Mississippi’s troubled mental health system shows signs of repair, report says

by Sara DiNatale, Mississippi Today
March 13, 2023

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.”

Workers like peer 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.

Bailey 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.