When Betty Sue O’Brian picked up the phone in June and heard a nurse from a crisis unit in Laurel on the other end, her heart sank. Her brother Doug had been admitted to the unit and, the nurse explained, after a few days on medication, staff had decided he was stable enough for release. The nurse told O’Brian she’d have to find him a new place to live by the end of the week.
Doug, 73, is a Mississippian with mental illness. For 50 years, he has cycled through state facilities and group homes, his illness and its violent outbursts burning bridges between him and anyone who’s tried to care for him along the way.
This happened most recently in May, at a group home in Purvis. After 18 months of deteriorating mental health, Doug had lashed out at the man running the home and found himself in Laurel’s crisis stabilization unit. And now, one week into his stay, a nurse was telling O’Brian that if she didn’t find staff would drop him off at the closest Salvation Army, making him effectively homeless.
“They said he’s not placeable anymore,” said Doug’s other sister, Pat Abernathy. “Nobody with his record can get in a (group) home, so they’re going to have to put him on the street.”
Like many Mississippians with a severe mental illness, Doug’s life has been a rotation through state mental health facilities. His sisters – who asked that his last name not be printed out of fear that their criticism of the state mental health system might result in retaliation against Doug – say they’ve lost count of his trips to group homes, crisis stabilization units and state hospitals.
Cases like Doug’s are part of the reason the federal Department of Justice is currently suing Mississippi over its mental health care system. Wednesday marked the twelfth day of a trial in U.S. District Court that is projected to stretch into mid-July. The federal government is accusing the state of either warehousing patients in its state hospitals or turning them out on the street with few resources, setting up a cycle where, like Doug, patients bounce between temporary housing, institutions and short-term treatment centers.
“This is not a case of people falling through the cracks. This is a case of thousands of people falling through the gaping holes in the state system,” said Deena Fox, an attorney for the Department of Justice, in her opening statement.
The crisis stabilization unit that took Doug in is operated by one of Mississippi’s community mental health centers, which provide mental health care to patients outside those state hospitals and institutions. But CSUs, as they’re known, are designed as short-term solutions, a way to get a patient having a mental health crisis stabilized in a couple of weeks.
“(The staff) told me they needed the beds for someone else,” O’Brian said. “I said do you have a social worker who can help him with this and (the nurse) said no.”
The Department of Mental Health, which oversees community mental health centers, did not answer whether the agency had policy in place to keep patients from becoming homeless. However, Director of Communications Adam Moore said O’Brian should reach out to the agency’s Office of Consumer Report which he said works “to resolve grievances related to access to services and service provision.”
The state for its part hasn’t denied that significant gaps in support exist. Mississippi is instead asking the judge to let Mississippi fix its system on its own timetable.
“A win for Mississippi in this case is simply this: time to finish the job,” said James Shelson, a private attorney representing the state.
Some patients, however, are running out of time.
Doug’s health is poor. In addition to a mental illness that seems to change diagnosis depending on where he’s being treated, he has a severe limp and emphysema, both collateral damage from his struggles with mental health.
“And I’m thinking, “Oh lord, my brother is about to be stuck out on the street and can’t walk and can’t breathe,” O’Brian said.
Although neither of Doug’s sisters can recall how many trips Doug has made to the Mississippi State Hospital, Abernathy does remember Doug’s first trip there, shortly after Doug’s 22nd birthday, back when it was known simply as “Whitfield.”
The paranoid delusions that started in college had culminated in a days-long hallucination that rats were chasing him. At one point, he grabbed a gun and climbed up a tree in his mother’s yard, shooting indiscriminately and refusing to come down.
That first trip to Whitfield lasted over a year. But he responded well to medication and his treatment plan and when he emerged, a year later, he seemed better. Outside the hospital, though, Doug struggled to keep a routine. Eventually he stopped taking his medication and a year or so later he was back at Whitfield — beginning the cycle that would define the next five decades of his life.
Doug’s sisters were cautiously optimistic about his last group home in Purvis. O’Brian said Jerry, the man who ran it, would go out of his way for Doug, picking up things he needed and running errands with him. And at 18 months, it was the longest Abernathy can remember Doug staying anywhere outside a state institution.
But Doug didn’t like that other residents also got Jerry’s attention. When he again stopped his medication, tensions in the home escalated.
“He’s difficult. He’s not an easy patient,” Abernathy said. “I don’t know what’s going to happen to poor Doug. We try to talk to him and say, ‘You’ve got to be good. You can’t get kicked out again. But he can’t help it.”
“We try to have him committed but that doesn’t do any good. He’s out in what, two weeks? Ever since the government passed their law it’s been a nightmare.”
Olmstead, the law Abernathy is referencing, forms the foundation of the Department of Justice’s lawsuit against Mississippi. In 1999, the U.S. Supreme Court ruled that relying almost exclusively on state hospitals for mental health care — as Mississippi and other states were doing — stigmatized and isolated patients, violating the Americans with Disabilities Act. As a result, the federal standard shifted to let patients receive care while living in their own communities.
The Justice Department alleges that not only did Mississippi wait until just a few years ago to begin transferring patients out of hospitals – it did so without building a proper community-based system. Instead of the alternative to hospital care being community care, as intended, it became little or no care at all.
For Doug, according to O’Brian and Abernathy, this meant that six-month stays that would treat Doug through ongoing periods of crisis became two-week trips. In between, he went to group homes, and when that hasn’t worked, he’s fended for himself. One time he took up residence in an empty storage unit. Another time, they found him up in Memphis, frostbitten and wandering the streets.
“It’s disgusting,” Abernathy said. “They have put Doug out so many times without any medicine or money. They just turn him out.”
Expert testimony in the trial has returned again and again to one of the pillars of this system known in Mississippi as Programs of Assertive Community Treatment. These teams deploy specialists in a range of areas—such as psychology and medication, housing and employment assistance—to help severely mentally ill patients get stabilized and avoid recommitment to hospitals.
“It decreases the risk of hospitalization,” said Dr. Carol Vanderzwaag, an expert witness on community mental health care for the Department of Justice. “A PACT team is not going to let someone disappear from treatment for any period of time. If they’re hard to find you’re going to figure out what’s happening with them.”
Doug has often responded well to structure, Abernathy said. In high school he flourished and a coach recruited him to the basketball team. Later, after he became ill, he had a brief period of stability around 2004. With regular check-ins from a social worker, he got his own apartment and a truck. He stayed on his medication.
“But then Katrina hit,” O’Brian said. “The apartment — everything — fell apart.”
Neither O’Brian nor Abernathy said they’ve heard of Mississippi’s PACT teams and said Doug has never been connected with services like that, even though Harrison is one of the just 18 counties in Mississippi that has PACT access.
But O’Brian said she’s not sure a PACT team would even work for Doug now. She said at this point he probably needs to be in an institutional setting.
“He’s not going to get back to being a normal citizen after all these years of institutionalization. He’s not going to be a productive member of society,” O’Brian said.
In some ways, though, she acknowledges that Doug is lucky. At least he has family willing to invest time and resources into finding him a place to stay. Without them, Abernathy is matter-of-fact: “He would have probably died by now on the streets.”
On Monday, she received a call from the crisis center. They had found Doug a place in a personal care home. The person explained it as a step up from a group home. Here Doug would have a nurse to administer his medication.
But O’Brian said she knows this is just a temporary stop for Doug, not a full solution.
“It’s pretty much what has been going on his whole life, so depending on how long his life is, I’m pretty sure he will go back to another hospital. I’m pretty sure it will happen again.”
Editor’s note: This article is part of Mississippi Today’s ongoing coverage of the U.S. Department of Justice’s lawsuit alleging Mississippi’s mental health system violates the Americans with Disabilities Act. Readers can share their stories with Mississippi Today by emailing us at firstname.lastname@example.org.