Mississippi lawmakers consider mental healthcare challenges

Last week, members of the Mississippi House and Senate Public Health Committees heard from mental health professionals as well as local county clerks regarding workforce, the commitment process, and more.

Within Mississippi, about 950 people with mental illnesses are being served at state hospitals on any given day. Among the regional and community programs, there are another 1,200 people being served for mental health, according to Department of Mental Health Executive Director Wendy Bailey.

Bailey, who spoke last week to members of the Mississippi Senate and House Committees on Public Health and Welfare, agrees the numbers are concerning but said the state is making progress.

Mental Health Workforce Declining

One hurdle to meeting the growing need in delivering mental health services is the available workforce. According to data Bailey showed the committee, in 2009 there was a mental health workforce of just under 9,000. This past fiscal year, that number was nearly half at 4,684.

“Another thing I want to point out is mental health workforce availability. We can’t do anything without a workforce. And Mississippi is 42nd compared to 44th in the previous report of having a mental health workforce,” Bailey said.

The shortage of psychiatrists prompted Mississippi State Hospital to open a residency program. So far, the program has been successful.

“We do not have enough psychiatrists in the state,” Bailey told the Senators. “The first year this program opened was July 2021, and they had about 50 applicants. The last two years they’ve had over 500 applicants for the residency program and they’re coming from all over the nation and we’re going to do our very best to keep them in Mississippi. We need them to stay.”

By the Numbers

Mental health commitments through the chancery court system have risen, partly due to an increase in the number of available beds being reopened. Thirty of those beds were reopened at East Mississippi State Hospital and 20 more were reopened at Mississippi State Hospital. The initial closure of those 50 beds was due to a combination of staffing challenges and the effects of COVID, Bailey said.

“Are people still waiting in jail on civil commitment? Yes. Has that decreased? Yes. In fiscal year [2022] it was an average of eight days from the time we got the civil commitment to the time they were placed in state hospital bed. It is 2.7 days right now,” Bailey noted.

She added that in Fiscal Year 2023, there were 1,965 commitments in state hospitals compared to the prior fiscal year of 1,684. However, the totals are down from Fiscal Year 2019, where there were 2,212 admissions. 

Bailey reminded the committee of the always available mental health emergency hotline, 988, which is helping hundreds of people avoid mental health commitments. Mississippi’s 988 call centers also tout one of the highest in-state answer rates across the nation.

This year, the two centers in the Magnolia State fielded 13,549 calls, a 20 percent increase from the previous year. Of those callers, 80 percent found the help they needed without being admitted to a hospital. 

Statewide, additional beds have also been created in the state’s Crisis Stabilization Units (CSU) through American Rescue Plan Act, or ARPA, funding appropriated by the Legislature. Bailey said every CSU with less than 16 beds statewide will be increased to that number, which is the federally mandated maximum. Last year, CSUs served 3,402 people, 92 percent of which were diverted away from state hospitals. 

“Also, if you look at the first half of 2023 compared to the first half of Fiscal Year [2024] we’re now seeing a 30 percent decrease in the people being held in jail. So, it is improving. Again, it’s a challenge and we got to keep working on it. But we are seeing some improvements in this area,” Bailey elaborated.

The rising need for CSUs has prompted officials in Lamar County to work to develop a new crisis stabilization unit in an old National Guard Armory. Aultman said through a collaboration with Lamar County, Forrest County, the City of Hattiesburg, the Legislature and a federal grant, roughly $5 million has been allocated to achieve that goal, Aultman outlined. The project is nearing the bid phase.

The chancery clerk said this effort is partially in response to the fact people are at times placed in jail while waiting for a bed at a state hospital due to a court ordered mental commitment, even though they are not violent. 

“We don’t want to put anyone in services that doesn’t need it,” Aultman told the committee. 

He added that if someone being committed is violent, they need to be placed in a jail for their, and others’, safety. Otherwise, it is best to divert them to other forms of treatment. That is where the CSU comes in, and those facilities are not just used by that county’s population.

“We’re wanting to show the state that we want to have skin in the game as an area, a region. And to help with the Department of Mental Health and alleviate some of the stress off of their system. Because Pearl River County is growing, the Gulf Coast is growing, Lamar County is growing leaps and bounds,” Aultman said. “We got a problem, we have to deal with an area, not just one county.”

Changes in How Commitments are Handled

During the Senate hearing, lawmakers were asked for changes in the way mental health commitments take place in the state and for safeguards to protect citizen’s liberties. 

Lamar County Chancery Clerk Jamie Aultman told lawmakers that the person being committed is usually not involved in the initial court filing process and has to be picked up at a later date.

Additionally, several steps within the court system are needed before the person being committed sees a medical professional. At times, those persons have to wait in jail before being placed in a hospital, largely depending on bed availability.

Keeping track of bed availability through the state’s facilities is gradually improving after the passage of House Bill 1222 in 2023, a bill that not only mandates each law enforcement agency have a crisis intervention team officer on staff, but also mandates the tracking of involuntary placements.

As part of the implementation of the new law, a bed registry system was established so areas with high levels of commitments know where a person can be placed sooner. 

The goal for Bailey and Aultman is to get to a point where chancery courts have no commitments. The two would like to see the commitment process changed.

“So, one of the things that we would love to see is when you look at the civil commitment process, as it was said, you walk into the chancery clerk’s office, and you file an affidavit and a writ is issued, and law enforcement goes and picks [that person] up and [they] go have a pre-evaluation screening,” Bailey explained. “So, a writ’s been issued, and you’ve had an encounter with law enforcement before a mental health professional has seen you. We would like the pre-evaluation screening moved to the first part of the process.”

To effectively deter civil commitments, Bailey advocates for families to use community services first. 

State Representative Sam Creekmore also wants to see more people diverted from state hospitals, and for families to seek treatment elsewhere instead of issuing a writ through a chancery court. 

“I’m not picking on anyone, but that’s not the law that somebody is to be in jail because they got a mental illness, and yet it’s going on. Do these counties not understand that’s what the law is, and arguably could be opening the state up to litigation even further? I mean you’re depriving people of their liberty,” Creekmore said.

Bailey agreed.

“Having a mental illness is not a crime and if you are sick and you need a court commitment that is not a reason to place an individual in jail unless they have charges. If that person doesn’t have charges and they’re being placed in jail only because they’re in need of treatment, we do not need that occurring in our state,” she added.

Misuse of Mental Health Commitments

State Senator Chad McMahan posed the question whether mental commitments are being filed falsely by people with ill intent. 

“I do think there are some families that are weaponizing our legal system against others and I think mental health is one of those areas being weaponized,” McMahan said.

Forrest County Chancery Clerk Lance Reid said that of the 170 mental health commitments filed in 2023 in his county, about 12 were found to be false. To deter that, one of the questions posed when a family member tries to file the affidavit is if a divorce is underway. If there is, Reid said it is typically a red flag and the commitment process stops there until further investigation is conducted.

Of the remaining 158 cases, 45 were commitments for drug or alcohol related issues in his county, Reid added.