Mississippi Today
A new Mississippi law aims to limit jailings of people awaiting mental health treatment. Is it working?
Officials say a new law to decrease the number of people being jailed solely because they need mental health treatment has led to fewer people with serious mental illness detained in jails – but the data is contradictory and incomplete.
A state agency, counties and community mental health centers – all of which have roles in carrying out the new law – reported vastly different numbers of people who spent time in jail during the civil commitment process during the first three months the law was effective.
Community mental health centers reported that 43 people were jailed from July to September 2024, less than half the number the Department of Mental Health reported: 102 people. And the department’s figure is likely an underrepresentation, because it only documents people who were later admitted to a state hospital – meaning the figure does not include people who were jailed before they were released or received treatment elsewhere.
Department of Mental Health spokesperson Adam Moore told Mississippi Today he couldn’t explain the discrepancy.
Counties’ reporting of commitment data has been patchy since lawmakers mandated chancery courts to report psychiatric commitment data to the state in 2023. Only 43 of Mississippi’s 82 chancery court clerks complied and submitted the most recent report. Those counties reported a total of 25 people being held in jail during the same period while in the civil commitment process.
Six counties – Alcorn, Choctaw, Holmes, Issaquena, Kemper and Sharkey – have never reported the data to the state. Only Choctaw County Chancery Clerk Steve Montgomery responded to Mississippi Today’s inquiries as to why, saying he was not aware the court had not reported the data.
“It’s been inconsistent. It’s been sometimes just absent in different parts of the state,” said Rep. Sam Creekmore IV, a Republican from New Albany who chairs the Public Health and Human Services Committee. “And so it’s really hard for us to evaluate how well or how bad we’re doing when the numbers aren’t consistent.”
Creekmore sponsored changes to Mississippi’s civil commitment law in 2024 and reporting requirements in 2023. He said he plans to propose legislation this year that would ensure more counties submit mandatory data.
“It really makes it impossible to legislate changes to (the new civil commitment laws) when our data is not complete,” he said.
After changes to the civil commitment law passed last year, Creekmore said the Department of Mental Health would “police” counties to ensure compliance. But the agency told Mississippi Today and ProPublica it would educate county officials and mental health workers on the new law, but wouldn’t enforce it.
The Department of Mental Health sends quarterly reminders to clerks about reporting deadlines, has provided access to training videos, written instructions and established a help desk for technical questions, said Moore, the agency’s spokesperson.
The state Legislature approved changes to the state’s civil commitment law in May after Mississippi Today and ProPublica reporting revealed that hundreds of people with no criminal charges were held in Mississippi jails each year as they awaited involuntary mental health evaluation and treatment. They frequently received no mental health care in jail and were treated like criminal defendants.
The new law went into effect in July 2024. Now, local community mental health center staffers screen people who are reported to be a potential danger to themself or others before they are taken into state custody and must note why a less restrictive treatment is not an option. A person cannot be held in jail unless all other options for care have been exhausted, they are “actively violent” and never for more than 48 hours.
The new law also requires that people in crisis see mental health professionals first. The screeners can recommend commitment or suggest voluntary treatment options that are more suitable, avoiding the civil commitment process entirely.
Over 500 people were diverted to a less restrictive treatment than civil commitment, and 1,330 screenings for commitment by mental health professionals were conducted statewide during the first three months after the new law took effect, according to community mental health center reports.
Wait times in jail for people who have been ordered to be admitted to a state hospital by a judge decreased by a day and a half in a year, said Moore, but the agency does not know how long people wait in jail before a judge orders commitment.
“I think this was the most sweeping change they’ve made since I’ve been in office,” said Butch Scipper, who has served as the chancery clerk of Quitman County since 1992, of the new law.
He, like many other chancery court judges, sheriffs and mental health professionals, have lauded the policy for weaning Mississippi off its longstanding dependence on jails to house people with severe mental illness awaiting treatment at the state hospital.
Most states do not regularly hold people in jail without charges during the psychiatric civil commitment process. At least 12 states and the District of Columbia prohibit the practice entirely. And only one Mississippi jail was certified by the state to house people awaiting court-ordered psychiatric treatment in 2023.
Sheriffs, who have long decried the burden of housing people with mental health concerns in jails as inappropriate and unsafe, have been largely supportive of changes to the law.
“It’s fantastic for the sheriffs, because the sheriffs don’t want people that are sick in the jail,” said Will Allen, the attorney for the Mississippi Sheriffs Association. “They certainly don’t want people who have not committed a crime in the jail.”
Challenges with implementation
Implementing the law has proved challenging for areas of the state with limited resources, particularly those without nearby crisis stabilization units, which provide short-term treatment to people in psychiatric crises.
And even in well-resourced areas, limited crisis beds can force counties to transport patients or house them in a nearby private treatment facility at their own expense.
Community mental health centers, which run the state’s crisis stabilization units, reported this happening 114 times due to limited bed or staffing capacity between July and September 2024.
There are 14 state-funded crisis stabilization units with 204 beds – up from 180 last year – across the state.
The restrictions on housing people in jail have proved to be a “nightmare” for Calhoun County, which is more than 30 miles away from the nearest crisis stabilization unit, said Chancery Clerk Kathy Poyner.
“We don’t have anywhere else to put them,” she said. “We can’t afford a psychiatric cell. Rural counties just can’t meet the financial obligations.”
Law enforcement officers are legally responsible for transporting patients. But some counties argue this can be costly and time consuming for their officers.
The state’s crisis stabilization unit beds were never all full during fiscal year 2024, said Adam Moore, spokesperson for the Department of Mental Health. “There is always an open CSU bed somewhere in the state if a sheriff is willing to transport a person,” he said.
Creekmore said he also hopes to introduce a bill for a pilot transportation program that would offset the costs of transporting patients to mental health treatment. The program would be modeled after a similar one in Tennessee.
The Department of Mental Health has provided additional funding to community health centers for mental health screening, crisis stabilization units, mobile crisis response teams and court liaisons, but does not fund transportation by law enforcement officers.
Being responsible for transportation rather than jailing people is a good deal for sheriffs, said Allen, because the costs of transportation pale in comparison to the liability risks of holding someone experiencing an acute mental health crisis in jail.
“That was sort of the tradeoff,” he said. “They’re not going to be in jail, but (law enforcement is) going to have to take them places.”
Some counties have explored other solutions, like establishing crisis stabilization units closer to home.
DeSoto County will open a 16-bed stabilization unit in Hernando this year, said County Supervisor Lee Caldwell. Funding the new facility quickly in the wake of the new law was challenging but necessary because the county is a significant distance from the nearest crisis centers, she said.
Some advocates say the law’s stipulations should be more stringently supervised by the state.
The law includes no provisions to ensure that counties detain only people who meet the law’s stringent requirements – there are no other options and the person is “actively violent” – and do not hold people longer than 48 hours.
Greta Martin, the litigation director for Disability Rights Mississippi, said the lack of oversight in the law is concerning.
“If you are enacting legislation with a 48-hour cap on people being held in county jail and you do not provide any oversight ensuring that county jails are adhering to that, what’s the point of the legislation?” she said.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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Mississippi Stories: Chris Lockhart of Capital City Kayaks
In this episode of Mississippi Stories, Mississippi Today Editor-at-Large Marshall Ramsey took a tour of one of the best kept secrets in Jackson with Chris Lockhart of Capital City Kayaks. What started as a hobby to explore the green side of the capital city has turned into a family-fun spot for tourists and Jacksonians alike.
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This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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Mississippi Today
Lawmakers must pass new legislation to improve access to prenatal care
Lawmakers will file another bill this session to help low-income pregnant women get into the doctor earlier – after the federal government rejected the program set up under last year’s law.
The implementation of the program has been delayed for months as a result of the discrepancy between what was written into state law and federal regulations for pregnancy presumptive eligibility.
Rep. Missy McGee, R-Hattiesburg, told Mississippi Today she will file a bill before next week’s deadline.
“It’s a priority to get pregnant women into the doctor as early as possible,” said McGee, who authored last year’s bill and chairs the House Medicaid committee. “The goal is the same, the priority for us is the same.”
The problem with the 2024 legislation is that it included a proof of income requirement – meaning patients would need to bring paystubs into the doctor’s office – which the Centers for Medicare and Medicaid Services, the federal agency responsible for approving the state plan, does not allow. Although the law is intended for low-income individuals, the federal government maintains that vocal testimony should suffice.
Federal guidelines state that while the agency may require proof of citizenship or residency, it should not “require verification of the conditions for presumptive eligibility” – which are pregnancy and income.
McGee said she will be taking out the proof of income requirement. The proof of pregnancy requirement is null, she said, since doctors would be able to see pregnancy during the first visit.
The law presumes certain low-income pregnant women as eligible for Medicaid, and allows them to receive treatment right away at no cost to them while their official Medicaid application is pending. This interim coverage only lasts 60 days, at which point the Division of Medicaid will typically have approved or denied their application, according to average application processing times.
The policy will cost roughly $567,000 and could cut down on the number of premature infants who end up in the intensive care unit, where the state might pay up to $1 million caring for a single baby. Mississippi has the nation’s highest rate of preterm birth, which adequate prenatal care has been proven to mitigate.
Advocates argue that the mandatory documentation is just another burden on pregnant women already facing socioeconomic barriers to health care.
Officials with the Mississippi Division of Medicaid said several times throughout the summer and fall that they were in negotiations with the federal government to work out the problem with state law.
Matt Westerfield, spokesperson for the Division of Medicaid, confirmed that the agency could not work out with the federal government the proof of income requirement state lawmakers wrote into the law.
McGee said the easiest solution is to draft new legislation. She is hopeful that the policy will garner the same overwhelming support this year that it had from lawmakers in both chambers last year.
“We do not believe that the changes do any harm to our objective, so we are willing to make these changes,” McGee said. “And really, I think it’s been helpful for the Division of Medicaid to have these in-depth conversations [with CMS] so we have a better idea of what CMS is looking for.”
The House passed the law 117-5 last year, and the Senate passed it 52-4.
The deadline to file bills is Jan. 20. McGee says she hopes to push the bill through the Legislature early on this year – as she did last year. In 2024, it was sent to the governor less than halfway through the session.
Thirteen providers were approved to participate in the policy in 2024, including the University of Mississippi Medical Center – the state’s largest Medicaid provider.
In addition to negotiating with CMS and accepting provider applications, the Division of Medicaid also conducted several provider training sessions throughout the fall.
Westerfield was not able to comment on whether the approved providers would be automatically enrolled in 2025 or whether they would need to reapply. He also declined to comment on whether the implementation process would be streamlined the second time around.
Other than minor changes to income verification, everything in this year’s bill will stay the same as last year.
An expectant mother would need to fall under the following income levels to qualify for presumptive eligibility in 2025:
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1963
Jan. 14, 1963
On the same portico of the Alabama Capitol in Montgomery where Jefferson Davis was sworn in as president of the Confederacy, Alabama Gov. George Wallace delivered his inaugural address, telling the crowd, “In the name of the greatest people that have ever trod this earth, I draw the line in the dust and toss the gauntlet before the feet of tyranny, and I say segregation now, segregation tomorrow, segregation forever!”
Asa Carter, a member of the Ku Klux Klan, wrote his speech, which made national headlines and thrust Wallace into the national spotlight.
Seven months later, Martin Luther King Jr. responded to that speech, saying, “I have a dream that one day, down in Alabama, with its vicious racists, with its governor having his lips dripping with the words of ‘interposition’ and ‘nullification’ — one day right there in Alabama little black boys and black girls will be able to join hands with little white boys and white girls as sisters and brothers.”
Before his death, Wallace called his most famous phrase “his biggest mistake.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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