Tony Mantor: Why Not Me the World
Judge Milton Mack's Mission to Reform Mental Healthcare
Mon, 05 May 2025
Send us a textJudge Milton Mack shares his mission to reform the mental health system by moving from crisis intervention to early treatment and prevention. His groundbreaking work in Michigan demonstrates how changing laws and procedures can dramatically improve outcomes while reducing costs.• Moving from an inpatient model to an outpatient world where over 90% of mental health care now occurs• Changing intervention standards to help people before they reach crisis, not waiting for the "magic moment" of danger• Implementing mediation for mental health cases to increase engagement and compliance• Creating a system that reduces trauma by avoiding unnecessary hospitalization and incarceration• Demonstrating success through Genesee County's 70% reduction in hospitalization and 90% treatment compliance• Building coordinated stakeholder systems where law enforcement, hospitals, courts and treatment providers work together• Focusing on upstream solutions to prevent people from entering the criminal justice system• Recognizing that early intervention in mental health is as important as early intervention for cancerWe need to intervene early—we wouldn't wait to treat someone with cancer when they're stage four, and we do just as much damage by waiting to treat mental illness. Assisted outpatient treatment is the most humane option, far better than hospitalization, jail, or homelessness. This approach benefits everyone.https://tonymantor.comhttps://Facebook.com/tonymantorhttps://instagram.com/tonymantorhttps://twitter.com/tonymantorhttps://youtube.com/tonymantormusicintro/outro music bed written by T. WildWhy Not Me the World music published by Mantor Music (BMI)
What is Judge Milton Mack's mission for mental health reform?
Well, when I became a probate judge, that's when I started hearing these mental health cases, and I had no familiarity with them at all. But it did take me long to say, I don't think this is working. I'm seeing the same people over and over and over again.
This person's been hospitalized by every probate judge who's served since 1970, and with multiple hospitalizations, and it just seemed to me that things weren't working. We weren't accomplishing anything, that we were just in this revolving door. I started to agitate for change, you might say. This led to my being appointed to the Governor's Mental Health Commission in 2004.
When I was appointed, the points I wanted to make were the mental health system was an inpatient model in an outpatient world. It was focused on hospitalization and preventing hospitalization, but not promoting that, not focused on getting people well. So I advocated a number of changes, which the commission adopted, but I really got nowhere. But I kept plugging along.
And then one day, Channel 7 came in and wanted to film a mental health case. Early in my career, I probably would not have done that. But I thought, you know, the public should see this. They should see what's going on. So I'm televised a mental health trial. That led to the investigative reporter coming in and saying, you want to do a series?
Filming cases, talking to the family members, talking to persons with mental illness and so forth. And the series was called Waiting for Disaster. I said, the way the mental health system works is you just imagine a train going down the tracks and the bridge is out. So we have two choices. We can dial up the engineer and say the bridge is out, stop the train.
Or we can park ambulances at the bottom of the ravine and pick up the dead and wounded. Well, that's how the mental health system is working. We wait for crisis, and then we intervene. Now, the 2004 Mental Health Commission report said We live in the recovery era where mental illness is treatable, recovery is possible.
People with mental illness can lead productive, satisfying lives if they get early treatment. But the system was not designed to permit early treatment. It was designed to wait till that magic moment just before someone actually killed themselves or killed someone else or did something terrible.
Yes, I've heard that from several people. What approach did you take that you thought might work for change?
My effort has been trying to change the system. Ironically, I had thought I'd run into a brick wall with Michigan. And I've been a probate judge for 25 years, and the chief justice asked me to be state court administrator, so I agreed to do it. And when I became a state court administrator, this made me a member of the conference of state court administrators.
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