Federal district Judge Carlton Reeves ruled against Mississippi and in favor of the United States in the recent lawsuit about how to deal with the mentally ill.
The feds believe our state has not done enough to promote community-based mental health services, which is considered the ideal form of treatment. Mississippi still has five big mental health hospitals serving large swaths of the state. (It also has 15 smaller regional facilities.)
But the feds, and most of the mental health professionals, want much closer to the community than that. They want small group homes where the mentally ill can live and get treatment in their own neighborhoods.
A social worker would live in these homes with the multiple patients, monitor them, help them stay on their meds, help them get work and get them back on track where they can get back home and live independently. These would be half-way houses for people going through difficult mental situations.
The feds, supported by the mental health experts, believe a large, remote facility makes the stress trauma of mental illness worse, delaying, and even preventing, recovery. The feds also want trained community mental crisis teams, community crisis stabilization units as well as community residential group homes. As it stands now, when someone snaps, they often end up in jail and from there go to a big state facility where they are treated and stabilized with appropriate medications.
Once stabilized, they are released quickly because of a shortage of beds. They soon go off their meds because there is no follow up and the cycle of trauma starts all over again.
In the ideal fed world, a community-based crisis intervention team would immediately respond to a breakdown. The patient could get immediate treatment in a local crisis stabilization unit for a few days and then get several weeks or months of support in a group home run by a professional — all without going far from their home, thus avoiding the trauma of incarceration and commitment. These professionals would work with the patient to get on an appropriate drug regimen and then follow up once they leave the group home and begin to live on their own. This community treatment would be ongoing over the life of the patient or at least until there was evidence of permanent stabilization.
If done right, some argue, federal Medicaid dollars could pay for much of this, saving the state of Mississippi millions of dollars. The current big-box strategy of Department of Mental Health (DMH) employs 7,100 people, one-fourth of all state workers, and more than any other state agency. In comparison, the state prison system only has 2,610 employees. DMH has a budget of $250 million.
One obstacle is neighborhood opposition to group homes. Not In My Backyard (Nimby) is a powerful force. I recall a few years ago, the difficulties a couple had openning a group rehab home in Northeast Jackson. The neighborhood erupted in opposition.
So how do you create community-based mental treatment group homes when nobody wants them in their neighborhoods? The state hasn’t been able to do this. It will be interesting to see if the feds can succeed where the state has failed.
It’s a huge issue. Some 20 percent of us will face severe mental illness of some type at some point in our lives. The key is quick stabilization and treatment so it doesn’t destroy lives. That’s what community-based treatment is all about. It’s expensive. And it’s unclear how this will be funded. If it reduces severe mental illness, it will be a bargain, but getting there is no easy task.
Judge Reeves will be appointing “special masters” to prod the state mental health officials into moving faster on implementation of community-based treatment. We hope he considers some local experts who are actually working clinicians in the field such as University of Mississippi Medical Center’s Philip Meredith.
Wyatt Emmerich is president of Emmerich Newspapers, which owns the C-P and about 20 other newspapers, mostly in Mississippi. Reach him at wyatt@northsidesun.com.
