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.”

DMH wants 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.

Order Appointing Special Master

On Tuesday, February 25, 2020, Judge Carlton Reeves issued an order appointing a Special Master, Dr. Michael Hogan. Click here to read the order. Below is background information on Dr. Hogan.

According to the order, “What we need is a seasoned executive to propose a timeline for the State to reach full compliance. By when can the Department of Mental Health and the Division of Medicaid deliver the necessary community-based services-realistically-and how should we measure success along the way?” The order mentions 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.” This was also mentioned in Judge Reeve’s Memorandum Opinion and Order in September 2019.

Michael Hogan, PhD, served as New York State Commissioner of Mental Health from 2007 to 2012, and now operates a consulting practice in health and behavioral health care. The New York State Office of Mental Health operated 23 accredited psychiatric hospitals, and oversaw New York’s $5 billion public mental health system serving 650,000 individuals annually. Previously Dr. Hogan served as director of the Ohio Department of Mental Health (1991 to 2007) and commissioner of the Connecticut Department of Mental Health from 1987 to 1991. He chaired the President’s New Freedom Commission on Mental Health in 2002-2003. He was appointed as the first behavioral health representative on the board of The Joint Commission in 2007, and as a member of the National Action Alliance for Suicide Prevention in 2010. He served (1994-1998) on the National Institute on Mental Health’s National Advisory Mental Health Council, as president of the National Association of State Mental Health Program Directors (NASMHPD) (2003-2005), and as board president of NASMHPD’s Research Institute (1989-2000). His awards for national leadership include recognition by the National Governor’s Association, the National Alliance on Mental Illness, the Campaign for Mental Health Reform, the American College of Mental Health Administration and the American Psychiatric Association. He is a graduate of Cornell University, and he earned a MS degree from the State University College in Brockport, New York, and a PhD from Syracuse University. (Information provided by National Health Policy Forum)

State Response to Court Order

The State of Mississippi filed a response and report to the court on Friday, April 30, 2021. The report includes an overview of core community-based services, which includes intensive community services, crisis response services, peer support services, supported employment, and permanent supportive housing. Mississippi has continued to expand these services since December 31, 2018, the trial evidentiary cut-off date, and there has been increasing availability of these services since the trial took place in 2019.

Intensive community services includes PACT, ICORT, and ICSS. Mississippi had eight PACT teams as of December 31, 2018, but now has 10. As of December 31, 2018, Mississippi had no ICORTs. Mississippi has developed ICORT as a modification of the PACT model to provide intensive community services in less densely populated/rural counties. Mississippi is implementing and will sustain a total of 16 ICORTs in the state. The state will also fund and sustain 35 full-time Intensive Community Support Service positions.

The state will also fund and sustain Mobile Crisis Response Teams, with one team in each CMHC region except Region 12, which is operating one team in Hattiesburg and another in the former Region 13. Mississippi now has crisis residential services provided through Crisis Stabilization Units for every CMHC region except Region 11, though funds are available to implement those services. Prior to 2019, Mississippi had only eight, 16-bed CSUs; the state now has 13 CSUs and a capacity of 172 crisis residential beds for adults in mental health crisis.

The expansion of services and supports since 2018 has also included Peer Support, Supported Employment, Supportive Housing, and more. Response to Court Order, Report, and Exhibits – April 2021.

Court Appointed Monitor And Report

In September 2021, United States District Judge Carlton Reeves appointed Dr. Michael Hogan to serve as monitor in this case. The order of appointment sets out Dr. Hogan’s duties as follows:

The Monitor shall assess compliance with each obligation in the Court’s Remedial Order and shall provide the State with technical assistance as necessary to support the State in reaching compliance.

While conducting the Monitor’s regular assessment, the Monitor shall review and validate data and information, speak with State officials, providers, and individuals receiving services, and participate in the annual Clinical Review required by the Remedial Order. When speaking with State officials, counsel for the State may be present.

The Monitor shall provide written reports on the State’s compliance with the Remedial Order every six months. Each report shall describe the State’s level of compliance (e.g., noncompliance, partial compliance, or substantial compliance) as to each obligation in the Remedial Order and include a summary of the data that led to the Monitor’s assessment of compliance.

The written reports shall be filed on the Court’s docket and the Court will hold a status conference following submission of each report. The Parties shall establish procedures for review and comment on draft reports by the State and the United States before the reports are filed with the Court.

In March 2022, Dr. Hogan released the first Report of the Court Monitor. In this first report, Dr. Hogan acknowledges the stresses that have been caused by the global COVID-19 pandemic and the challenges that have resulted for people who depend on and provide care. He noted that this first report is a “stage setting” report that includes some early findings on compliance, as well as background and context on mental health care in Mississippi. He stated that future reports will focus more exclusively on compliance with the court order, but that it is not possible at this time of this first report to to make definitive determinations of compliance for many requirements of the order. The first report includes an appendix titled The Context of Care and Compliance in Mississippi that is intended as a complement to the assessments of compliance, with Dr. Hogan noting he hopes the information and perspectives there are useful to stakeholders and officials.

The Mississippi Department of Mental Health has appreciated working with Dr. Hogan during his visits to the state, and has also appreciated the opportunity to provide him with the data he has requested. His report acknowledges progress that has been made in the state’s mental health system in a variety of areas, such as the facilitation of a warm hand-off in the discharge transition process. DMH plans to continue enhancing this process over the next year, including partnering with the Community Mental Health Centers to complete intakes prior to discharge. The agency also appreciate that he acknowledges the effectiveness of intensive community services like PACT and ICORT as these services relate to the data around readmissions to state hospitals. DMH is moving forward with conducting fidelity reviews for PACT, ICORT, ICSS, Supported Employment, and Mobile Crisis listed in the remedial order. More initiatives under way are planned to assist with crisis services, including the implementation of the 988 system. DMH has also proposed the utilization of federal ARPA funding to expand he number of Crisis Stabilization Unit beds in the state by approximately 60 beds, to add 18 court and law enforcement liaisons around the state to intervene during the commitment process and connect people to appropriate services in their communities, and to pilot three peer support respite programs that offer support to individuals at risk of a behavioral health crisis. The agency has recently provided training for judges and other judicial professionals on mental health services and alternatives to civil commitment, as well as facilitated technical assistance from experts from other states for several topics relevant for Mobile Crisis Response Teams. DMH is also working with several other states on technical assistance related to several of the areas in the order as well, and is adding an Office of Utilization Review to be responsible for tracking and analysis of the utilization of behavioral health services for state operated programs and key community-based services.

DMH is committed to expanding the availability of community-based services in Mississippi.


Click Here for the DMH Response to the Most Recent Report of the Court Monitor

Remedial Order Paragraph 24 Data Report

In September 2021, the Honorable Judge Carlton Reeves issued a Final Judgement and Remedial Order in the case of United States of America v. State of Mississippi (Cause No. 3:16-CV-622-CWR-FKB).  Paragraph 24 of the Remedial Order states that beginning with the end of Fiscal Year 2022, the Mississippi Department of Mental Health (DMH) will post on its agency website the data components described in paragraphs 19-21 of the Remedial Order. The purpose of this report is to provide the data elements and corresponding narratives pertaining to these sections of the Remedial Order for Fiscal Year 2022.

DMH is committed to providing an array of services and supports to Mississippians by offering a continuum of care for adults with serious mental illness. In the Remedial Order, a number of adult mental health services are collectively referred as “Core Services.” These Core Services include Mobile Crisis Response Teams, Crisis Residential Services (also referred to as Crisis Stabilization Units or CSUs), Programs of Assertive Community Treatment Teams, Intensive Community Outreach and Recovery Teams, Intensive Community Support Services, Supported Housing, Supported Employment, Peer Support Services, and Community Support Services. The key aims of the identified Core Services for adults with serious mental illness are to provide people with access to local crisis service options, to enable people to be served in their communities, and to help people avoid unnecessary hospitalization.

As previously stated, DMH is also working to enhance transition planning as people return to their communities from state hospitals and the agency is committed to people receiving services in the least restrictive environment and in their own communities to meet their specific needs. DMH is continuing efforts in Fiscal Year 2023 and beyond to help with the provision and monitoring of community-based mental health services for adults in our state. Service provision data outcomes, such the ones included in this report, are crucial in supporting the agency’s mission. Data informatics allow DMH to make decisions about the services available to Mississippians and to strategize, plan and allocate resources, accordingly.  

A strong mental health workforce equipped to address the unique needs of our state is also a fundamental aspect of quality service provision. Throughout Fiscal Year 2022, amidst the backdrop of unprecedented staffing shortages faced not only by Mississippi but by the entire nation, DMH has engaged in many endeavors to obtain, maintain, retain, and perhaps most importantly, sustain, an oftentimes beleaguered labor force. Over the past year, to address the training needs of our workforce and to support them in developing the tools needed to craft a service delivery system predicated on community and choice, DMH has offered provider technical assistance, education, and consultation activities in the Core Services areas. This information is also featured in this report.  DMH is inspired by the future and encouraged by ways we can continue to partner with people, families, organizations, and communities for the benefit of the people we serve.

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 each heading to expand for more information.

Shift from Institutional Budgets

Crisis Stabilization Units

Mobile Crisis Response Teams

Programs of Assertive Community Treatment (PACT) Teams

Intensive Community Outreach and Recovery Teams (ICORT)

Intensive Community Support Services (ICSS)

CHOICE Housing Program

Supported Employment

Community Transition Homes

Certified Peer Support Specialists