I recently listened to closing arguments in the mental health lawsuit pitting Mississippi against the United States. With $500 million a year in state money on the line, you would think the audience would be packed, but there was plenty of room.
Earlier in the month, I covered the trial one day for the Associated Press. The media is so thin these days that the few reporters who are still left have to tag team just to cover a major trial. In the pre-Facebook/Google days, there would have been six or seven reporters all from independent newspapers or news agencies. So sad.
At stake was how we treat the mentally ill: Lock them up for a while in a big state hospital or briefly stabilize them in a community-based facility and send them back home.
Locking them up in an institution is the old way. The new way is to:
• Stabilize them in a small, unthreatening community facility.
• Get them back on their meds.
• Quickly get them back to their normal family and routine with a minimal amount of trauma.
• Help them learn to live independently and get federally subsidized jobs.
Ironically, both the U. S. and Mississippi agree the new way is best. The question is the pace of change. The feds think Mississippi is moving way too slowly.
The role of money is interesting in this case. The feds argue that if Mississippi would shut down its five big mental health facilities, it would have more than enough to fund the hundreds of small non-profits delivering community-based mental health services. Federal grants and Medicaid would increase funding.
Critics of the big-facility approach to mental health argue that Mississippi spends far more on mental health than comparable states for inferior treatment. One critic told me that if Mississippi eliminated the Department of Mental Health and made it an adjunct of the Department of Medicaid, both the taxpayers and the mentally ill would be better off.
The irony here is that most of the mentally ill are in prisons, not the large mental health facilities. If you close the mental hospitals without properly developing community-based programs, even more mentally ill people will be in prisons or on the streets.
Sitting through the trial, it was hard to imagine just 154 years has passed since Mississippi fought the United States with guns and guts on the battlefield. Now, instead of blood, sweat and tears, it was a war of words, with both sides using logic and evidence to make their case to U.S. District Judge Carlton Reeves. The air conditioner worked flawlessly. This is progress.
This is not the first such legal battle between Mississippi and the United States. Similar lawsuits are being fought over the handling of Child Protective Services and our prison system.
True to our rebellious heritage, the state of Mississippi has fought the feds tooth and nail, creating millions in legal fees for those firms lucky enough to get the contract.
So my question is this: Why did the Department of Mental Health not settle this lawsuit and welcome whatever assistance they can get from the federal experts? Almost every other state settled. Mississippi didn’t. Surrender? Hell no!
In a settlement, the top honchos at the Department of Mental Health would have to engage federally recommended experts to hasten the path toward community-based mental health services.
Usually, these experts are non-profit organizations dedicated to improving the mental health services. That doesn’t sound too horrible.
DMH is a strange agency to begin with. It is an independent agency with its own staggered board. There is little oversight from the Legislature or our state’s executive branch. It could probably use some help.
How are the feds even involved? It all stems from the American Disabilities Act of 1990, signed by the first George Bush. That act designated mental illness as a disability, which must be treated in the “least restrictive environment,” according to the U.S. Supreme Court’s 1999 Olmstead ruling. Twenty years later, a small army of U.S. Justice Department attorneys are suing states to comply.
Regan Rush made the closing argument for the feds. “The Medicaid 1915(i) program has been available to Mississippi since 2016. Why the state has failed to use the money is an unsolvable mystery,” she said.
“The Mississippi Department of Mental Health could encourage community-based providers to increase use of Medicaid and other federal funding services. State hospitals should be used only as a last resort.”
Rush said, “There is overwhelming evidence that Mississippi has discriminated against thousands of mentally ill citizens. The time to leave Mississippi to its own devices has passed.”
Reuben Anderson of the Phelps Dunbar law firm spoke in defense of Mississippi.
“To ask the state with the lowest per capita income to achieve what the highest per capita income states have failed to achieve makes no sense,” Anderson said. “Mississippi is deinstitutionalizing responsibly. We ask the court to allow Mississippi to continue to downsize responsibly.”
Phelps Dunbar attorney Jim Shelson defended DMH, saying, “What we are really arguing about is the pace of change. There is no clear definition of what DOJ wants Mississippi to do.”