When I first started working in community mental health over two decades ago, I was fresh out of grad school, all nerves and notebooks and a desperate hope that I wouldn’t mess everything up. My first job was at a small nonprofit on the east side of Philadelphia, tucked between a mechanic’s garage and a barbershop. We served folks who were often left behind by the big systems — people living with schizophrenia, PTSD, deep poverty, trauma, addiction, and sometimes a lifetime of feeling like no one really saw them.
We weren’t perfect, but we knew our people. We knew Ms. Jackson didn’t do mornings. We knew to call before visiting Mr. Reyes because his paranoia would spike if someone knocked unannounced. We knew which grocery store offered double coupons on Wednesdays and which ER nurse would actually listen if we had to escalate a client’s care. That local knowledge — that deep, human connection — saved lives.
It’s why the new move in Michigan hits such a tender nerve.
The state has announced plans to open its mental health service contracts to competitive bidding. On the surface, it’s couched in the usual language: efficiency, quality improvement, better oversight. I’ve been around long enough to recognize those words when they start floating through press releases. They can be genuine. But they can also be glossy wrapping paper over a much harder package: the outsourcing of care to the highest bidder, often far removed from the communities they’re supposed to serve.
And that has consequences. Real ones.
See, mental health care doesn’t work on a factory model. You can’t slap a one-size-fits-all solution on it and expect the same kind of precision you’d get from, say, assembling a desk. Human beings are messy, layered, brilliant and struggling all at once. They don’t respond well to being treated like numbers in a spreadsheet.
When states like Michigan open up community mental health contracts to competitive bidding, there’s a very real possibility that smaller, locally rooted providers — the ones who understand the emotional architecture of their neighborhoods — will be pushed out by larger, often out-of-state corporations. Companies whose bottom line is profit, not proximity. And that shift, no matter how well-intentioned, can erode the continuity and trust that are the bedrock of good mental health care.
Imagine a young woman who’s finally started to stabilize after years of housing insecurity and trauma. She’s been seeing the same case manager for 18 months. They’ve built trust — slowly, painfully, inch by inch. But then the agency that employs her case manager loses its contract. A new provider steps in. New staff, new systems, new rules. Her case gets reassigned. She has to start over. Again.
That kind of disruption isn’t just inconvenient — it’s traumatic.
I’ve worked with people who have had six therapists in two years. Who’ve had to re-explain their most painful memories again and again to new faces. Who’ve been just a few steps away from finding their footing, only to have the ground shift beneath them because of decisions made in sterile boardrooms miles away.
Now, I’m not against improvement. God knows the mental health system needs it. We’ve got waitlists a mile long, underpaid staff burning out faster than ever, and a patchwork of services that leave too many people falling through the cracks. But “improvement” isn’t always achieved by shaking up the snow globe and hoping the flakes settle in a better pattern.
It requires listening.
Listening to the professionals who’ve been showing up day after day, not for the paycheck (which, let’s be honest, often barely covers their own therapy) but because they genuinely care. Listening to the clients who’ve spent more time in ERs and shelter beds than they ever should have. Listening to the community partners who’ve built decades-long relationships across food banks, schools, churches, and housing agencies that money alone can’t replicate.
There’s a deep wisdom in these relationships. A kind of lived intelligence that can’t be bought, scaled, or outsourced.
Competitive bidding can make sense in some industries. Try getting a new sidewalk built or a septic tank installed — go ahead and get a few estimates. But when it comes to mental health care, especially for vulnerable populations, who are often already exhausted from being asked to prove their worthiness over and over again, there’s something sacred that gets lost when we treat care like a commodity.
I’ve sat in rooms with people who’ve lost everything — family, safety, dignity — and the only thing keeping them tethered to hope was the connection they felt with someone who really saw them. That’s not easily replaced. That doesn’t get awarded to the “lowest responsible bidder.”
It’s ok to demand better oversight. It’s ok to dream bigger for our behavioral health systems. But we have to ask — better for whom?
Better should mean a warmer welcome when someone walks into an intake appointment scared out of their mind. Better should mean fewer people having to re-tell their stories to yet another stranger in a system that already makes them feel invisible. Better should mean bold investment in people over profit, in relationships over revenue.
I believe in accountability. I believe in refining services, strengthening programs, and cutting out the fluff that doesn’t serve our clients. But I also believe in roots. And when we start pulling up those roots in favor of sleek new models and national contracts, we risk losing the very soul of what makes community mental health work: community.
We say that phrase so often — “community mental health” — like it’s just a type of clinic or funding structure. But it’s more than that.
It’s Auntie Brianna who runs a grief group in the church basement because she lost her son and doesn’t want other mothers to suffer alone.
It’s James, the peer support specialist in recovery who walks a man to his first NA meeting every Thursday night because those steps are terrifying to take alone.
It’s the receptionist who remembers how you like your coffee and tells you, honestly, that she’s glad you came in today.
That’s what’s at risk here.
So if you live in Michigan — or frankly, anywhere — pay attention. Ask questions. Stay curious. Talk to your legislators, your neighbors, the people behind those desks who are quietly holding our mental health system together with duct tape and sheer love.
Because when we protect the heart of our community-based care, we protect more than just programs. We protect the humanity of our neighbors. Of ourselves.
And I think that’s worth fighting for.
