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Accountability, real-world outcomes...

Accountability, real-world outcomes needed in Mississippi mental health system

By: Joy Hogge - January 20, 2023

At issue is whether the state’s mental health system helps people with mental illness.

In 2016, seven years after issuing a letter of findings about Mississippi’s mental health system, the United States sued Mississippi, alleging the state’s mental health system violates the Americans with Disabilities Act (ADA) by unlawfully segregating people with mental illness in institutions. 

The ADA and a related 1999 United States Supreme Court case, Olmstead v L.C., require care for people with disabilities be provided in integrated, community-based settings when possible.

The State lost this suit in District Court in 2019 and then appealed to the Fifth Circuit in 2022. The Fifth Circuit Court of Appeal’s ruling could come any day. 

Throughout its twelve-year battle with the federal government, the State has consistently argued three points:

  • Mississippi’s mental health system does not and never has violated the ADA.
  • To implement the changes the federal government demands would fundamentally alter Mississippi’s mental health system.
  • There should not be a monitor to oversee Mississippi’s compliance and progress. 

The State may win its appeal on the technicalities of one or more of these points, especially given the millions of tax-payer dollars it has spent on outside counsel. That is a very different issue than whether Mississippi’s mental health system helps people with mental illness. 

I encourage all of us to thoughtfully examine Mississippi’s mental health system through the lens of the State’s arguments. 

Mississippi’s mental health system does not and never has violated the ADA.

 The State’s appeal brief, echoing arguments Mississippi has used throughout the case, asserts that Mississippi’s mental health system already satisfies the requirements of the ADA because it funds an array of services. Yet, it offers no evidence that people with mental illness benefit from or even receive the services.

Joy Hogge

Whether more people with mental illness can successfully live and work in the community is the measure of a responsive mental health system. This approach is called a recovery-oriented system of care. It emphasizes employment, the right kind of housing and meaningful connections in the community, alongside any indicated individualized mental health treatment. People with mental illness can and do get better when they have this kind of help.

Recent legislative hearings make it clear that Mississippians with mental illness cannot always live in the community and, with alarming frequency, end up in jail simply because they need treatment. Dr. Michael Hogan, the court-appointed monitor, found, “In a substantial percentage of cases where information was available … we found delays in access, and that a number of people were held in jails.” The Department of Mental Health’s (DMH) Response to the Remedial Order reports that last year 734 people without charges waited in jail for mental health care.

DMH’s Fiscal Year 22 Report indicates that more community-based services are available, but it’s not clear if those services help people successfully live and work in the community. The number of people committed to state hospitals has decreased, which is promising, but needs to be thoughtfully examined in light of the fact that people are still in jail awaiting treatment. 

To implement the changes the federal government demands would fundamentally alter Mississippi’s mental health system.

On its website, DMH reports that in 2019 it diverted $15,100,000, or 2.5% of its annual budget of $589,572,425 to services related to the lawsuit.  This does not appear to be a fundamental alteration to the system from a fiscal standpoint.

The programmatic remedy demanded by the lawsuit is the option the state proposed when both parties were ordered to submit proposals. The remedy requires that the DMH ensure the services it says it already offers are available statewide. It lists specific numbers for some services. It requires the DMH to monitor the implementation and delivery of services, which state law and the DMH’s standards already require. It orders the DMH to track if services help people live in the community. It also appoints a monitor to oversee these activities.

Requiring the state to implement the plan it proposed with the services it already has doesn’t seem to fundamentally alter the system. 

There should not be a monitor to oversee Mississippi’s compliance and progress. 

In his remedial order, District Judge Carlton Reeves wrote, “…the trial record revealed a disconnect between the services promised by the State and the services delivered on the ground,” and, “To all this, the State argues that it should not be held accountable for the ‘performance’ of its mental health system.”

Judge Reeves’ observations seem to accurately reflect ongoing challenges with the mental health system. Independent monitoring increases accountability and can also support DMH in its proposed improvements.

I urge all of us to demand accountability and real-world outcomes from the mental health system regardless of how the Fifth Circuit rules. Let’s also be united in our complete objection to people being in jail for no other reason than mental illness. 

About the Author(s)
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Joy Hogge

Joy Hogge is the executive director of Families as Allies, a statewide organization run by and for families of children with behavioral health and related challenges. It is the state chapter of the National Federation of Families, as well as Mississippi's designated statewide family network for children’s mental health and Family-to-Family Health Information Center. Dr. Hogge is the president of the board of the National Federation of Families and recently joined the national board of Choices Coordinated Care Solutions. Dr. Hogge is particularly interested in policy and system change that supports and engages as many families and recipients of services as possible. She is a licensed psychologist and received her Ph.D. and Master's from Texas A&M University.
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