Mississippi Today
Mississippi’s troubled mental health system shows signs of repair, report says
Mississippi’s troubled mental health system shows signs of repair, report says
Fewer Mississippians in mental health crises are stuck waiting in jail cells for a hospital bed each day than they were a year ago, but the state has yet to eliminate the troubling practice completely, according to a new report.
The latest data available shows that from December to mid-January, an average of 23 people in crisis waited for a hospital bed each day. Eight of those waited in jail, despite not being charged with any crime.
Those numbers were much higher not long ago: In the first quarter of this fiscal year, which started in July, an average of 72 people waited for a bed with 24 in a jail cell each day. Similar numbers had been reported for the prior fiscal year.
“The scope of progress is substantial,” wrote Dr. Michael Hogan, the author of a court-mandated biannual report on the state of Mississippi’s mental health system. “But the work is not complete, and some conditions remain that should satisfy no one.”
Hogan’s report comes as the result of a 2016 lawsuit filed against the state by the U.S. Department of Justice. A judge sided with the federal government in 2019, finding the state had violated the Americans with Disabilities Act by separating people with mental illness in hospitals from their homes and families. Hogan, a former New York State Commissioner on Mental Health, is now tasked with writing the twice-yearly reports on the state’s compliance with the lawsuit’s consent agreement as a court monitor.
Ultimately, the report found DMH was compliant or in partial compliance with all key issues pointed out in the agreement.
“The Mississippi system could fairly be described as the most unbalanced state system in terms of preferences for institutional care in the country,” Hogan wrote, referring to alarming issues in patient care first documented by the DOJ in 2011. “As this report is being written, a decade of attention means this imbalance in care has been substantially addressed.”
Late in 2022, DMH reopened a 30-bed unit at East Mississippi State Hospital that had been closed because of staffing shortages. A closed 20-bed unit at Mississippi State Hospital was reopened in January. The added beds contributed to keeping people with mental illness out of jail cells.
Patient counts that the department supplied to Mississippi Today show the number of people waiting in jail for a state hospital bed has been steadily declining for months.
“This is not a small undertaking and is due to the unwavering dedication of an incredible team of staff at DMH Central Office, the four state hospitals, and community mental health centers who strive daily to improve the state’s system of care,” the department’s Executive Director Wendy Bailey told Mississippi Today in a statement, “and to state leaders and legislators who are supporting and funding the efforts.”
The latest report, the third ever, was published this week and charted much of the Mississippi’s Department of Mental Health’s progress in care access across the state. However, lingering staffing retention troubles, data collection and use, patient outreach and communication issues, and jail stays remain sore points in need of improvement, according to Hogan’s report.
When community mental health centers were created 40 years ago – each with their own designated region – they operated with little oversight from the DMH, which focused on running state hospitals. As a result, statewide mental health care was often disjointed or inconsistent.
Hogan’s report studied discharge documentation to better understand how often patients across the state were getting intervention to lessen the likelihood they hit a severe crisis point again requiring inpatient treatment.
While entering inpatient treatment can help stabilize severe mental illness, it doesn’t cure it, Hogan points out. Follow ups are needed to prevent relapses and readmission. Hogan and his team found that community mental health centers contacted a hospitalized client, while the individual was in the hospital, at a rate of 45%.
He said “lukewarm success” in establishing relationships while people are still hospitalized makes impacts whether they attend a follow-up appointment after discharge. The overview found that initial visits were completed in 59 of 89 incidents they could track – about 66%. The rate of follow-up and engagement efforts were adequate in 56 of 87 cases they could track – or 64%.
“Some Regions do a good job on some elements and all do a good job some of the time,” Hogan wrote. “But consistency is lacking.”
Workers like peer support specialists who help contact patients after discharge are often paid at or below what a fast food worker can make, Hogan pointed out. The staffing shortages among these roles were higher than that of other vacancies, such as registered nurses and therapists.
Bailey acknowledged the same hardships but hopes average annual salaries for those support staff positions reach $30,000 by fiscal year 2025. The department has asked the legislature for more funding to help raise wages and improve retention rates.
“We are not only dealing with competition from the private sector, we are dealing with burnout from staff dealing with patients who require 24/7 care who have significant mental and behavioral challenges,” Bailey said in her statement.
Hogan’s first report, issued in March, described Mississippians sometimes waiting weeks in jail for a bed at a state hospital. He also found that some people admitted to state hospitals did not have a serious mental illness – meaning the hospital wasn’t the right place for them and they were occupying a bed that could have been used by someone else.
In his second report, he surveyed North Mississippi State Hospital and community mental health centers in the northern part of the state and did not find patients admitted without a serious mental illness diagnosis.
Bailey said that DMH expects to also see more positive results from people now working as court liaisons who help staff identify community treatment options. The department has also grown programs that provide transitional housing, supported employment and community outreach over the last several years.
Recently the agency began fidelity monitoring, or progress monitoring, of its mobile crisis teams, another positive step Hogan recognized.
“Are there improvements still to be made?” Bailey posed, reflecting on state’s mental health system. “Yes.”
“Has progress been accomplished? Absolutely.”
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1997
Dec. 22, 1997
The Mississippi Supreme Court upheld the conviction of white supremacist Byron De La Beckwith for the 1963 murder of Medgar Evers.
In the court’s 4–2 decision, Justice Mike Mills praised efforts “to squeeze justice out of the harm caused by a furtive explosion which erupted from dark bushes on a June night in Jackson, Mississippi.”
He wrote that Beckwith’s constitutional right to a speedy trial had not been denied. His “complicity with the Sovereignty Commission’s involvement in the prior trials contributed to the delay.”
The decision did more than ensure that Beckwith would stay behind bars. The conviction helped clear the way for other prosecutions of unpunished killings from the Civil Rights Era.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
Medicaid expansion tracker approaches $1 billion loss for Mississippi
About the time people ring in the new year next week, the digital tracker on Mississippi Today’s homepage tabulating the amount of money the state is losing by not expanding Medicaid will hit $1 billion.
The state has lost $1 billion not since the start of the quickly departing 2024 but since the beginning of the state’s fiscal year on July 1.
Some who oppose Medicaid expansion say the digital tracker is flawed.
During an October news conference, when state Auditor Shad White unveiled details of his $2 million study seeking ways to cut state government spending, he said he did not look at Medicaid expansion as a method to save money or grow state revenue.
“I think that (Mississippi Today) calculator is wrong,” White said. “… I don’t think that takes into account how many people are going to be moved off the federal health care exchange where their health care is paid for fully by the federal government and moved onto Medicaid.”
White is not the only Mississippi politician who has expressed concern that if Medicaid expansion were enacted, thousands of people would lose their insurance on the exchange and be forced to enroll in Medicaid for health care coverage.
Mississippi Today’s projections used for the tracker are based on studies conducted by the Institutions of Higher Learning University Research Center. Granted, there are a lot of variables in the study that are inexact. It is impossible to say, for example, how many people will get sick and need health care, thus increasing the cost of Medicaid expansion. But is reasonable that the projections of the University Research Center are in the ballpark of being accurate and close to other studies conducted by health care experts.
White and others are correct that Mississippi Today’s calculator does not take into account money flowing into the state for people covered on the health care exchange. But that money does not go to the state; it goes to insurance companies that, granted, use that money to reimburse Mississippians for providing health care. But at least a portion of the money goes to out-of-state insurance companies as profits.
Both Medicaid expansion and the health care exchange are part of the Affordable Care Act. Under Medicaid expansion people earning up to $20,120 annually can sign up for Medicaid and the federal government will pay the bulk of the cost. Mississippi is one of 10 states that have not opted into Medicaid expansion.
People making more than $14,580 annually can garner private insurance through the health insurance exchanges, and people below certain income levels can receive help from the federal government in paying for that coverage.
During the COVID-19 pandemic, legislation championed and signed into law by President Joe Biden significantly increased the federal subsidies provided to people receiving insurance on the exchange. Those increased subsidies led to many Mississippians — desperate for health care — turning to the exchange for help.
White, state Insurance Commissioner Mike Chaney, Gov. Tate Reeves and others have expressed concern that those people would lose their private health insurance and be forced to sign up for Medicaid if lawmakers vote to expand Medicaid.
They are correct.
But they do not mention that the enhanced benefits authored by the Biden administration are scheduled to expire in December 2025 unless they are reenacted by Congress. The incoming Donald Trump administration has given no indication it will continue the enhanced subsidies.
As a matter of fact, the Trump administration, led by billionaire Elon Musk, is looking for ways to cut federal spending.
Some have speculated that Medicaid expansion also could be on Musk’s chopping block.
That is possible. But remember congressional action is required to continue the enhanced subsidies. On the flip side, congressional action would most likely be required to end or cut Medicaid expansion.
Would the multiple U.S. senators and House members in the red states that have expanded Medicaid vote to end a program that is providing health care to thousands of their constituents?
If Congress does not continue Biden’s enhanced subsidies, the rates for Mississippians on the exchange will increase on average about $500 per year, according to a study by KFF, a national health advocacy nonprofit. If that occurs, it is likely that many of the 280,000 Mississippians on the exchange will drop their coverage.
The result will be that Mississippi’s rate of uninsured — already one of the highest in the nation – will rise further, putting additional pressure on hospitals and other providers who will be treating patients who have no ability to pay.
In the meantime, the Mississippi Today counter that tracks the amount of money Mississippi is losing by not expanding Medicaid keeps ticking up.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
Mississippi Today
On this day in 1911
Dec. 21, 1911
Josh Gibson, the Negro League’s “Home Run King,” was born in Buena Vista, Georgia.
When the family’s farm suffered, they moved to Pittsburgh, and Gibson tried baseball at age 16. He eventually played for a semi-pro team in Pittsburgh and became known for his towering home runs.
He was watching the Homestead Grays play on July 25, 1930, when the catcher injured his hand. Team members called for Gibson, sitting in the stands, to join them. He was such a talented catcher that base runners were more reluctant to steal. He hit the baseball so hard and so far (580 feet once at Yankee Stadium) that he became the second-highest paid player in the Negro Leagues behind Satchel Paige, with both of them entering the National Baseball Hame of Fame.
The Hall estimated that Gibson hit nearly 800 homers in his 17-year career and had a lifetime batting average of .359. Gibson was portrayed in the 1996 TV movie, “Soul of the Game,” by Mykelti Williamson. Blair Underwood played Jackie Robinson, Delroy Lindo portrayed Satchel Paige, and Harvey Williams played “Cat” Mays, the father of the legendary Willie Mays.
Gibson has now been honored with a statue outside the Washington Nationals’ ballpark.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
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