District Federal Judge Carlton Reeves ruled against Mississippi and in favor of the United States in the recent lawsuit about how to deal with the mentally ill.
The feds believe our state has not done enough to promote community-based mental health services, which is considered the ideal form of treatment. Mississippi still has five big mental health hospitals serving large swaths of the state. (It also has 15 smaller regional facilities.)
But the feds, and most of the mental health professionals, want much closer to the community than that. They want small group homes where the mentally ill can live and get treatment in their own neighborhoods.
A social worker would live in these homes with the multiple patients, monitor them, help them stay on their meds, help them get work and get them back on track where they can get back home and live independently. These would be half-way houses for people going through difficult mental situations.
The feds, supported by the mental health experts, believe a large, remote facility makes the stress trauma of mental illness worse, delaying, and even preventing, recovery.
The feds also want trained community mental crisis teams, community crisis stabilization units as well as community residential group homes.
As it stands now, when someone snaps, they often end up in jail and from there go to a big state facility where they are treated and stabilized with appropriate medications.
Once stabilized, they are released quickly because of a shortage of beds. They soon go off their meds because there is no follow up and the cycle of trauma starts all over again.
In the ideal fed world, a community-based crisis intervention team would immediately respond to a breakdown. The patient could get immediate treatment in a local crisis stabilization unit for a few days and then get several weeks or months of support in a group home run by a professional — all without going far from their home, thus avoiding the trauma of incarceration and commitment.
These professionals would work with the patient to get on an appropriate drug regimen and then follow up once they leave the group home and begin to live on their own. This community treatment would be ongoing over the life of the patient or at least until there was evidence of permanent stabilization.
If done right, some argue, federal Medicaid dollars could pay for much of this, saving the state of Mississippi millions of dollars. The current big-box strategy of Department of Mental Health (DMH) employs 7,100 people, one-fourth of all state workers, and more than any other state agency. In comparison, the state prison system only has 2,610 employees. DMH has a budget of $250 million.
One obstacle is neighborhood opposition to group homes. Not In My Backyard (Nimby) is a powerful force. I recall a few years ago, the difficulties a couple had opening a group rehab home in Northeast Jackson. The neighborhood erupted in opposition.
So how do you create community-based mental treatment group homes when nobody wants them in their neighborhoods? The state hasn’t been able to do this. It will be interesting to see if the feds can succeed where the state has failed.
It’s a huge issue. Some 20 percent of us will face severe mental illness of some type at some point in our lives. The key is quick stabilization and treatment so it doesn’t destroy lives. That’s what community-based treatment is all about.
It’s expensive. And it’s unclear how this will be funded. If it reduces severe mental illness, it will be a bargain, but getting there is no easy task.
Judge Reeves will be appointing “special masters” to prod the state mental health officials into moving faster on implementation of community-based treatment. We hope he considers some local experts who are actually working clinicians in the field such as University of Mississippi Medical Center’s Philip Meredith.
In the midst of all this, I received a call from a distraught young professional, who has gotten caught up in the chaos of what to do about the severely mentally ill. She is a Madison mother who has worked in the mental health system in Mississippi for 10 years after getting her master’s degree in mental health counseling from Mississippi College.
This woman, who asked that I not use her name, has been at ground zero, working in the Office of Mental Health within the state Division of Medicaid doing state-level case review and helping to coordinate care with Child Protective Services, the Department of Mental Health, United, Magnolia and Molina and other organizations involved in treating the mentally ill. She’s the only licensed clinician in the office.
She’s seen some bad situations in which mentally ill patients were simply not getting appropriate treatment. “Sometimes if there is no appropriate place to send someone, they’ll just put them in a hotel room and hire a sitter from a temp agency.”
As required by the licensing board of her profession, and state law in Mississippi, she would report cases of neglect and abuse through various online reporting systems maintained by the Department of Human Services, Child Protective Services and other agencies and non-profits. Over the years, she has reported 15 to 20 cases of neglect and abuse.
But she discovered that when she reported these cases of neglect and abuse, as required by law, it didn’t go down well with the powers that be — her bosses. She sought the advice of her licensure board and was told she was required to report these incidences. She asked the AG’s office for a written policy on how she should resolve these conflicts between her reporting requirements and her job. She got nowhere.
Most recently there was a case of a 17-year-old about to be released from the state mental hospital at Whitfield even though he was still severely mentally ill. The powers that be had found no appropriate place for him to go. She tried her best to intervene but to no avail. Her bosses told her not to report this. She did anyway, as the law and her professional ethics require.
Soon after she was censured by her boss for insubordination.
“I would think Medicaid would be delighted to have a professional reporting these things. That’s why I’m in shock,” she told me. “These are the ethical dilemmas you’re taught about in school but you think it’s never going to really happen.
“The mental health system in Mississippi is a nightmare. I’m scared. I’m fighting the system. I feel awful. I plan to get all the right people involved and raise awareness.
“I think this federal lawsuit shows there is no accountability in the state system. If the Department of Justice can’t get people to do their job, what hope do I have? I might as well move to Tennessee. They have a good system, I’ve heard.”