Grading the States 2006: Mississippi - Narrative
In Mississippi, people with serious mental illnesses are routinely housed in jails for the "crime" of having a mental illness. These deplorable practices have been occurring for many years.
That is the bad news. The good news is that there are finally some slight signs of progress in addressing this deplorable situation.
In response to challenges to these practices, funding was authorized in 1998 for the construction of seven mental health crisis centers to be built in rural communities to serve as alternatives to jail for people experiencing psychiatric crises. Incredibly, the new facilities then lay vacant for a number of years because no money was allocated by the legislature or the Department of Mental Health (DMH) to make them operational.
In 2004, after newspaper stories exposed the vacuum, five were opened—but only with enough funds for a capacity of eight people each, instead of the 16 for which they had been designed. The sixth center was funded in 2005. The seventh has yet to be built. Meanwhile, people with severe mental illnesses continue to be civilly committed and housed in jails, where they remain, often in solitary confinement without medical services, for weeks at a time until a psychiatric bed is found.
Nonetheless, the source of the problem is not lack of hospital beds. Nor are more hospital beds the solution. In a state with a population in 2005 of approximately 3,000,000, there are more than 1,600 state hospital beds for adults with serious mental illnesses. What is needed are community-based services. These services are in such short supply that many people ready for release remain hospitalized. The state is potentially vulnerable to lawsuits based on the Supreme Court's Olmstead v. L.C. decision, which requires treatment in the least restrictive, appropriate environment.
Fifteen regional mental health authorities provide community services in the state's 82 counties by relying primarily on Medicaid and federal block grant money due to minimal access to state mental health dollars. The state spends its own funds almost exclusively on hospital care. Quality and effectiveness of services among the regional mental health authorities vary greatly. Some regions provide recovery-based, consumer-driven services, while others are still clinic-based models from the 1970s. Because their resources are limited, there is an incentive to send consumers to hospitals for care which, ironically, shifts the financial burden back onto the state.
There is discussion about the value of evidence-based community services, but no tangible effort has been made to implement them. Not a single Assertive Community Treatment (ACT) program exists in the state, even though ACT is one of the oldest, mosteffective evidence-based models for helping people with serious mental illnesses. For the first time in 2005, the DMH sent staff members to the national ACT conference, which indicates that the programs are being considered.
Other emerging signs of progress include the employment by the DMH of a housing coordinator who works with the regional mental health authorities to identifyor develop affordable housing alternatives. Although housing is in short supply, particularly in the wake of Hurricane Katrina along the Gulf Coast, the state is moving forward to address this ongoing problem.
The DMH also has worked with the 15 regional mental health authorities to develop integrated treatment programs for people with co-occurring mental illness and substance abuse disorders. It is not clear whether these programs reflect the most effective, evidence-based model, but the essential vision is correct and, if necessary, can be refined over time.
DMH also supports peer-run education programs for consumers and family members which are essential to the recovery model.
Mississippi has a long way to go. Change is overdue. The use of jails to incarcerate people with mental illnesses who have not committed crimes is horrendous and must stop. The faint outlines of a structure are emerging that can support transformation of the system. If the governor and legislature mobilize, they havean opportunity to begin implementing the most cost-effective, proven practices that in the long run will benefit both consumers and taxpayers.
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