Wendy Bailey, executive director of the Mississippi Department of Mental Health, came by the Northside Sun and gave me an earful about what’s going on with mental health in Mississippi.
I much appreciated her visit and taking the time to add to my knowledge base about mental health public policy in our state. It’s a huge issue and one that is mired in considerable controversy.
I wish more public officials would do what Wendy did. I see my job as a journalist as trying to explain in understandable terms complex public policy issues so readers can become better voters and better citizens. A knowledgeable electorate and citizenry is crucial to social and economic progress.
It’s my experience that the overwhelming majority of people in public service are committed, well-intentioned people trying to do the right thing. Wendy Bailey is a good example.
She is grappling with a huge issue. One out of five Mississippians will battle serious mental illness at some point in their lives. Managing these unfortunate and usually temporary mental breaks appropriately is vitally important to the well being of our state.
To quickly recap, our nation, and Mississippi, is in the middle of a decades-long transition of mental illness treatment from hospitalization in big centralized facilities to out-patient treatment in a local setting.
Back in the old days, if someone snapped, we just locked them away in a big mental institution. Unfortunately, such trauma is the absolute worst thing you can do to someone undergoing the stress of a mental break. It takes a bad situation and makes it much worse, often causing permanent damage to the brain.
As society has progressed in its understanding of mental illness, treatments have improved. We’ve learned to gently nurse the mentally ill back to health with a minimum of trauma. Just like cancer, the recovery rate from mental illness has greatly improved over the years thanks to better treatment procedures.
In 1999, the U. S. Supreme Court ruled in the Olmstead decision that many states were violating the constitutional rights of mentally ill individuals. As a result, the U. S. Justice Department sued 24 states demanding they improve their mental health policies. Mississippi is one such state and recently lost a lawsuit to the feds, which the Mississippi Attorney General’s office is appealing.
As a result of the lawsuit, federal district judge Carlton Reeves appointed a special master, Dr. Michael Hogan, to work with the Mississippi Department of Mental Health to accelerate treatment improvements.
As it turns out, Bailey thinks Hogan is a good choice and looks forward to working with him to achieve further progress.
So then why is Mississippi appealing Judge Reeves’ decision in favor of the feds? Bailey’s answer: “The State of Mississippi was sued, not the Mississippi Department of Mental Health. As such, the Mississippi Attorney General’s Office represents the State of Mississippi as a whole and has opted to file the appeal. The decisions for an appeal is not something I can speak to because the Attorney General’s Office is who represents the state.”
The decision to appeal wasn’t made by the very agency affected by the lawsuit. It was made by the Mississippi Attorney General’s Office.
That seems really bizarre to me, but here’s how I think it works. These massive federal versus state lawsuits are a new type of federal-state governance mechanism. The lawsuits really never end, they just go on and on, operating almost like a parallel universe to the actual public policy that happens day-to-day in the field. Lawyers gotta eat too!
The U. S. Justice Department Civil Rights Division has hundreds of lawyers engaged in suing the state. The states have hundreds of lawyers engaged in defending the state. And, of course, there are big legal contracts to be let for politically connected law firms. And on it goes.
Now the good news: Outside of all this legal noise, great progress is being made to reconfiguring treatment along the new improved protocols. This involves the creation of local response teams manned with appropriate professionals to rapidly intervene in mental health crises to prevent the need for institutionalization.
Every county in Mississippi now has some sort of community based mental health service, either PACT team (Programs for Assertive Community Treatment) or a scaled down service such as ICORT (Intensive Community Outreach and Recovery Teams).
In conjunction with a new federal law, Mississippi will soon be rolling out a new emergency number 988 (remember that number!) to go along with 911. The idea is to train ordinary citizens to call 988, not 911, when there is a mental health crisis. Calling 988 will quickly connect the newly created Mobile Crisis Response Teams which have the necessary skill to handle the mental health situations.
And, as always, public awareness of and sympathy for the nature of mental illness is critical. It may be you next time.
Ten years ago there were no Mobile Crisis Response Teams. Now there are 14.
Looking at my pages and pages of notes and dozens of acronyms, it’s impossible to include all the details of the new programs in this column. But I was very impressed that the MDH is making strides toward improving the situation.
In summary, acute hospital psychiatric admissions have dropped from 3,682 in 2011 to 1,784 today. Instead today 80,000 people per year are getting locally-based, out-patient treatment, including a wonderful program that employs recovered patients to serve as therapists.
There are taxpayer benefits as well. DMH has a $600 million budget of which about $220 million comes from the state general fund. Less institutionalization means less cost. Community based treatment is often paid for with federal Medicaid dollars rather than state funds.
Of course, there will always be a need for some institutionalization, but it should be a last resort, not a first resort. And use of temporary, local-based Crisis Stabilization Units is much less traumatic to the patient than longer-term institutionalization at one of the four state facilities.
Another big push: Training of police to understand mental health situations. Eventually, the goal is to make it part of the training at the state police academy. It’s a tragedy when a mentally ill person dies in the hands of an untrained police officer.
Another huge issue: Perhaps a third of the prison and jail population consists of the mentally ill. Better prevention and treatment could reduce this atrocity, saving both public money and individual lives.
Of all the human organs to fail, the brain is the worst. People are still blamed for mental illness, as though somehow it was their fault. The reality is the brain is extremely fragile. Given enough stress, anybody can snap. And Lord knows there is plenty of stress in modern society.