

Alcona Health Center has locations inside Alpena Public Schools and at Alcona Elementary School.

Hepburn, the Thunder Bay Community Health program development director, said some services in the schools include crisis intervention, behavioral assessments, confidential services, and individual and family counseling.

“In such a rural area, there are some that don’t have the ability to access (services), so it brings the support to the kids,” Hepburn said.

Each intermediate school district in Michigan in the spring received $294,500 from the state for mental health and support services, and $142,857 for behavioral team pilot programs.

Ashley Wilmot, coordinator of instructional services for the Alpena-Montmorency-Alcona Educational Service District, said the behavioral team pilot program will help build knowledge about social and emotional curriculum in the classroom.

The Cheboygan-Otsego-Presque Isle Educational Service District will pool funds together to expand existing school-based mental health services, Superintendent Jamie Huber said. The district will also create new mental health services with master-level counselors who were not available before in a school setting.

“They are all willing to provide the space necessary to provide the services to students,” Huber said of her district’s member schools.

FILLING IN THE GAPS

The use of technology has helped fill the gap caused by a lack of mental health providers.

While telemedicine — the use of screens to connect patients with physicians when they can’t be in the same place — may seem impersonal, and doesn’t entirely substitute for hands-on care, it is actually well-received by many patients, according to Misak, of the Alpena hospital’s Behavioral Health. Young patients are especially receptive, having grown up accustomed to on-screen interactions.

At Pointe East, a full-time psychiatrist sees patients daily via screen while living at his home in South Carolina.

One private provider in Alpena, Madeleine McConnell, offers clients neurofeedback technology she learned on the West Coast. In the therapy, nodes recording brain activity give feedback to the patient’s brain, teaching it to respond in healthier ways to mental health struggles.

“Why not bring something to a rural community, where there’s a major, major need?” McConnell said. “Any additional resources and tools that we can bring into this area to support our folks here is good.”

IT’S ALL OF US

Mental distress often comes with a stigma that can discourage people from seeking help — a stigma that some officials said can be worse in small towns, where anonymity can be harder to find.

To help overcome that stigma, Community Mental Health offers Mystrength.com, a website with an accompanying app that provides personalized self-care suggestions and steers users toward appropriate outside help.

Community programs and support groups such as Alpena’s Bay View Center further the treatment offered through many providers, offering support and affirmation groups. Agencies such as North Eastern Michigan Rehabilitation and Opportunity Center Inc. and the Light of Hope Clubhouse in Alpena help those with serious and persistent mental illness find employment and a sense of purpose.

In the halls of Light of Hope, it’s hard to tell the difference between those serving and those being served.

“There isn’t a face of mental health care or a mental health patient,” Misak said. “It’s all of us. It’s everyone.”

People are reluctant to talk about mental health, Misak said, and to admit that they need help catching their balance.

“It isn’t something to be ashamed of,” Misak. “It’s something to talk about to get the support that you need. Because there are more people struggling with mental health concerns than you think. And if people would just talk about them, you would realize that there’s a whole lot of support out there.”

Julie Goldberg can be reached at 989-358-5688 or jgoldberg@thealpenanews.com. Follow her on Twitter @jkgoldberg12. Julie Riddle can be reached at 989-358-5693, jriddle@thealpenanews.com or on Twitter @jriddleX.

About this series

For the past several weeks, News reporters have interviewed health care providers and compiled and reviewed local, state and national data to compile a comprehensive picture of the challenges of providing timely medical care in rural Northeast Michigan.

TODAY

∫ A look at behavioral health care in Northeast Michigan.

∫ The challenge of caring for Northeast Michigan’s athletes, 1B

MONDAY

∫ A look at plans for future improvements to health care our region.

∫ Our view: The News calls for residents, officials to share responsible for area care.

In case you missed it

Find previous stories online at TheAlpenaNews.com or stop into the news at 130 Park Place for a copy of a previous edition.

THURSDAY

∫ An overview of some of the strengths and weaknesses of Northeast Michigan health care.

FRIDAY

∫ A closer look at the time it takes for medical teams to respond to an emergency.

Behavioral Health

Services, MidMichigan Medical Center-Alpena

Outpatient Care: 800-288-7242

Inpatient Care: 800-288-7242

Catholic Human Services

989-356-6385

Northeast Michigan Community Mental Health

Alpena: 989-356-2161

Rogers City: 989-734-7223

Hillman: 989-742-4549

Alcona Health Center

alconahealthcenters.org

Thunder Bay

Community Health

Service

tbchs.org

Light of Hope Clubhouse

Alpena: 989-356-8468

Bay View Center

Alpena: 989-340-0955