Michigan Nearly Doubles Out-of-State Youth Mental Health Placements as In-State Facilities Close

Parents Watch as Children Sent Hundreds of Miles for Care

Eleanor Middlin was 15 when her family sent her to a Missouri boarding school, an 11-hour drive from her mid-Michigan home.

It was the worst thing that ever happened to her. It also saved her life.

"I'm alive because of it, and I will never be able to forget it," Middlin, now 20, told Bridge Michigan.

Her experience leaving Michigan for long-term care represents an emerging trend for the states youth in severe mental health crises. In the years following the COVID-19 pandemic, a growing number of teens and children are being sent hundreds or thousands of miles from home, often because the state lacks the resources to treat them here.

State Numbers Show Doubling of Out-of-State Placements

State reports show out-of-state placements have surged in recent years as a series of Michigan facilities closed. As of September, 152 youth in Michigans direct-placement program were living in out-of-state facilities — some as far away as Hawaii and Arizona, according to a recent report from the Department of Health and Human Services.

That was up from 122 children sent out of state in 2024 and more than double the 74 children in 2023.

Parents Say System Throws Children to the Wolves

Forcing a child to travel for care is like throwing them to the wolves, said Laura Marshall of Cedar Springs, whose son was sent to a Wyoming long-term treatment facility through court order.

"We had no control over where he was going," Marshall said.

Families say the extreme distance makes it challenging to plan visits and some facilities further limit contact. The isolation can be detrimental to their childrens recovery and traumatizing for parents to endure.

"Horr or stories about abuse and staff misconduct dominate conversations about youth treatment facilities, adding a layer of fear for parents that their loved ones may return in a worse condition," the CBS Detroit report said.

"Youre shipping your kid, in some cases, across the country," Marshall said. "There really isnt any way as a parent to be able to vet what's really going on."

State Officials Defend Placement Decisions

State officials believe the rise in out-of-state placements is largely limited to court-supervised youth in the juvenile justice system, not children they directly oversee.

But counties that report placement data to the state are not required to share that information, a spokesperson said.

"The Michigan Department of Health and Human Services believes that placement decisions for youth in foster care and those involved with the juvenile justice system must be guided by safety, stability and the best interests of each individual child to ensure they receive the care and treatment they need to thrive," spokesperson Erin Stover wrote in an email.

Lawmakers Question Liability

The confusion is a symptom of a larger problem, lawmakers contend: A massive department overseeing a sprawling landscape of juvenile facilities that could lead to kids falling through the cracks — or needing to seek care elsewhere because state offerings are not accessible at the time.

"The liability question is really huge, because who is responsible?" State Rep. John Roth, R-Interlochen, said.

"If that kid gets seriously injured in an out-of-state facility, is it the state that they went to's problem now?"

Pandemic Accelerated Mental Health Crisis

Eleanor Middlin was hospitalized for self-harm at 12 years old. Throughout her adolescence, Eleanor had seen therapists and received medication. But her mental health issues compounded during the pandemic, a period marked by intense isolation and complete access to the internet.

Snapchat, Instagram and Yubo became social media vehicles toward a path of feeling horrible about herself, she said.

"It was the perfect environment for me to get worse," she said.

She developed substance-use disorders — mainly downers like Xanax and opioids — and eating disorders. Many of her habits were unknown to her mother, Jennifer Middlin.

"It felt shameful even though we tried everything that we could try," Jennifer told Bridge. "It's sort of this secret club that no one wants to be part of and no one admits to being part of."

Families Pay Huge Costs for Out-of-State Care

The cost of out-of-state care came out-of-pocket for the Middlins — Jennifer estimates her family spent $90,000 on her daughter's treatment. Insurance did not cover her daughter's frequent therapy sessions at the boarding school.

The loans and the toll on her savings to make payments were financially devastating.

The state also carries a significant financial cost to send its youth out-of-state for treatment — it paid more than $13 million in related costs last fiscal year, with about half coming from the state.

That was up from $9.7 million the prior year. That amounted to $392 per day of care, up from $379.

Capacity Crisis Shrinks In-State Options

Parents and mental health advocates describe a system that consistently fails children with complex psychological disorders, where the needed treatment does not exist anywhere in Michigan.

They point to several intersecting factors — limited in-state capacity, insurance not offering enough support and publicly-funded community mental health services not meeting the needs of families.

Several of those facilities, which house children and teens with significant emotional, behavioral or mental health challenges, have closed since the onset of the pandemic, when about 1,200 beds for child caring institutions were operating.

Today, there are fewer than 400 beds available.

Dan Gowdy, the president of the Association of Accredited Child and Family Agencies and the CEO of the Grand Rapids-based Wedgewood Christian Services, describes a perfect storm that enabled the current capacity crisis.

Insurance and Public Systems Fight to Cover Care

Emergency calls to deal with youth in crises are frequent, setting the stage for many youth to have prolonged encounters with the criminal justice system to address their needs.

Insurance companies and the public mental health system are constantly fighting it out to cover care, said Rachel Cuschieri-Murray, a cofounder of a local parents group called Advocates for Mental Health of MI Youth.

"So it's not being done by anyone," she said.

There were 9,200 children in Michigan's welfare system as of December 2024, according to recent state reporting. Of those, 468 lived in institutional centers that include youth residential treatment facilities.