On May 20, the U.S. Department of Justice filed a remedial plan that is aimed at getting Mississippi in compliance with a U.S. Supreme Court decision over the treatment of the mentally ill.
The special master appointed by U.S. District Judge Carlton Reeves, Dr. Michael Hogan, is an experiment in public mental health administration and his role was to draft a plan to get Mississippi’s mental health system to conform to federal law.
After a 2011 investigation and a 2016 lawsuit, officials from the DOJ’s Civil Rights Division have argued 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 in court filings that it is now meeting the standard and should be released from court monitoring.
The state’s dependence on segregated state hospital settings and not enough community-based alternatives — which can provide an alternative to hospitalization for many with serious mental illnesses — 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.
The plan would require the state to procure more community-based care for those both in state hospitals or those at risk of being admitted unnecessarily to one of the state’s four psychiatric hospitals.
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 order says the state would have to emplace a PACT team in every region of the state, with one staffer (a PACT team includes a nurse, psychiatrist or psychiatric nurse practitioner, a peer support specialist, a substance abuse specialist, an employment specialist and other mental health professionals) for every 10 patients. The state would have a year to have PACT teams in every region of the state, including a second team in heavily populated Hinds County.
The order would also require the state to cover more housing vouchers for the mentally ill, with 250 more patients receiving housing assistance in the first year, 500 more in the second and 750 more in the third year.
Within 45 days of the issuance, the state would have to provide every community mental health center a list of all individuals admitted to a state hospital or crisis stabilization unit two or more times in the last two years or admitted to a state hospital for more than 60 days.
The Department of Health would have to allocate $200,000 annually for a medication assistance fund.
The state would have 120 days after the issuance of the order to present a detailed plan to get the state into compliance.
The order would terminate when the state achieved “substantial compliance” and maintained it for a year.
Mississippi would be required to expand its Individual Placement Support employment within two years to all of the seriously mentally ill statewide.
It would also require a court-appointed monitor to act as an agent of the U.S. District Court for the Southern District of Mississippi and supervise the state’s compliance with the order.
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 public employer.
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, which represents 3.8 percent of the $5.8 billion general fund budget.
There are 6,351 full-time employees employed by the agency.
