Mississippi Today
Mississippi’s troubled mental health system shows signs of repair, report says
Mississippi's troubled mental health system shows signs of repair, report says
Fewer Mississippians in mental health crises are stuck waiting in jail cells for a hospital bed each day than they were a year ago, but the state has yet to eliminate the troubling practice completely, according to a new report.
The latest data available shows that from December to mid-January, an average of 23 people in crisis waited for a hospital bed each day. Eight of those waited in jail, despite not being charged with any crime.
Those numbers were much higher not long ago: In the first quarter of this fiscal year, which started in July, an average of 72 people waited for a bed with 24 in a jail cell each day. Similar numbers had been reported for the prior fiscal year.
“The scope of progress is substantial,” wrote Dr. Michael Hogan, the author of a court-mandated biannual report on the state of Mississippi's mental health system. “But the work is not complete, and some conditions remain that should satisfy no one.”
Hogan's report comes as the result of a 2016 lawsuit filed against the state by the U.S. Department of Justice. A judge sided with the federal government in 2019, finding the state had violated the Americans with Disabilities Act by separating people with mental illness in hospitals from their homes and families. Hogan, a former New York State Commissioner on Mental Health, is now tasked with writing the twice-yearly reports on the state's compliance with the lawsuit's consent agreement as a court monitor.
Ultimately, the report found DMH was compliant or in partial compliance with all key issues pointed out in the agreement.
“The Mississippi system could fairly be described as the most unbalanced state system in terms of preferences for institutional care in the country,” Hogan wrote, referring to alarming issues in patient care first documented by the DOJ in 2011. “As this report is being written, a decade of attention means this imbalance in care has been substantially addressed.”
Late in 2022, DMH reopened a 30-bed unit at East Mississippi State Hospital that had been closed because of staffing shortages. A closed 20-bed unit at Mississippi State Hospital was reopened in January. The added beds contributed to keeping people with mental illness out of jail cells.
Patient counts that the department supplied to Mississippi Today show the number of people waiting in jail for a state hospital bed has been steadily declining for months.
“This is not a small undertaking and is due to the unwavering dedication of an incredible team of staff at DMH Central Office, the four state hospitals, and community mental health centers who strive daily to improve the state's system of care,” the department's Executive Director Wendy Bailey told Mississippi Today in a statement, “and to state leaders and legislators who are supporting and funding the efforts.”
The latest report, the third ever, was published this week and charted much of the Mississippi's Department of Mental Health's progress in care access across the state. However, lingering staffing retention troubles, data collection and use, patient outreach and communication issues, and jail stays remain sore points in need of improvement, according to Hogan's report.
When community mental health centers were created 40 years ago – each with their own designated region – they operated with little oversight from the DMH, which focused on running state hospitals. As a result, statewide mental health care was often disjointed or inconsistent.
Hogan's report studied discharge documentation to better understand how often patients across the state were getting intervention to lessen the likelihood they hit a severe crisis point again requiring inpatient treatment.
While entering inpatient treatment can help stabilize severe mental illness, it doesn't cure it, Hogan points out. Follow ups are needed to prevent relapses and readmission. Hogan and his team found that community mental health centers contacted a hospitalized client, while the individual was in the hospital, at a rate of 45%.
He said “lukewarm success” in establishing relationships while people are still hospitalized makes impacts whether they attend a follow-up appointment after discharge. The overview found that initial visits were completed in 59 of 89 incidents they could track – about 66%. The rate of follow-up and engagement efforts were adequate in 56 of 87 cases they could track – or 64%.
“Some Regions do a good job on some elements and all do a good job some of the time,” Hogan wrote. “But consistency is lacking.” support specialists who help contact patients after discharge are often paid at or below what a fast food worker can make, Hogan pointed out. The staffing shortages among these roles were higher than that of other vacancies, such as registered nurses and therapists.
Workers like peerBailey acknowledged the same hardships but hopes average annual salaries for those support staff positions reach $30,000 by fiscal year 2025. The department has asked the legislature for more funding to help raise wages and improve retention rates.
“We are not only dealing with competition from the private sector, we are dealing with burnout from staff dealing with patients who require 24/7 care who have significant mental and behavioral challenges,” Bailey said in her statement.
Hogan's first report, issued in March, described Mississippians sometimes waiting weeks in jail for a bed at a state hospital. He also found that some people admitted to state hospitals did not have a serious mental illness – meaning the hospital wasn't the right place for them and they were occupying a bed that could have been used by someone else.
In his second report, he surveyed North Mississippi State Hospital and community mental health centers in the northern part of the state and did not find patients admitted without a serious mental illness diagnosis.
Bailey said that DMH expects to also see more positive results from people now working as court liaisons who help staff identify community treatment options. The department has also grown programs that provide transitional housing, supported employment and community outreach over the last several years.
Recently the agency began fidelity monitoring, or progress monitoring, of its mobile crisis teams, another positive step Hogan recognized.
“Are there improvements still to be made?” Bailey posed, reflecting on state's mental health system. “Yes.”
“Has progress been accomplished? Absolutely.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1964
May 2, 1964
Henry Hezekiah Dee and Charles Eddie Moore, two 19-year-old Black Americans, were simply trying to get a ride back home. Instead, Klansmen abducted them, took them to the Homochitto National Forest, where they beat the pair and then drowned them in the Mississippi River.
When their bodies were found in an old part of the river, FBI agents initially thought they had found the bodies of three missing civil rights workers, James Chaney, Andrew Goodman and Michael Schwerner.
Thanks to the work of Moore's brother, Thomas, and Canadian filmmaker David Ridgen, federal authorities reopened the case in 2005. Two years later, a federal jury convicted James Ford Seale. He received three life sentences and died in prison.
Ridgen did a podcast on the case for the CBC series, “Somebody Knows Something.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Lt. Gov. Delbert Hosemann shuts down House Republican idea to let voters decide Medicaid expansion
After House Republicans asked Senate leaders to agree to a proposal that would place Medicaid expansion on November's statewide ballot, Senate leader Lt. Gov. Delbert Hosemann said the idea had no legs in his chamber and added that expansion talks were likely done for the year.
House Speaker Jason White, a Republican from West, announced the idea in a statement Wednesday night and pointed out it had become clear over the last few days that House and Senate Republicans were still far from agreement over the best way to expand Medicaid coverage.
The bill narrowly escaped death on Wednesday afternoon until House Democrats forced a procedural vote that granted everyone more time to find compromise.
“This session proved that a consensus has formed and we all share the same goal: to provide healthcare access to low-income Mississippians,” White said. “Creating a referendum process for this issue is a clear direction forward. We hope that our colleagues in the Senate will take this opportunity to finally hear from the electorate once and for all.”
About an hour after White announced the referendum idea, Hosemann poured cold water on the idea with a statement of his own.
“We had some discussions with senators today about the possibility of a non-binding referendum on the ballot and the idea was not well received,” Hosemann said. “We are disappointed in the outcome this year, but value the discussions which occurred this session — the first time this Legislature has seriously considered healthcare reform in our state.
“I remain committed to finding ways to increase access for working Mississippians who otherwise do not have the resources for a simple check-up or an extended hospital stay,” Hosemann continued. “A strong work requirement, with necessary exceptions, is a bottom line for many Senators. We look forward to continuing the conversation on access to healthcare in the future.”
READ MORE: Lawmakers buy one more day to reach Medicaid expansion compromise
The House's full proposal was not made available on Wednesday night, but White's statement said the proposed referendum would be two-fold: Voters would decide if they think Medicaid should be expanded to the working poor and if the program should include work requirements for recipients.
House Democratic caucus leadership supported the House Republican effort, saying in a statement Wednesday night that if the language in the House's referendum is “very clear” and allows working Mississippians to get the “health care we know that they need,” then they would likely support the new proposal.
“We are excited about the opportunity to finally give the people of this state a chance to voice what we know to be — that they want this, and they want it as quickly as possible,” read a statement from Reps. Robert Johnson and Daryl Porter, the House Democratic leaders.
The statewide ballot referendum idea was seen late Wednesday as a renewed chance for Republicans to find an expansion agreement — something that had become elusive during the first legislative session that expansion was earnestly considered.
At the heart of the Senate and House disagreement was a requirement that mandated Medicaid recipients work — a provision that the federal government had blocked in 13 other states.
House and Senate Republican negotiators earlier in the week agreed to a deal that would expand Medicaid only if a strict work requirement was approved by the federal government. House Republicans, who had previously proposed an expansion program that would go into effect even without federal approval of a work requirement, caved late Monday and agreed to the Senate Republicans' demand to include the make-or-break work requirement provision.
But House Democrats, who had for weeks vowed to not support any expansion plan that included a work requirement, fulfilled that promise on Wednesday and threatened to vote against the Republican bill on the House floor. The Democrats' dug-in position against the bill would likely have killed the proposal, which needed a three-fifths majority vote to pass.
Rep. Bryant Clark, D-Ebenezer, said he was one of 29 Democrats who would not vote for the agreement as it stood on Wednesday. He said he was unsure whether he would support the issue going to a statewide referendum.
“I think we as a Legislature should do it — that's what people hired us to do,” Clark said. “I wouldn't be just totally opposed to that idea, but sometimes the devil is in the details. What would be put before the people? Would it be a clean expansion proposal, or something else? I am 85% sure the citizens of Mississippi would pass something that is a clean Medicaid expansion proposal.”
Note: This article will be updated.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Lawmakers buy one more day to reach Medicaid expansion compromise
Facing a late Wednesday deadline, the House and Senate procedurally voted to give themselves at least one more day to deliberate a proposal that could make Mississippi the 41st state to expand Medicaid under the Affordable Care Act.
House and Senate Republican negotiators earlier in the week agreed to a deal that would expand Medicaid only if a strict work requirement for recipients was approved by the federal government. House Republicans, who had previously proposed an expansion program that would go into effect even without federal approval of a work requirement, caved late Monday and agreed to the Senate Republicans' demand to include the make-or-break work requirement provision.
But House Democrats, who had for weeks vowed to not support any expansion plan that included a work requirement, fulfilled that promise on Wednesday and threatened to vote against the Republican bill on the House floor. The Democrats' dug-in position against the bill would likely have killed the proposal, which needed a three-fifths majority vote to pass.
With the federal Centers for Medicare and Medicaid Services under the Biden administration unlikely to approve Mississippi's Medicaid expansion plan with a work requirement, Senate Republican leaders have expressed optimism that Donald Trump would be reelected and that he would approve Mississippi's plan.
However, the realpolitik is that Trump has loudly voiced his opposition to Medicaid expansion, and his approval of Mississippi's work requirement would usher expansion in for the Magnolia state over the wishes of a Republican governor (Tate Reeves) whom he supports. When he was president, the Trump administration approved Medicaid work requirements for some states, but only as a means of limiting participation where it had already been expanded, not to help a state implement expansion.
Waiting on approval from CMS under either Biden or Trump could keep Mississippi's expansion of coverage as it now stands in limbo indefinitely.
“We will vote for Medicaid expansion,” Rep. Robert Johnson III, the House minority leader, said after the recommittal on Wednesday. “This is not Medicaid expansion. At least we got a do-over.”
Johnson said that shy of going back to the original House position — or removing the work requirement the Senate demanded — House Democrats want to remove language that says the state would reapply for work requirements each year while expansion remains in limbo until such time as a work requirement is approved. He said the Democrats told the Republican leadership that they would agree to the work requirement, but not reapplying on an annual basis for the work requirement wavier. Instead, he said the state should apply once for the work requirement and if it is rejected by federal officials the Legislature should act to remove the requirement.
“We're not saying we are against the work requirement,” he said, adding House Democrats oppose it because it would keep Medicaid from being expanded,
Johnson added, “We're saying fine, we will try that once and show you it will not work, then we move on (removing the work requirement and expanding the program).”
When it was clear the House Democrats' dissension might kill the expansion program, House Republicans moved to recommit the bill to conference committee. The Senate Republicans followed suit a few minutes later, effectively extending the deadline for a final plan to be hammered out between House and Senate negotiators until 8 p.m. Thursday.
House and Senate Republican leaders declined to comment about what they may bring to the negotiations or what the next few hours may look like. House Democrats claimed a small victory and reiterated their desire to pass an expansion plan that would actually go into effect and provide health coverage to an estimated 200,000 Mississippians.
As news of the recommittal spread quickly through the Capitol on Wednesday afternoon, many people floated the notion of placing a Medicaid expansion issue on a statewide ballot, where voters could mandate what they wanted lawmakers to do.
“I have heard talk about that, but it would confuse voters with a work requirement,” Johnson said, adding he would support placing Medicaid expansion without a work requirement on the ballot.
Rep. Bryant Clark, D-Ebenezer, said he was one of 29 Democrats who would not vote for the agreement as it stood on Wednesday. He said he is unsure whether he would support the issue going to a statewide referendum.
“I think we as a Legislature should do it — that's what people hired us to do,” Clark said. “I wouldn't be just totally opposed to that idea, but sometimes the devil is in the details. What would be put before the people? Would it be a clean expansion proposal, or something else? I am 85% sure the citizens of Mississippi would pass something that is a clean Medicaid expansion proposal.”
As the extraordinary politics played out on Wednesday, dozens of clergy and other citizens came to the Capitol to express their support of expansion. Many Capitol attendees specifically said they did not support the compromise plan that included the work requirement.
“There are people in Mississippi who are sick, hurting, in pain and broken,” said the Rev. Dawn Douglas Flowers, a minister at Parkway Hills United Methodist Church. “We have a way to enter into that brokenness and offer healing right away. I hope lawmakers can find a way to compromise and allow Medicaid expansion to happen now because what they've come up with is just a delay. The work requirement will not allow us to get help to people who need help today. We can't just kick the can down the road any longer.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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