The fight over whether the Mississippi mental health system is meeting the requirements of federal law could be nearing an end.
The federal government says that the state’s mental health programs unnecessarily require those with serious mental illnesses to receive services in the state’s four mental health hospitals, rather than in their communities. The state says that it is now meeting the standard and should be released from court monitoring.
According to the federal government's arguments, Mississippi depends too much on segregated state hospital settings and not enough community-based alternatives, which can provide an alternative to hospitalization for many with serious mental illnesses. This is in violation of the 1999 U.S. Supreme Court Decision, Olmstead v. L.C., in which the court says individuals with mental disabilities have the right to live in the community rather than be institutionalized.
According to federal filings, Mississippi is the only state to house most of its seriously mental ill in the state’s four hospitals: the Mississippi State Hospital in Whitfield in Rankin County, East Mississippi State Hospital in Meridian, North Mississippi State Hospital in Tupelo and the South Mississippi State Hospital in Purvis.
The state Department of Mental Health is already the state’s largest employer in government.
In the fiscal year that ends on June 30, the department received more than $211 million in funds from the state’s general fund and will receive $214 million in fiscal 2022.
There are 6,351 working for the department full-time, making it a larger agency than corrections (2,357 full-time employees) and public safety (1,827 full-time employees).
The Department of Justice began an investigation in 2011 and issued a findings letter to then-Gov. Haley Barbour. The state and the DOJ went into a round of negotiations to come up with a solution acceptable to both sides, but the DOJ later filed a lawsuit against the state on August 11, 2016 filed in U.S. District Court.
The federal government won the first round on September 3, 2019 after a four-week bench trial conducted by U.S. District Judge Carlton Reeves. The trial had 33 witnesses, 2,500 pages of transcripts and 400 exhibits.
Reeves ruled in favor of the federal government and designated a special master, Dr. Michael Hogan, to help the court develop a remedial plan to help the state meet federal requirements.
With the goal of reaching a final settlement, Reeves ordered on February 22 that the state submit a remedial plan on April 30 and the federal government to submit a response 21 days later, which has been filed.
The key point of contention between the two sides is how much community care is needed. The state has said in its response
According to federal filings, the length of stay at Whitfield’s continuing care unit was 4.5 years and 1,200 patients admitted to state hospitals between 2015 and 2017 remained for longer than two months.
The DOJ says in its remedial plan that providing community-based services wouldn’t fundamentally alter the state’s programs. Even though it credits the state with adopting some of the standards, such as mobile crisis teams, crisis stabilization units (facilities that provide intensive short-term mental health care for those experiencing acute psychiatric crises), Programs for Assertive Community Treatment (PACT), supported housing, peer support services and support employees, the DOJ says the state hasn’t provided enough of the services to those who need them.
The state of Mississippi in its response filed on April 30 says that the state is meeting the Olmstead standard and has or will imminently address the violations. Attorneys for the state argue that the state has implemented the community-based model since the trial evidence cutoff date of December 31, 2018 and that the DOJ won’t specify the amount of community-based services to meet the Olmstead standard.
The state has 14 mobile crisis teams in every region of the state and will have a crisis stabilization unit in every region of the state as well. Attorneys for the state also say that the state meets the standard with PACT and other related services available in each county.
