Last February, WXYZ Channel 7 reporter, Heather Catallo, investigated on-going allegations against Michigan psychiatrist, Dr. Nagy Kheir, for pre-signing documents to hospitalize people against their will through the civil commitment process, and extending patients’ stays by giving them severe diagnoses such as Bipolar Disorder, but failing to evaluate these patients beforehand. Past patients of Dr. Kheir, interviewed by Catallo, described their experience in the hospital as “traumatic” and never meeting with Dr. Kheir throughout their entire stay.

Since the allegations were made public, Dr. Kheir resigned from Pontiac General Hospital in the spring of 2023 where he was the chief psychiatrist for seven years. However, he is still currently affiliated with Harbor Oaks Hospital in New Baltimore and Stonecrest Center in Detroit.

While the alleged pre-signing of documents seems to be an isolated incident, it has raised questions about ongoing reports of abuse and negligence in psychiatric hospitals in Michigan in recent years, particularly violence among patients. Harbor Oaks Hospital has had several reports of assault since 2017.State-run psychiatric hospitals like Hawthorn Center for children and adolescents in Northville made news last April when staff members failed to intervene when a fifteen -year old girl physically assaulted a ten-year old boy, who were both receiving care at the hospital. As a result, the boy suffered mild brain damage.

Allegations of negligence and abuse often go unchecked because more than two- thirds of private psychiatric hospitals assign part-time employees to investigate these claims. Typically, staffing levels can indicate how effective a hospital is at investigating complaints, as hospitals with lower staff levels open up less investigations. In state-run hospitals, the state recipient rights office often fails to open investigations immediately after receiving complaints.

Dr. Theadia Carey, who is the president of the Michigan Psychiatric Society, as well as a certified general psychiatrist and addiction psychiatrist, says that understaffing can lead to situations of negligence, providing an example, “Sometimes if you’re in a situation where you have one staff member assigned to one patient, the staff member could not leave this patient. If you have another patient who starts to escalate, where will the negligence come from? Will it come if I leave the patient I’m supposed to be with in order to intervene, because there was no staff nearby or does it come because I saw a problem and didn’t intervene? It leaves us in a quandary.” Dr. Carey suggests that taking the time to “appropriately evaluate the patient and look at their history” to have an understanding of what their needs are and having enough staff to accommodate those needs can be helpful in preventing these situations.

Understaffing has been and continues to be a challenge in Michigan mental health hospitals. In 2022, three state-run psychiatric hospitals in Michigan had to close more than 70 beds as a result of understaffing. Beds continue to be cut, as understaffing is a complex issue with several factors contributing to it. A news article written by Tyler Schnieder and published in the “City Pulse” last August, featured Robert Sheehan, executive director of the Community Mental Health Association of Michigan, who suggested lack of interest in psychiatry among younger generations may contribute to understaffing. Saying younger people ”just aren’t getting into the field like they used to,” Dr. Carey echoed this, stating that the median age of psychiatrists in Michigan is 50 years old.

Dr. Carey also believes that there are not enough training programs for aspiring psychiatrists to truly “meet the needs of patients” and that if there were enough programs, the number of training slots would still be an issue, given, after medical school, psychiatrists would be training in the residency program for typically three to four years, longer than pediatricians and family medicine doctors.

One of Dr. Carey’s responsibilities as the president of the Michigan Psychiatric Society, which is a branch of the American Psychiatric Association, is to look out for new laws that may affect mental health patients. She informed me that due to the understaffing of psychiatrists, Michigan legislation is proposing a change to expand the responsibilities of medical doctors and nurse practitioners, including permitting them to write prescriptions for psychiatric medications and determining if a patient needs to be involuntarily committed. While Dr. Carey understands the rationale behind this, she expresses many concerns, saying, “There is research out there that shows that if you take a psychiatrist and you take an emergency medicine physician, it’s difficult to get them to agree consistently on which patients meet criteria for involuntary hospitalization. What’s going to happen when you have someone with two years of training making that decision? I think we’re going to have more problems and more challenges, and my concern is having grown up in an inner city under-resourced area, that is the population that’s going to be most adversely affected.”

The Michigan mental health system is often referred to as a “revolving door” as people often return to the emergency room soon after being released from a psychiatric facility. The low recovery rates can be in part due to insurance.

Following a psychiatric emergency, when an individual is a threat to themselves and/or others, most patients only stay in the hospital for about a week, no matter their safety, because that is all insurance can cover. Upon discharge, patients are typically provided with two weeks worth of medication and are expected to follow up with a mental health professional at an outpatient appointment. Dr. Carey says this is an issue, as many have transportation issues, and their insurance may not be accepted by a private practice and cannot afford to pay out of pocket. She explains, “Insurance is supposed to provide patients the opportunity to have transportation. If you have Medicaid or Medicare, they’re supposed to get you a driver to get you to your appointment. Sometimes those drivers don’t come. I remember a time when I had a patient who was 69 years old. She had made the call for transportation, and instead they sent her bus tickets in the mail to come to her appointment.”

When a patient is unable to see a private psychiatrist, they are able to go to community mental health, but this does not eliminate transportation issues and is often a lengthy process. She continues, “The setup requires that patients have to have an appointment through the access system, so they call and they’re going to have to tell their story to someone over the phone before you can even get that first appointment. Then, the first appointment would be with a social worker and have an intake session. Because of all the questions they’re required to ask, it may last two to three hours. Then, legally, they have to make a pre plan to sketch out what they think they might need; then they have to have a meeting for your individual plan of service. All of that has to happen before they are typically even scheduled to see a psychiatrist.”

Dr. Carey says changing the requirements of a patient having to do an individual plan of service to not before they can see a psychiatrist but to a later date would remove a barrier, so patients can meet with a psychiatrist at least two weeks after discharge.

Dr. Carey states that the Michigan Psychiatric Society continues to have open communication with Michigan’s legislative branch. The director of the association, Bob Kawoloski, coordinates meetings with Michigan legislators to provide them with up to date education about mental health. Dr. Carey says, “Sometimes they are very amenable to our suggestions, and then other times, I think that they may be focused and going in a different direction because of other influences.”

Further information and questions and concerns regarding mental health in Michigan can be directed to the Michigan Psychiatric Society on their website: michiganpsychiatricsociety.com.