Olmstead

In 2011, the United States  Department of Justice (DOJ) investigated the State of Mississippi’s public mental health system, issuing a Findings Letter in December 2011 that alleged the State of Mississippi fails to provide services to qualified individuals with disabilities, including mental illness and intellectual and developmental disabilities, in the most integrated settings appropriate to their needs, in violation of the Americans with Disabilities Act. Since 1997, the United States Department of Justice has been involved with more than two dozen states with regard to allegations of Olmstead/ADA violations. DOJ’s involvement ranges from filing Statements of Interest in cases to formal investigations and the issuing of Findings Letters to States with the hope of states entering into multi-year, multi-million-dollar settlement agreements. In 2009, on the tenth anniversary of the Supreme Court’s decision in Olmstead v. L.C., 527 U.S. 581 (1999), President Obama launched “The Year of Community Living” and directed federal agencies to vigorously enforce the civil rights of Americans with disabilities. Since then, the Department of Justice has made enforcement of Olmstead a top priority.

In 2016, DOJ filed a complaint against the State of Mississippi, alleging that the state failed to provide adults with mental illness with community-based mental health services.

Federal Court Order

Following a four-week trial in the summer of 2019, United States District Judge Carlton Reeves issued a Memorandum Opinion and Order, writing that the United States proved its case, while also acknowledging the complexity of the mental health system and the progress the state made in moving towards a community-based system of care.  The Memorandum Opinion and Order stated:

“This case is well‐suited for a special master who can help the parties craft an appropriate remedy—one that encourages the State’s forward progress in a way that expedites and prioritizes community‐based care. The evidence at trial showed what the State needs to do. The primary question for the special master is how quickly that can be done in a manner that is practical and safe for those involved. 

The parties are therefore ordered to submit, within 30 days, three names of potential special masters and a proposal for the special master’s role. A hearing will be held this fall. The proposals and lists may be separate, but the parties should confer prior to that date to see if there might be any agreed-upon candidates respected, competent, and neutral enough to do the job.” 

 

DMH Response

The Mississippi Department of Mental Health (DMH) was notified in September 2019 that Judge Carlton Reeves issued a Memorandum Opinion and Order in response to the Department of Justice (DOJ) lawsuit. The lawsuit against Mississippi alleged the State has insufficiently complied with the principles of the 1999 Supreme Court case Olmstead v. L.C.  In finding the State in violation, the Court recognized the efforts that have been made toward expanding community-based care.  In the Memorandum Opinion and Order, Judge Reeves said, “Since the United States has proven its case, the Court could order the remedy proposed at trial by the Department of Justice and its experts. Acknowledging and understanding the complexity of this system, the progress that the State has made, and the need for any changes to be done in a patient centered way that does not create further gaps in services for Mississippians, however, the Court is not ready to do so. The Court is hesitant to enter an Order too broad in scope or too lacking in a practical assessment of the daily needs of the system. In addition, it is possible that further changes might have been made to the system in the months since the factual cutoff. This case is well‐suited for a special master who can help the parties craft an appropriate remedy—one that encourages the State’s forward progress in a way that expedites and prioritizes community‐based care.”

In his Order, Judge Reeves also acknowledges that, “at no point during the four weeks of trial was any expert willing to parade their home state as an example of a mental health system without flaws. States from every corner of the country have struggled to provide adequate mental health care services. Mississippi has its own unique challenges due to its rural nature and limited funding.”

We want to provide hope to Mississippians by supporting a continuum of care for people with mental illness, alcohol and drug addiction, and intellectual or developmental disabilities. By inspiring hope, helping people on the road to recovery, and improving resiliency, Mississippians can succeed. To help in our mission, over the past several years many services and supports have been expanded and new ones implemented, including mobile crisis response teams, community transition homes, crisis stabilization beds, Programs of Assertive Community Treatment, Intensive Community Outreach and Recovery Teams, supported employment, supported housing, Mental Health First Aid trainings for the public, court liaisons, and Crisis Intervention Teams. DMH is also working to enhance transition planning as people leave the state hospitals and return to their communities. DMH has and will continue its commitment to the mission of the agency and the people of Mississippi. 


Progress Update on the Mississippi Mental Health System

Since the DOJ issued its Findings Letter in 2011, DMH and the public mental health system have continued to make strides to improve the availability of community-based services for individuals with a mental illness and/or intellectual and developmental disabilities. Included below are examples of the progress the State has made. Click the arrows to read more about each topic:

Shift From Institutional Budgets

With state source level funding in FY19, DMH shifted funds from institutional budgets to the Service Budget to expand community-based services to reduce the reliance on institutional care. A total of $8 million was granted to the 14 Community Mental Health Centers (CMHCs) for the expansion of crisis services, including crisis stabilization beds, court liaisons, crisis counselors, and an additional PACT team. In addition, $900,000 is for the continuation/expansion of the development of Community Transition Homes, which are community-based living opportunities for individuals that have been receiving continued treatment services at Mississippi State Hospital. A total of $400,000 is for the continuation of jail-based competence education project involving Forensic Services at Mississippi State Hospital.

Since 2011, the number of people served at DMH’s behavioral health hospitals and the number of beds available at those programs has decreased. In FY11, 4,119 adults received acute psychiatric services at the four state hospitals, while 258 adults received continued treatment services. In FY18, 2,684 adults received acute psychiatric services and 100 received continued treatment services. Bed capacity has also decreased. In FY11, there were 646 acute psychiatric beds available at the four state hospitals. As of July 2019, there were 401, including 75 beds available for continued treatment services.

 

Crisis Stabilization Units

The role of a Crisis Stabilization Unit is to provide stabilization and treatment services to persons who are in psychiatric crisis. Many people with mental illness can be treated at the unit and returned to the community without an inpatient admission to the state psychiatric hospital. The more quickly a person receives treatment, as opposed to being “held” without treatment, the less likely his or her condition will worsen. An individual can receive involuntary and voluntary treatment at a Crisis Stabilization Unit. After treatment, individuals will already be connected with their local Community Mental Health Center. As of August 2019, there are now 13 Crisis Stabilization Units. Previously, there were eight, 16-bed Crisis Stabilization Units across the state. The funding shift from DMH programs to the DMH Service Budget in FY19 allowed additional crisis stabilization beds to open in CMHC regions that did not have CSUs: LifeCore Health Group (Region 3) opened eight crisis beds in Tupelo; Community Counseling Services (Region 7) opened eight beds in West Point; Singing River (Region 14) opened eight beds in Gautier; Hinds Behavioral Health Services (Region 9) opened 12 beds in Jackson; and Region One Mental Health Center opened eight beds in Marks. The beds offer time-limited residential treatment services designed to serve adults with severe mental health episodes that if not addressed would likely result in the need for inpatient treatment.

 

Mobile Crisis Response Teams

In 2014, each of the 14 Community Mental Health Centers (CMHCs) developed a Mobile Crisis Response Team (MCRT) to provide community-based crisis services to the location where an individual is experiencing a crisis.  These MCRTs deliver solution-focused and recovery-oriented behavioral health assessments and crisis stabilization services, working hand-in-hand with local law enforcement, Chancery Judges and Clerks, and the Crisis Stabilization Units to promote a seamless process. The Teams ensure an individual has a follow-up appointment with his or her preferred provider and monitor the individual until the appointment takes place. In FY18, the Teams provided 18,651 face-to-face interventions. A total of 27,349 calls were received by the Teams in FY19. Out of those calls, 21,366 were diverted from a more restrictive environment, and 20,529 calls involved face-to-face interaction.

 

Programs of Assertive Community Treatment (PACT) Teams

In 2011, Mississippi had two PACT Teams. Now, Mississippi has 10 PACT Teams that are operated by the following Community Mental Health Centers (CMHCs): Warren-Yazoo Behavioral Health, Life Help, Pine Belt Mental Healthcare Resources (operates one in Hattiesburg and one on the Gulf Coast), Hinds Behavioral Health, Weems Community Mental Health Center, Life Core Health Group, Region 8 Mental Health Center, and Timber Hills Mental Health Services (operates one in Desoto and one in Corinth).  PACT is a person-centered, recovery-oriented, mental health service delivery model for facilitating community living, psychological rehabilitation and recovery for persons who have the most severe and persistent mental illnesses and have not benefited from traditional outpatient services. PACT Teams are mobile and deliver services in the community to enable an individual to live in his or her own residence. In FY19, 500 people received services through PACT Teams.

 

Intensive Community Outreach and Recovery Teams (ICORT)

In FY19, DMH piloted an Intensive Community Outreach and Recovery Team (ICORT), with the Region 2 CMHC, Communicare. In FY20, DMH is providing four grants for ICORTs in regions that do not have a PACT Team. These teams are able to target more rural areas where there may be staffing issues or clients are spread out over a large geographical area. ICORT is a recovery and resiliency oriented, intensive, community-based rehabilitation service for adults with severe and persistent mental illness. ICORTs are mobile and deliver services in the community to enable an individual to live in his or her own residence. An ICORT has fewer staffing requirements and higher staff client ratios than a traditional PACT Team. An ICORT is staffed with registered nurse, a Master’s level Mental Health Therapist, a Certified Peer Support Specialist, and an administrative assistant. ICORT can also utilize a part-time Community Support Specialist if needed. Services are provided 24-hours per day, 7-days a week just like PACT. An ICORT is an opportunity for CMHCs that are unable to sustain a PACT Team to provide a similar intensive service to help keep people out of the hospitals.

 

CHOICE Housing Program

Permanent Supported Housing is available in Mississippi through a program known as CHOICE – Creating Housing Options in Communities for Everyone. CHOICE ensures people with a serious mental illness can live in the most integrated settings in the communities of their choice by providing an adequate array of community supports/services. While CHOICE provides the assistance that makes the housing affordable, local Community Mental Health Centers provide the appropriate services. The CHOICE program is a partnership between DMH, Mississippi United to End Homelessness, Open Doors Homeless Coalition, Mississippi Home Corporation, and the CMHCs.  In June 2019, CHOICE housed the 600th person through its program.

 

Supported Employment

Supported Employment programs for people with severe mental illness have also expanded. In FY18, there were four Supported Employment sites, located in Regions 2, 7, 10, and 12. To help expand the programs, DMH provided funding in the second quarter of FY19 to Community Mental Health Centers to add seven more Supported Employment programs at Region 3, 4, 8, 9, 11, 14, and 15.  Currently, there are 11 Supported Employment programs for people with severe mental illness across the state. DMH is in the process of developing a memorandum of understanding with Department of Rehabilitation Services to assist with training and job placement.

 

Community Transition Homes

As part of the shift in funding from the institutional budgets to the Service Budgets, DMH moved $900,000 to continue and expand the development of Behavioral Health Homes for individuals who have been receiving continued treatment services at Mississippi State Hospital. DMH, Region 8 Community Mental Health Center, Hinds Behavioral Health Services, and The Arc of Mississippi have partnered to provide community-based living opportunities for individuals that have been receiving continued treatment services at Mississippi State Hospital. Region 8 began a Community Transition Home for four females in Simpson County in April 2018 and have added an additional house for four more females. Region 9 began a Community Transition Home in May 2018 for four males in the Jackson area.  These individuals have been unsuccessful living in the community in the past. Now, with 24/7 support and assistance, the individuals pay their own rent, purchase their own food and participate in the community.

 

Certified Peer Support Specialists

Mississippi’s Certified Peer Support Specialist (CPSS) Training is an intensive, 34-hour course followed by a written exam. CPSSs are individuals who self-identify as a family member or an individual who received or is currently receiving mental health services. Upon completion of the training, successfully passing the CPSS examinations, and obtaining employment by a DMH certified provider, participants become Certified Peer Support Specialists. The training and certification process prepares CPSSs to promote hope, personal responsibility, empowerment, education, and self-determination in the communities in which they serve.

The first CPSSs with a designation of a Parent/Caregiver completed their training at DMH in March 2017. The Parent/Caregiver designation is an expansion of the CPSS Program. This designation of peers focuses on those who will be working with children with behavioral health issues. The training is a customized, two-day block within the current CPSS training program. In FY19, a total of 20 Parent/Caregiver designations were received.

In June 2019, DMH completed the first training for people with a designation of Youth and Youth Adult CPSS. A Youth/ Young Adult Peer Support Specialist is a person between the ages of 18‐26 with lived experience with a behavioral health or substance use diagnosis. Thirteen young people participated in the training, which was developed in conjunction with NAMI Mississippi. The Youth and Young Adult training is a 2.5‐day block in the CPSS training that consists of several youth‐specific modules.

In FY19, there were 201 CPSSs in Mississippi.

 

Additional details about the ways DMH has helped expand access to community-based services, including intellectual/developmental disability services, can be found in the below document the Department of Mental Health has developed to provide an overview of Mississippi’s Public Mental Health System and the efforts made by the department in its expansion of community-based services and the transformation to a person-centered and recovery-oriented system of care. It is revised every fall to reflect data from the most recent fiscal year. Click the heading below to read or save the document.

Progress Update on the Mississippi Public Mental Health System 

(White Paper revised November 2019)