Morning Zen

Mississippi Policymakers Are Beginning to Address the Problem of Overreliance on Institutional Care in the Mental Health System

January 07, 2018

Morning Zen Guest Blog Post ~ Joy Hogge, Ph.D. ~

The rest of the story…. words that rang through my mind as I read “Doing Less with Less: Mental Health Care in Mississippi” “ a Pro Publica article written by Sarah Smith. Ms. Smith provides a snapshot of Mississippi’s mental health care system characterized by a dearth of qualified providers, policymakers divided along political lines, and crippling funding cuts.

To actually experience Mississippi is much more like a being in a movie than in a snapshot: a movie with an unknown ending, filled with unexpected plot twists and very human characters who cannot be easily divided into good and evil.

I know. I have lived in Mississippi for 23 years. For 17 of those years, I have raised a wonderful son who I am not sure has ever gotten the types of services and supports I wish he had. For the last six years, I have been the executive director of Families as Allies, the state chapter of the Federation of Families. Every day I work with families across the state who also struggle to find what they want for their children.

Mississippi often lives up to its stereotypes. It is the poorest state in the union. Corruption scandals occur with eerie regularity. It had the highest rate of slave ownership, and institutional racism permeates almost all of its nooks and crannies. It staunchly defends states’ rights and resists federal intervention, yet for every tax dollar it sends to the federal government, it gets $2.34 in return.

Some days I hate Mississippi. Some days it makes me want to tear my hair out. But every day I love the people. The resiliency, the gut-level honesty, and the sense of community are hard to describe but very real to experience.

To truly understand Mississippi, one must fully accept its paradoxes, strengths and bitter truths. To do otherwise risks responding to a snapshot that only captures a moment in time, but does not provide the necessary depth and context to grasp the state’s reality.

Any issue in Mississippi’s mental health system must be viewed in this context: in spite of its strapped resources, Mississippi spends disproportionately more on institutional care than almost any other state in the country.

Most states have moved the majority of their services to the community, recognizing that people with mental illness do better when they can work, go to school and be with their family and friends while they receive care. Arkansas, very similar to Mississippi in demographics and geography, has done just this and now has only one state-run facility for people with mental illness. Mississippi has six state-run facilities, all of which remain open even as the number of beds within them shrink.

This begs the question: Why is Mississippi so reliant on institutional care at the expense of providing more services in the community? As a state, we need to both honestly examine who is most benefiting from such a system and also face some hard facts:

  • Mississippi didn’t close, and even continued to build, state-run psychiatric institutions after all states were federally mandated in 2000 to develop a plan to transition people in facilities to the community. 

  • The number and location of the state-funded facilities means that almost all state elected officials have a fair number of constituents with a vested interest in those facilities. 

  • The Mississippi Department of Mental Health remains one of the largest employers of State employees and historically has been very effective at mobilizing employees to contact legislators when institutional funding is threatened. 

  • Medicaid funding, which contributes three federal dollars for every state dollar spent, is not maximized to help people with mental illness live in the community and assist with our budget shortfalls; instead, state dollars that cannot be matched are used to fund facility-based care.

  • The Justice Department is suing Mississippi for unlawfully segregating people with mental illness in institutions, a suit that is likely to be prolonged and expensive, with no guarantee that it will result in improved services.

  • Over-reliance on institutional care makes it more difficult for people such as Tyler Haire, whose tragic story Ms. Smith describes in a related article, to get beds in facilities because resources are already deployed to support people who could likely be served in less restrictive settings.

It was within this complicated context that the legislative funding cuts that Ms. Smith described occurred. It should also be noted that in the same 2017 legislative session, two taxpayer-funded assessments of our mental health system that were completed as a result of negotiations with the Justice Department finally became available to legislators after a two-year battle to make them public. Those reports had implications for the services, structure, and funding of the mental health system. To simply propose restoring funds to our system without addressing the systemic reform needed is short-sighted.

The good news, and the rest of the story – perhaps the real story – is that Mississippi policymakers began addressing the systemic reform needed after the difficult conversations that began in the last legislative session. Governor Phil Bryant, a self-described conservative Republican, came forward to meet with families from our organization. Lt. Governor Tate Reeves, another conservative Republican, made public statements about the importance of everyone being able to live in the community. Attorney General Jim Hood, the only statewide elected Democrat, formed a bipartisan mental health task force. Legislators from both sides of the aisle began talking about community-based care. The board and executive leadership of the Department of Mental Health reached out to groups they hadn’t traditionally partnered with, including Families as Allies, and also started in earnest to look at ways to move funds to the community.

It feels like a transformative start, but right now it is just a start. All of these leaders need to put aside their political interests to come together with each other, with people receiving services and their families, and with everyone else who wants to be at the table to look at how we create a truly responsive system of care in Mississippi. They also need to delve into the already available recommendations and consultant reports that describe how to do this.

After needed reform is determined and planned for, we can then look at the type and amount of funding needed to support such a system. Engaging in funding battles and questions outside of the context of system reform, or allowing others to put us in that positon, simply places us back in the same battle stances we’ve hidden behind for far too long. We need to put aside our partisan wrangling and demand transparency and accountability from our elected leaders, the media, and each other.

Governor Bryant began his meeting with families by saying the reason we were there was because he “didn’t want to go to any more funerals” of children who died from overdoses or suicide. All of our conversations about mental health need to be driven by the importance of each and every life while still acknowledging our difficult history, the challenges we face, and the need to work together across the aisle and beyond our familiar battlefields.

We owe that to Tyler Haire, and to every child and every adult in Mississippi affected by mental illness.

joyJoy Hogge has been the executive director of Families as Allies since 2011. She has a seventeen-year-old son who has managed a life-threatening medical condition since he was three. Together they have traversed different systems and challenges and learned a lot about self-advocacy and their love and trust for each other along the way. She is particularly interested in policy and system change that supports and engages as many families as possible. She serves on the boards of the National Federation of Families and the Family Run Executive Directors Leadership Association. Before she was a mom, she was a licensed psychologist and will be forever grateful to the families who patiently taught her about family-driven care as she did that work.

Families as Allies is the only statewide organization in Mississippi run by and for families of children with mental health challenges. Families as Allies’ mission is to make sure families are partners in their children’s care. We support each other and work together to make things better for our children. Our core values define us. We value every child and family, excellence, partnership, and accountability. Our work is built on three pillars: supporting families, supporting community and supporting positive change.

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