Last winter, a George County woman spent weeks in jail waiting for a bed in a mental health facility.
The civil recognizance – when a local court orders someone to be hospitalized for treatment – is meant to be used when a person with a serious mental illness is in crisis, not when someone has an addiction or an intellectual disability or dementia. The George County woman’s diagnosis was ‘major neurocognitive disorder’, a umbrella term that includes dementia.
In September 2021, staff at the local community mental health center recommended that he not be hospitalized.
The court dismissed her anyway – twice. The first time, in October, she was released after about two weeks. The second time, in late November, she waited in the George County Jail until at least January 6. Eventually, the state hospital notified county officials that she was ineligible for treatment there.
Her story — without a name or other identifying details — was included in the first report of the court-appointed monitor evaluating Mississippi mental health services at the community level. A judge appointed the monitor following the decision of the US Department of Justice 2016 lawsuit against the State of Mississippi for violating federal law by failing to provide adults with mental illness with community services.
So far, according to the monitor, the picture of how services are working remains incomplete, with key data not available until later this year. This data includes engagement statistics by county, information on the number of people receiving services in all counties, and calls to mobile crisis teams and the results of those calls.
But it’s not uncommon for people like this George County woman to spend days or weeks in jail because treatment isn’t readily available.
The monitor, Michael Hogan, noted that the state has reduced the number of people hospitalized and the length of stays. It has also provided funding for services at community mental health centers, although not all programs are operational – and it is not yet clear whether the reduction in hospitalizations means people are accessing community services.
“Given the early timing of this report, and despite a number of state efforts to expand and improve care, it is not yet possible to definitively determine compliance with many College requirements” , he wrote.
He pointed to problems with the civil commitment process, including the widespread practice of sending people to jail to wait for a bed in a public hospital. He also described cases in which people with disabilities, dementia and substance abuse problems, without serious mental illness, were interned.
In 2019, a federal court found that Mississippi violated the rights of people with mental illnesses by hospitalizing them instead of providing services closer to home. Last year, U.S. District Court Judge Carlton W. Reeves approved a recovery plan for the state and appointed Hogan to compile compliance reports every six months.
Hogan described his first, filed in court Friday, as a “staged” report, providing general information about the state’s mental health system and preliminary information about the availability of services. Parts of the plan have been put on hold as Mississippi appeals Reeves’ decision to the United States Court of Appeals for the 5th Circuit.
In an email to Mississippi Today, Department of Mental Health Communications Director Adam Moore said the agency “appreciated working with Dr. Hogan” during his review and providing the data that he had asked. Moore noted that Hogan has seen low rates of hospital admissions among the hundreds of people served by the state. community treatment teams for people with serious mental disorders. The agency is also continuing its review of the programs listed in the judge’s order.
“DMH is committed to continuing to make improvements to the system,” he wrote.
To prepare for his report, Hogan visited three state hospitals and six of the state’s 13 CMHCs, which serve as hubs for local mental health services.
The Department of Mental Health encourages families to contact their local CMHC obtain help for a loved one in crisis before considering civil commitment.
If someone believes that a loved one or relative poses a danger to themselves or others, or that they need treatment to prevent further deterioration, they may file an affidavit with the local chancery clerk to have the person committed. Then a judge determines if they should be hospitalized.
If the judge decides the person should be committed, they are supposed to seek treatment at a public hospital or Crisis Stabilization Unit (CSU), where people can receive mental health care that can eliminate the need for hospitalization . But often no bed is immediately available.
Hogan reviewed the records of 21 people which included information about where they stayed before being admitted for treatment. While the majority waited in hospitals or CSUs, nine of them waited in prison. The longest wait recorded was 18 days.
“We don’t know if statewide data on this is being reviewed by DMH; the model needs attention,” he wrote.
Hogan’s report did not specify how many people are hired each year statewide.
Hogan reviewed 25 sets of patient charts that included a discharge diagnosis. In eight cases, or almost a third, the diagnosis was not a serious mental illness, but something else, including a substance use disorder and an intellectual or developmental disability.
Mental hospitals are generally not equipped to provide inpatient treatment for such conditions, Hogan said.
“Their admission to hospitals is stressful for them, a challenge for staff and their interactions with people with MMS [serious mental illness] may be problematic,” he wrote, noting that his sample size was too small to draw general conclusions.
Moore said DMH recently provided training to local justice officials on mental health services and alternatives to civil recognizance.
Planning for a patient’s discharge and continued care in their community is supposed to begin within 24 hours of hospitalization, according to the court order. Hogan found that “the progress is evident”. Hospital staff routinely schedule appointments after discharge and send people home with a supply of medication and a prescription.
But Hogan also found shortcomings. Local mental health staff are supposed to meet each person before they are discharged from hospital. He found little evidence that this was happening.
Many people are hired more than once: In Harrison County, 136 of the 338 people hired in 2020 had already gone through the process – one of them 16 times. For people who have been committed within the past year, the court-ordered reorganization plan requires discharge planning to include a review of previous plans and treatment so that the new plan can be improved to reduce the likelihood of repeated institutionalization.
Although it happened at South Mississippi State Hospital, Hogan didn’t see it happen at the other two hospitals he reviewed.
In two cases where people were readmitted within two months, Hogan wrote, both had legal issues “and there was pressure to ‘do something with them'”.
Moore said DMH plans to continue improving the discharge process, “including partnering with community mental health centers to complete admissions prior to discharge.”
Hogan’s review and the state’s expansion of community mental health services both took place in the context of the COVID-19 pandemic, which has created understaffing at hospitals run by the Department of Health. mental health. A rise in COVID-19 cases also forced the cancellation of some of Hogan’s planned visits to CMHCs and public hospitals.
He praised the “valiant efforts” of state and local staff to provide care amid the challenges of health risks, staffing shortages and funding issues.
“This report comes at a time when we all hoped we were past the pandemic – but it continues,” he wrote in an acknowledgment at the start of the report. “The oversight team recognizes these challenges and the burden placed on those who depend on and provide care. We salute the courage of those who struggle and we mourn those who have been lost.
Hogan’s next report will be released in September.