Mississippi Today
Mississippi jailed more than 800 people awaiting psychiatric treatment in a year. Just one jail meets state standards.
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In Mississippi, many people awaiting court-ordered treatment for mental illness or substance abuse are jailed, even though they haven't been charged with a crime. Read our full series here.
Fourteen years ago, Mississippi legislators passed a law requiring county jails to be certified by the state if they held people awaiting court-ordered psychiatric treatment.
Today, just one jail in the state is certified.
And yet, from July 2022 to June 2023, more than 800 people awaiting treatment were jailed throughout the state, almost all in uncertified facilities, according to state data.
Mississippi Today and ProPublica have been reporting on county officials' practice of jailing people with mental illness, most of whom haven't been charged with a crime, as they await treatment under the state's civil commitment law. After the news organizations started asking about the 2009 law earlier this year, the state attorney general's office concluded that it is a “mandatory requirement” that the Mississippi Department of Mental Health certify the facilities where people are held after judges have ordered them into treatment.
The Department of Mental Health, which oversees the state's behavioral health system and has no other responsibility for jails, responded by sending letters to county officials across the state encouraging them to stop holding people in uncertified jails. But the law provides no funding to help counties comply and no penalties if they don't.
Under state law, counties are responsible for housing people going through the commitment process until they are admitted to a state hospital. Counties are allowed to put them in jail before their court hearings if there's “no reasonable alternative.”
The last time the Department of Mental Health tried to ensure those jails met state standards, more than a decade ago, it had little success. After the law passed, the agency got to work to inform counties about the new rules. Some didn't respond. Others expressed interest but didn't follow through. By 2013, just two jails had been certified. (One of them no longer is.) After that, the effort apparently petered out, according to a review of state documents.
To be certified, a jail must offer on-call crisis care by a physician or psychiatric nurse practitioner and must have a supply of medications. Staff must be trained in crisis intervention and suicide prevention. People detained during the commitment process must be housed separately from people charged with crimes, in rooms free of fixtures or structures that could be used for self-harm, according to Department of Mental Health standards that took effect in 2011.
“If they're going to be held in jail, they have to receive some kind of treatment in a semi-safe environment,” a department attorney told The Clarion-Ledger at the time.
Until recently, many county officials weren't even aware of those requirements, according to interviews across the state — even though they were routinely jailing people solely because they might need mental health treatment. Mississippi appears to be the only state in the country where people awaiting treatment are commonly jailed without charges for days or weeks at a time.
Mississippi jails are subject to no statewide health and safety standards. Many jails treat people going through the civil commitment process virtually the same as those who have been charged with crimes, Mississippi Today and ProPublica found. They're shackled and given jail uniforms. They're often held in the same cells as criminal defendants. They receive minimal medical care. Some said they couldn't access prescribed psychiatric medications. Since 1987, at least 18 people going through the commitment process for mental illness and substance abuse have died after being jailed, most of them by suicide.
Some local officials say getting certified could be expensive. Sheriffs worry it could codify their role as their county's de facto mental health care provider.
“It looks like the state wants the sheriff to be the chief mental health officer,” said Will Allen, attorney for the Mississippi Sheriffs' Association. “This is coming down to the state stuffing the cost of this down to the counties, and frankly I just think that's wrong.”
‘Are you going to shut the jail down? No.'
The genesis of the 2009 law was a conversation state Sen. Joey Fillingane had with his girlfriend at the time, a social worker who worked with troubled youth. She told him that Mississippians going through the commitment process in some counties were locked in jail cells like criminals, while in other counties they were held in hospitals like patients, according to a 2011 news story in The Clarion-Ledger.
Fillingane's bill addressed that. “Shouldn't there be some kind of minimum standard where you're holding people who haven't committed a crime?” the Republican from Sumrall, near Hattiesburg, said in that story about his legislation.
His bill passed with little fanfare. It made it “illegal for individuals committed to a DMH behavioral health program to be held in jail unless it had been certified” as a holding facility, an agency staffer wrote in a timeline of the law's implementation obtained by Mississippi Today and ProPublica.
The board overseeing the Department of Mental Health set detailed standards for those facilities. Department staff surveyed counties to see whether they could meet them.
Ed LeGrand was head of the department when the law passed. He said he viewed it as a progressive effort that could spur counties to stop holding mentally ill people in jail. And even if that didn't happen, the law would improve jail conditions — at least somewhat.
“I didn't think that everybody would be able to meet those standards. I thought they would give it a try,” he said in a recent interview. “A lot of them did, but some of them didn't.”
Department staff met with county officials and toured jails to offer assistance. Those visits, which records show mostly took place in 2011 and 2012, were the first time the Department of Mental Health had tried to get a comprehensive look at the local facilities where Mississippians awaited psychiatric treatment in state hospitals, LeGrand said.
Many jails were poorly equipped to care for these people, according to notes by agency staff.
“Toured the current jail (scary),” reads a status update written after staff visited Tishomingo County, in the northeast corner of the state, shortly before the county opened a new jail. In Jones County in south Mississippi, where the jail had 180 inmates and only four staff: “The holding cells are not safe for violent behavior. Too much cement.”
Jones County Sheriff Joe Berlin said the cells have not changed since then, though now detainees are monitored with cameras.
In early 2011, LeGrand told county officials who hadn't already begun the certification process that they had six months to find a certified provider to house people awaiting treatment.
Sheriffs were frustrated. Some objected to being told they had to upgrade their jails and train guards so they could care for mentally ill people they didn't think they should be responsible for in the first place.
“What do they expect of me?” one sheriff was quoted as saying in the 2011 news story. “What they need to do is turn around and certify some places that are under Mental Health's control so they can be responsible for it, not me.”
Some county officials concluded there was little the state could do if they didn't comply. Mike Harlin, the jail administrator in Lamar County, discussed the standards with a Department of Mental Health staffer in 2012, according to an agency memo. In an interview this year, Harlin said he remembered thinking, “What are you going to do? Are you going to shut the jail down? No.”
By June 2013, jails in just two of the state's 82 counties had been certified, according to the department's tally. (A hospital was certified in another county, and a different type of facility was certified in a fourth.)
Six counties said they couldn't meet the standards. Another 23 had received guidance from the department on how to meet them. Thirty, including a few of the counties that had received advice, eventually said they didn't jail people, some because they had contracts with providers. Twenty-one never responded.
Mississippi Today and ProPublica requested all Department of Mental Health records since 2010 related to enforcement of the certification law and correspondence with counties. Documents through 2013 included standards, correspondence, memos describing visits to county facilities and a log summarizing contact with each county. After that, the records released show no statewide outreach.
The final entry in the department's timeline of the law's implementation reads: “June 2013 was the last attempt to update the information about DMH Designated Mental Health Holding Facilities due to lack of additional responses from the counties.” That timeline is undated, but a department spokesperson said data in the file shows that it was created in January 2015 by a staffer who held positions in the certification and behavioral health divisions.
LeGrand, who served until 2014, said he doesn't recall any decision to stop contacting counties about the law.
Katie Storr, the current chief of staff at the Department of Mental Health, told Mississippi Today and ProPublica it's possible staff did communicate with counties beyond what the records indicate. “After more than a decade, a lack of correspondence, email, or other documentation is not indicative that communication and follow-ups did not take place,” she wrote in an email. However, she said the department had no additional records that would show this.
During this time, Storr wrote, the department was focused on trying to get counties to hold people going through the commitment process in short-term crisis stabilization units rather than jail.
Department can't ‘boss counties around'
The recent effort to implement the certification law stems from inquiries by Mississippi Today and ProPublica.
In January, the news organizations asked the head of the Department of Mental Health, Wendy Bailey, if the department certifies jails where people are held as they await admission to a state hospital. Bailey, who handled communications for the department when the certification law passed, initially said it didn't apply to jails. In March, after reviewing documents showing prior efforts to certify jails, she said she didn't believe the law was intended to apply to them.
After our inquiries, Bailey sought an opinion from the attorney general. (Such opinions are not binding, but officials who request and abide by them are protected from liability.)
Around the same time, the Department of Mental Health contacted the four facilities it had previously certified to schedule inspections. The department's standards say such inspections will happen annually, but this was the first year in which staff had sought to visit all of them since 2017. (Storr said the inspection effort was planned before inquiries by Mississippi Today and ProPublica.)
In March, staffers inspecting the Chickasaw County jail in rural northeastern Mississippi found serious violations. Inmates and people awaiting mental health treatment were housed together in the same cells, where beds were anchored with long bolts that “could be used by a person to harm themselves,” the reviewers recorded.
The department suspended the jail's certification in August, but reinstated it after the county submitted a compliance plan that included shortening the bolts and providing mental health training for staff.
Lafayette County told the state it didn't want its jail to be certified anymore. The certification for a holding facility in Warren County, home to Vicksburg, was suspended. A hospital in Alcorn County in northeast Mississippi maintained its certification.
In August, the attorney general's office confirmed that the department must “ensure that each county holding facility, including but not limited to county jails,” meets its standards. If they don't, an assistant attorney general wrote, the law allows the department to require counties to contract with a county that does have a certified facility.
When Bailey informed county officials about the opinion in her October letter, she instructed that if a county holds someone in an uncertified facility, including a jail, officials should contact the department to seek certification or work with local community mental health centers. These are publicly funded, independent providers set up to ensure that poor, uninsured people can access mental health care.
Several counties, including Lamar, have taken up the matter in public meetings or have contacted the department to begin the certification process.
Storr told Mississippi Today and ProPublica that the department asked counties to initiate the certification process because the law says it's up to counties to determine which facility they use.
But the Department of Mental Health already knows which counties have held people in uncertified jails. Starting in July 2021, in response to a federal lawsuit over the state's mental health system, department staff have tracked how many people come to state hospitals directly from jails for psychiatric treatment.
The tally for the year ending in June breaks down all 71 jails, only one of which is certified, where a total of 812 people who had been civilly committed were held before being admitted to a state hospital. (The tally doesn't include anyone who was jailed and released without being admitted to a state hospital.)
In Lauderdale County, on the Alabama line: 83. Across the state in DeSoto County: 76. A couple hundred miles down the Mississippi River in Adams County: 33.
Storr and Bailey have emphasized that they have limited authority over counties and no way to force them to do anything. The department's only means of enforcement, Storr wrote, is to put a jail on probation, then revoke certification — if the jail in question even was certified in the first place — and require the county to contract with another provider.
LeGrand said a law without teeth is effectively optional. “The department's not really in a good position to boss counties around,” he said.
James Tucker, an attorney and the director of the Alabama Disabilities Advocacy Program, which has sued that state over its civil commitment process, said the agency has a responsibility to make sure counties are treating people properly. “You don't discharge that duty by sitting on your hands and waiting for every local sheriff to report in,” he said.
Bailey's department encourages counties to connect families with outpatient services in order to avoid the commitment process. If someone does need to be committed, the department said, counties should hold people in crisis stabilization units operated by community mental health centers.
“I do not believe jails are an appropriate location to hold someone who is not charged with a crime and is awaiting admission to a treatment bed,” Bailey told Mississippi Today and ProPublica in an email. “The person should be in a safe location, receiving treatment.”
But there are only 180 crisis beds in the state, and crisis stabilization units frequently turn people away because they are full, can't provide the needed care, or deem a patient too violent. Storr said the agency is working to reduce denials and plans to use one-time federal pandemic funding to expand capacity.
Allen, the sheriffs' association attorney, said the state will need more crisis beds if officials want to keep people out of jail as they await mental health care. He said he's been meeting with sheriffs and county officials since the guidance was issued.
“This has catalyzed the county governments and law enforcement to do something,” he said. Sheriffs agree on the need for “certified centers, just not in the county jail.”
Mollie Simon of ProPublica contributed research to this story.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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For help, call or text the National Maternal Mental Health Hotline at 1-833-TLC-MAMA (1-833-852-6262) or contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.” Spanish-language services are also available.
BRIDGEPORT, Conn. — Milagros Aquino was trying to find a new place to live and had been struggling to get used to new foods after she moved to Bridgeport from Peru with her husband and young son in 2023.
When Aquino, now 31, got pregnant in May 2023, “instantly everything got so much worse than before,” she said. “I was so sad and lying in bed all day. I was really lost and just surviving.”
Aquino has lots of company.
Perinatal depression affects as many as 20% of women in the United States during pregnancy, the postpartum period, or both, according to studies. In some states, anxiety or depression afflicts nearly a quarter of new mothers or pregnant women.
Many women in the U.S. go untreated because there is no widely deployed system to screen for mental illness in mothers, despite widespread recommendations to do so. Experts say the lack of screening has driven higher rates of mental illness, suicide, and drug overdoses that are now the leading causes of death in the first year after a woman gives birth.
“This is a systemic issue, a medical issue, and a human rights issue,” said Lindsay R. Standeven, a perinatal psychiatrist and the clinical and education director of the Johns Hopkins Reproductive Mental Health Center.
Standeven said the root causes of the problem include racial and socioeconomic disparities in maternal care and a lack of support systems for new mothers. She also pointed a finger at a shortage of mental health professionals, insufficient maternal mental health training for providers, and insufficient reimbursement for mental health services. Finally, Standeven said, the problem is exacerbated by the absence of national maternity leave policies, and the access to weapons.
Those factors helped drive a 105% increase in postpartum depression from 2010 to 2021, according to the American Journal of Obstetrics & Gynecology.
For Aquino, it wasn't until the last weeks of her pregnancy, when she signed up for acupuncture to relieve her stress, that a social worker helped her get care through the Emme Coalition, which connects girls and women with financial help, mental health counseling services, and other resources.
Mothers diagnosed with perinatal depression or anxiety during or after pregnancy are at about three times the risk of suicidal behavior and six times the risk of suicide compared with mothers without a mood disorder, according to recent U.S. and international studies in JAMA Network Open and The BMJ.
The toll of the maternal mental health crisis is particularly acute in rural communities that have become maternity care deserts, as small hospitals close their labor and delivery units because of plummeting birth rates, or because of financial or staffing issues.
This week, the Maternal Mental Health Task Force — co-led by the Office on Women's Health and the Substance Abuse and Mental Health Services Administration and formed in September to respond to the problem — recommended creating maternity care centers that could serve as hubs of integrated care and birthing facilities by building upon the services and personnel already in communities.
The task force will soon determine what portions of the plan will require congressional action and funding to implement and what will be “low-hanging fruit,” said Joy Burkhard, a member of the task force and the executive director of the nonprofit Policy Center for Maternal Mental Health.
Burkhard said equitable access to care is essential. The task force recommended that federal officials identify areas where maternity centers should be placed based on data identifying the underserved. “Rural America,” she said, “is first and foremost.”
There are shortages of care in “unlikely areas,” including Los Angeles County, where some maternity wards have recently closed, said Burkhard. Urban areas that are underserved would also be eligible to get the new centers.
“All that mothers are asking for is maternity care that makes sense. Right now, none of that exists,” she said.
Several pilot programs are designed to help struggling mothers by training and equipping midwives and doulas, people who provide guidance and support to the mothers of newborns.
In Montana, rates of maternal depression before, during, and after pregnancy are higher than the national average. From 2017 to 2020, approximately 15% of mothers experienced postpartum depression and 27% experienced perinatal depression, according to the Montana Pregnancy Risk Assessment Monitoring System. The state had the sixth-highest maternal mortality rate in the country in 2019, when it received a federal grant to begin training doulas.
To date, the program has trained 108 doulas, many of whom are Native American. Native Americans make up 6.6% of Montana's population. Indigenous people, particularly those in rural areas, have twice the national rate of severe maternal morbidity and mortality compared with white women, according to a study in Obstetrics and Gynecology.
Stephanie Fitch, grant manager at Montana Obstetrics & Maternal Support at Billings Clinic, said training doulas “has the potential to counter systemic barriers that disproportionately impact our tribal communities and improve overall community health.”
Twelve states and Washington, D.C., have Medicaid coverage for doula care, according to the National Health Law Program. They are California, Florida, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, Oklahoma, Oregon, Rhode Island, and Virginia. Medicaid pays for about 41% of births in the U.S., according to the Centers for Disease Control and Prevention.
Jacqueline Carrizo, a doula assigned to Aquino through the Emme Coalition, played an important role in Aquino's recovery. Aquino said she couldn't have imagined going through such a “dark time alone.” With Carrizo's support, “I could make it,” she said.
Genetic and environmental factors, or a past mental health disorder, can increase the risk of depression or anxiety during pregnancy. But mood disorders can happen to anyone.
Teresa Martinez, 30, of Price, Utah, had struggled with anxiety and infertility for years before she conceived her first child. The joy and relief of giving birth to her son in 2012 were short-lived.
Without warning, “a dark cloud came over me,” she said.
Martinez was afraid to tell her husband. “As a woman, you feel so much pressure and you don't want that stigma of not being a good mom,” she said.
In recent years, programs around the country have started to help doctors recognize mothers' mood disorders and learn how to help them before any harm is done.
One of the most successful is the Massachusetts Child Psychiatry Access Program for Moms, which began a decade ago and has since spread to 29 states. The program, supported by federal and state funding, provides tools and training for physicians and other providers to screen and identify disorders, triage patients, and offer treatment options.
But the expansion of maternal mental health programs is taking place amid sparse resources in much of rural America. Many programs across the country have run out of money.
The federal task force proposed that Congress fund and create consultation programs similar to the one in Massachusetts, but not to replace the ones already in place, said Burkhard.
In April, Missouri became the latest state to adopt the Massachusetts model. Women on Medicaid in Missouri are 10 times as likely to die within one year of pregnancy as those with private insurance. From 2018 through 2020, an average of 70 Missouri women died each year while pregnant or within one year of giving birth, according to state government statistics.
Wendy Ell, executive director of the Maternal Health Access Project in Missouri, called her service a “lifesaving resource” that is free and easy to access for any health care provider in the state who sees patients in the perinatal period.
About 50 health care providers have signed up for Ell's program since it began. Within 30 minutes of a request, the providers can consult over the phone with one of three perinatal psychiatrists. But while the doctors can get help from the psychiatrists, mental health resources for patients are not as readily available.
The task force called for federal funding to train more mental health providers and place them in high-need areas like Missouri. The task force also recommended training and certifying a more diverse workforce of community mental health workers, patient navigators, doulas, and peer support specialists in areas where they are most needed.
A new voluntary curriculum in reproductive psychiatry is designed to help psychiatry residents, fellows, and mental health practitioners who may have little or no training or education about the management of psychiatric illness in the perinatal period. A small study found that the curriculum significantly improved psychiatrists' ability to treat perinatal women with mental illness, said Standeven, who contributed to the training program and is one of the study's authors.
Nancy Byatt, a perinatal psychiatrist at the University of Massachusetts Chan School of Medicine who led the launch of the Massachusetts Child Psychiatry Access Program for Moms in 2014, said there is still a lot of work to do.
“I think that the most important thing is that we have made a lot of progress and, in that sense, I am kind of hopeful,” Byatt said.
Cheryl Platzman Weinstock's reporting is supported by a grant from the National Institute for Health Care Management Foundation. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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The state's officer certification and training board now has the power to investigate law enforcement misconduct.
Gov. Tate Reeves signed the bill making it official.
Public Safety Commissioner Sean Tindell, who pushed for the legislation, said that House Bill 691 authorizes the Board of Law Enforcement Officer Standards and Training “to launch its own investigations into officer misconduct. This change, along with the funding to hire two investigators, will improve the board's ability to ensure officer professionalism and standards.”
The new law comes in the wake of an investigation by the Mississippi Center for Investigative Reporting at Mississippi Today and The New York Times into sheriffs and deputies across the state over allegations of sexual abuse, torture and corruption.
Tindell said the new law will “improve law-enforcement training in Mississippi by requiring all law enforcement officers to receive continuing training throughout an officer's career.”
Under that law, deputies, sheriffs and state law enforcement officers will join police officers in the requirement to have up to 24 hours of continuing education training. Those who fail to train could lose their certifications.
Other changes will take place as well. Each year, the licensing board will have to report on its activities to the Legislature and the governor.
Tindell thanked Reeves “for signing this important piece of legislation and the legislative leaders who supported its passage, including the author of HB 691, Representative Fred Shanks.”
Shanks, R-Brandon, praised the “team effort with some very smart people who want a top-notch law enforcement community.”
The new law creates a 13-member board with the governor having six appointments – two police chiefs, two sheriffs, a district attorney and the director of the Mississippi Law Enforcement Officers' Training Academy.
Other members would include the attorney general or a designee, the director of the Mississippi Highway Patrol, the public safety commissioner and the presidents of the Mississippi Association of Chiefs of Police, the Mississippi Constable Association, the Mississippi Campus Law Enforcement Association and the Mississippi Sheriffs' Association (or their designees).
“We obviously need checks and balances on how law enforcement officers conduct themselves,” said state Sen. John Horhn, D-Jackson. “This is a good first step.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Lawmakers punt to next year efforts to expand college aid for low-income Mississippians
A bill to open a college financial aid program for the first time ever to Mississippians who are adult, part-time and very low-income students fell to the wayside in a legislative session dominated by fights over Medicaid and K-12 funding.
The effort to expand the Mississippi Resident Tuition Assistance Grant, called MTAG, died in conference after it was removed from House Bill 765, legislation to provide financial assistance to teachers in critical shortage areas. The Senate had attached MTAG's code sections to that bill in an attempt to keep the expansion alive.
This takes Jennifer Rogers, the director of the Mississippi Office of Student Financial Aid, back to the drawing board after years of championing legislation to modernize the way the state helps Mississippians pay for college.
“At the end of the day, there was no appetite to spend any additional money on student financial aid,” Rogers said. “Obviously, I'm disappointed.”
All told, the original proposal would have resulted in the state spending upwards of $30 million extra each year, almost doubling OSFA's roughly $50 million budget.
The increase derived from two aspects of the proposal: An estimated 37,000 Mississippians who have never been eligible for college financial aid would have become eligible to receive it, and the scholarship amounts would have increased.
While college students from millionaire families can get MTAG, the state's poorest students are not eligible, Mississippi Today previously reported.
Rep. Kent McCarty, R-Hattiesburg, said he supports efforts to help low-income Mississippians afford college, but that HB 765 was not an appropriate vehicle to do so because it was not an appropriations bill. Attempting to expand MTAG through that legislation would have put the original subject of HB 765, the Mississippi Critical Teachers Shortage Act, at risk.
“We didn't feel it was appropriate to include an appropriation in a bill that had not been through the appropriations process,” he said.
McCarty, a member of the House Universities and Colleges Committee, added that he is in favor of changing MTAG and doesn't understand the logic behind excluding from state financial aid Mississippi college students who receive a full federal Pell Grant, meaning they come from the state's poorest families.
“What is the purpose of financial aid? To aid those who need financial aid,” he said. “Excluding a group of students because they're eligible for other financial aid doesn't make a lot of sense to me.”
Ultimately, the Mississippi House deemed the proposal too expensive. It never passed out of that chamber's Appropriations Committee.
READ MORE: ‘A thing called money:' Bill to expand financial aid stalled after House lawmakers balk at price tag
Rogers said she plans to work with lawmakers to convince them that it is a good use of state dollars to invest in financial aid. She added that the support of the business community helped keep the bill alive as long as it did this session. The Mississippi Economic Council supported the legislation.
“I don't understand why there is such a hesitancy to invest more in the future workforce of the state,” she said. “I don't understand why there isn't a willingness to invest in student financial aid as a way to help more Mississippians complete meaningful certificates or degrees, valuable certificates or degrees and improve the quality of the workforce.”
Senate Education Committee Chairman Dennis DeBar, R-Leakesville, told Mississippi Today that he hopes to take a closer look at MTAG this summer, noting that the Senate's version of the proposal, which also included a last-dollar tuition scholarship, was a priority of the lieutenant governor on last year's campaign trail.
“We had so many issues last session,” DeBar said. “Hopefully there won't be as many next year so we can just focus this year and get it across the finish line.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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