Grand Traverse County commissioners voted unanimously Wednesday to approve a new enabling agreement between the six counties that make up the Northern Lakes Community Mental Health Authority (CMH) – a move that protects CMH from dissolution and creates a new committee to handle disputes if they arise in the future. Grand Traverse County is the fifth county to approve the agreement, clearing the way for its adoption if Missaukee County commissioners also approve it at their meeting next Tuesday.

Six counties entered a joint agreement in 2003 to provide mental health services to their residents by founding CMH, including Grand Traverse, Leelanau, Crawford, Missaukee, Roscommon, and Wexford. Commissioners in some of those counties have expressed dissatisfaction in recent years over CMH operations, with reasons ranging from costs to quality of services to dysfunctional staff and board dynamics. Last May, Grand Traverse County commissioners voted to dissolve their relationship with CMH, giving the county at least a year to actually exit the authority and create its own alternate system for delivering mental health services to residents. Any county’s departure from CMH would dissolve the authority, requiring the other counties to either reestablish CMH under a new operating agreement or launch their own alternate mental health systems.

But in September, county commissioners agreed to try and preserve CMH, signing a memorandum of understanding signaling their willingness to work with other counties on overhauling the enabling agreement before taking the drastic step of dissolving the authority. What followed was a “long, challenging process” to produce a new agreement, County Administrator Nate Alger said Wednesday, with the commission chair and administrator of each county meeting monthly with the CEOs of CMH and Northern Michigan Regional Entity (NMRE), which is assisting with CMH leadership transitions.

“We basically implemented a system similar to collective bargaining,” Alger said. The group went through the agreement section by section, Alger said, proposing changes and debating revisions. “The relationship early on was very strained,” Alger said, noting that some of the other counties didn’t understand Grand Traverse County’s desire to upend the status quo. “One of the most beneficial things that came out of this process is we currently have a much better relationship with the (other) five counties that comprise CMH,” he said.

The new agreement – which went through seven draft versions before being brought to commissioners Wednesday – expands and better details contract definitions and adds multiple new sections, including outlining CMH board and CEO duties. “There just needed to be more stated clarity around what those roles look like,” said Sarah Bannon of Lakeview Consultants, which is assisting with the rewrite. The new agreement also builds in more accountability and transparency, Bannon said, including a list of “key performance indicators” on which CMH will provide quarterly updates to each county board. Those indicators range from patient readmissions to filed grievances to client follow-ups to community outreach.

One new section – “scrutinized more closely than any other section,” Bannon said – outlines a dispute resolution process when one or more counties are unhappy with services or have conflicts with each other or the CMH board or CEO. If the CEO can’t resolve the dispute amicably through discussion with board members, the issue can be taken to a new dispute resolution committee. That committee will have seven voting members: two from Grand Traverse County, which at $682,200 annually is the largest funding contributor to CMH by nearly fivefold, and one each from the remaining five counties. A non-voting member will also be appointed by NMRE. A supermajority vote of five committee members will result in a binding decision on a dispute, provided that decision is not superseded by state or federal law.

County Commissioner TJ Andrews said the dispute resolution process gave her “significant pause,” saying she didn’t believe in creating boards to solve other boards’ problems. However, Andrews said she appreciated that “a lot of work has gone into this process” and that she was “willing to take a leap of faith that the boards will use this dispute resolution process sparingly and with public awareness and knowledge and oversight.” Noting that the new agreement is a “living document” that can be updated if needed, Andrews said: “We need to move forward, and I think this is a good way to do that.”

Chair Rob Hentschel concurred that the new agreement is “not perfect,” saying he still believes Grand Traverse County shoulders a disproportionate share of the funding burden for CMH compared to its population size. But he said there had been a “robust input process” on the document and would support it. “I’m going along with this agreement because I think it’s the best we can do,” he said. “It’s not like it can never be reopened.”

Alger said county leaders – who now have a closer working relationship after going through the rewrite process together – will continue to have regular ongoing discussions “about the performance of (CMH).” Alger expressed support for the new agreement, which was unanimously approved by commissioners Wednesday, and highlighted its importance to the region. “5,733 clients systemwide are relying on this agreement to work,” he said. “The counties are relying on the agreement to work.”