LANSING - It started slowly, when the Traverse City Regional Psychiatric Hospital shut its doors in the mid-1980s. Then in the 1990s, 10 more folded in rapid succession. And like the last teetering blocks in a long line of dominoes, Northville Regional Psychiatric Hospital fell in 2003 and the Mount Pleasant Center in 2009.
Now, the state continues to grapple with lasting effects of those closures. Officials and psychiatric professionals say prisons and jails have become the new home for the many seriously psychologically troubled, and at a high price for both inmates and taxpayers.
The projected 2013 cost for Corrections Department psychotropic drugs is $3,431,500.
In a matter of 12 years, the state went from running 17 mental institutions to just five. Most closed during Gov. John Engler's administration. Many of those former patients ended up in prison, experts say.
Professionals say psychiatric wards are overflowing with "forensic cases," or severely mentally ill patients with criminal records.
Only one forensic-specific institution exists - the Ann Arbor-based Center for Forensic Psychology - which has 210 beds, a number experts say is far too low.
Forensic cases flood the four state hospitals left, leaving inadequate space for others who need treatment but don't have a criminal record, says Mark Reinstein, president of the Mental Health Association in Michigan, based in Southfield.
Some experts say prisons and jails became the only place left for many of the severely mentally ill.
"We've just traded hospitals for prisons," Reinstein said. "The Wayne County Jail is, in effect, the largest psychiatric institution in Michigan."
Wayne County has the largest jail in the state, with 2,600 people.
"The only shot they really have for getting the most intensive psychiatric care available is to stay at a community or private psychiatric hospital where Medicaid will pay for it," Reinstein said.
That's not an option for many who can't afford private insurance, or whose private insurance doesn't cover mental health or for those ineligible for Medicaid.
And Reinstein said prisoners with less-severe symptoms might receive treatment before those with more aggravated illnesses.
A 2010 University of Michigan study claimed nearly two-thirds of severely mentally ill prisoners hadn't received treatment within the past year the study was conducted. That estimate didn't account for those with substance abuse problems, which would raise the figure, he said.
The U-M study claimed more than 20 percent of the prison population is severely mentally ill, meaning diagnoses like schizophrenia or bipolar disorder.
But that number is disputed by the Corrections Department, which lists the number of prisoners undergoing treatment at 5.9 percent. That's a difference of nearly 7,000 prisoners.
Still, Daniel Heyns, the Corrections director, said many former state psychiatric patients ended up in prison "by default" after state-run hospitals closed.
The reason is simple, says Terry Jungel, executive director of the Michigan Sheriffs' Association. "Those hospitals were strictly closed for economic reasons to save money."
In 2013, $278,492 was appropriated for state-run psychiatric and forensic institutions, from a total Community Health Department budget of more than $15 million. More than $2 billion is spent on Corrections.
As of April 2013, 781 patients were in state psychiatric and forensic centers. Community Health says those facilities are close to capacity.
Many people spill into county jails, too, where Jungel estimates 30 to 40 percent of inmates have severe psychological illnesses.
Psychotropic drugs are "the most significant expense in any jail medical budget," Jungel said.
Angela Minicuci, public information officer for Community Health, acknowledges a "service gap" issue, meaning some don't receive needed treatment.
"What we've done is we've shifted care," Minicuci said. "In that process, there are people in our corrective systems.
"We recognize that's an issue."
She declined to comment on whether inmates with psychological illnesses receive proper treatment, another accusation in dispute between the corrections department and some psychiatric professionals.
"Michigan is known for being a leader for shifting from state-based care to community-based care," Minicuci added. "It definitely has gaps in service that we need to address. But the shift is a very good one."
The five remaining state-operated hospitals are the Caro Center; Kalamazoo Psychiatric Hospital; Walter Reuther Psychiatric Hospital in Westland; Hawthorn Center in Northville; and the Center for Forensic Psychology.
Ingham County is no exception to the trend. Sherriff's Capt. Tom Wheeler said many people with mental illnesses end up in the 601-person jail.
Capt. Tim Schuler from the St. Joseph County Sherriff's Department said its small 165-bed facility doesn't handle many psychologically troubled individuals, but he recounted one instance.
"Couldn't tell you what year it was," Schuler said. "We've known him from prior issues - he had some major mental illness. He was a handful.
"He had busted off the top shield of the drinking fountain and slit himself pretty good."
After that, Schuler said he and his co-workers put the inmate in a restraining chair. "But of course you can only keep him in there for two hours."
Schuler said the man was eventually released from the restraint chair after promising to calm down, but proceeded to rip a camera from a ceiling and was then restrained again.
"They're off their medication and that just sends them clear off into space," Schuler said.
The man was eventually released and sent to a psychiatric facility in Kalamazoo.