When Travis Patten became Adams County’s sheriff in 2016, he never thought he would be thrust into the role of social worker, fielding calls from desperate families looking for help for loved ones having a mental health crisis.
“When a family member calls me, they are at their wits end with whatever is going on with their loved one, and they have nowhere else to turn but me, so I have to do something, but I need help, too,” Patten said.
Patten is one of numerous law enforcement officers in Mississippi and around the country on the frontlines of psychiatric care, whose resources are stretched due to inadequate mental health treatment and support for people with serious mental illnesses.
Mississippi’s Department of Mental Health data show that almost 91,000 Mississippians experienced a serious mental illness in 2017 that interfered with their life activities
A significant number of these individuals are trapped in a dysfunctional mental health system that deprives them of their civil rights and shuffles them from jails to psychiatric hospitals to homeless shelters or leaves them on the streets, according to the U.S. Department of Justice, which has prevailed in a lawsuit against the state over its treatment of people with mental illness.
On Sept. 4, U.S. District Court Judge Carlton Reeves rendered a defeat to state officials in the lawsuit filed in 2016.
In his ruling, Reeves said, the state’s failure to provide adequate community-based services has resulted in the unnecessary commitment of thousands of people to psychiatric hospitals who could have been treated on an outpatient basis.
“The jail has been the go-to spot for all the mentally ill people,” Patten said. “The local officials, when you go to them and ask for help, they will tell you that the responsibility for providing mental health services falls on the state, and the state in return will say they don’t have the funding. In the meantime, the mental health consumers are not getting the health care that they need, and it’s falling on the backs of all 82 county sheriffs.
Although officials from the state’s Department of Mental Health say a Mobile Crisis Response Team was established in all of Mississippi’s 82 counties in 2014, Patten testified during the trial: “When people call the mobile crisis line, the Adams County Sheriff’s Department is dispatched to respond to the call. That is in large part because the mobile crisis team is based in McComb, over an hour away.”
Mental Illness is a neurobiological disease that can be terminal to the patient and others if untreated, said Julie Teater, a clinical psychologist in the Gulf Coast.
“Early intervention is critical,” she said. “You can prevent someone from killing themselves and harming others if you get them treatment early.”
“The majority of people with mental illness have jobs and live full lives. They are no different than people who have high blood pressure or who have diabetes. They have an illness they need to manage,” Teater said.
Micah Dutro, legal director of Disability Rights Mississippi, said the state is about 25 years behind the national trend of shifting people with serious mental illness from psychiatric hospitals to outpatient, community-based care. While the state tries to catch up, many people are not getting the care they need because the services do not exist in their area or they do not have access to services because they are uninsured or they do not have transportation to get to a treatment facility, Dutro said.
Mental Health America ranks Mississippi as the worst state for access to mental health care services in its 2019 annual report.
‘Quality and care shouldn’t depend on where you live’
State and local officials, mental health advocates and providers say the mental health crisis in Mississippi is magnified by a major shortage of psychiatrists and psychiatric nurse practitioners, a large number of uninsured individuals with serious mental illness and limited funding.
Dutro and other advocates contend the primary barrier to providing adequate mental health services is the state’s fragmented infrastructure, which has led to inconsistencies in care, especially in rural areas that have high concentrations of poverty and more uninsured people. The U.S. Census Bureau’s data show Mississippi has the largest percentage of families living in poverty.
Mississippi’s Department of Mental Health operates 12 inpatient psychiatric facilities but depends on 14 independent Community Mental Health Centers – divided into regions across the state – to provide mental health services. But services vary from region to region. Those who live in more populated, prosperous areas have access to more services, because they get more money from the counties within their regions.
“The quality and care you get shouldn’t depend on where you live. It shouldn’t matter if you live in the Delta or Jackson or in Tupelo or the Gulf Coast, you should be able to get the same kind of mental health services everywhere, and that system does not exist. The state has not directly set it up,” Dutro said.
“The people who are going to the community mental health centers are generally people living in poverty or close to it,” Dutro said, so if the services do not exist in their region, they are “out of luck.”
The DOJ lawsuit forced the Department of Mental Health to step up efforts to increase community-based services. In fiscal year 2019, agency officials said the department shifted $13.3 million from its institutional budget to expand community. Of these funds, $8 million was used to expand crisis services and Programs of Assertive Community Treatment, known as PACT, from two in fiscal year 2014 to 10. PACT teams provide consistent services to people with severe and persistent mental illnesses who have not benefited from traditional outpatient services. They go directly to individuals whether they are living at home or under a bridge, but Reeves said most of the counties do not have PACT teams. The state also increased its Crisis Stabilization Units from eight, 16-bed CSU units to 13 units with a varying number of beds.
Additionally, $900,000 of the $13.3 million was spent to expand Community Transition Homes that allow individuals receiving continued treatment services at Mississippi State Hospital to live in the community; and $400,000 to expand a jail-based pilot program begun in Hinds and Madison counties in 2017 to eight other counties. The program is aimed at reducing how long people with mental illness charged with a crime must wait for court-ordered treatment at Mississippi State Hospital to restore them to competency to stand trial, said Adam Moore, DMH’s director or communications.
Patten said he has not seen any of these improvements in his rural Adams County, with an estimated population of 32,000.
The county does not have a Crisis Stabilization Unit for short-term, inpatient treatment, he said. These crisis units are crucial, because “some people may not need to be committed to a (psychiatric) hospital.” They may have just had a lapse in their medication and need to resume treatment, he said.
The jail is located next to the Southwest Mississippi Mental Health Complex, the county’s designated community mental health center. But Patten said he has to jail individuals having a mental health crisis that may make them a danger to themselves or others until he gets a court order to transport them to a suitable facility because the center does not have a place to house. The jail only has two holding cells, and people with mental illness have to be monitored constantly.
The county has one private hospital, and Patten said, it only accepts mentally ill patients who are elderly and only if they are not disruptive and have not been charged with a crime.
Pike County, where the closest Crisis Stabilization Unit to Adams County is located, is 50 miles away. The closest psychiatric hospital is in Whitfield, about 140 miles away.
When people without mental illness hear the cell doors behind them lock, it does something to their psyche, Patten said. For someone with a serious mental illness who is paranoid or hallucinating, it’s even more terrifying, he said. “It’s torture.”
Patten testified that someone with a mental illness chewed the padding around a drain in the middle of his cell.
“It’s a terrible situation for the mental health consumers,” Patten said, many of whom have to sit in jail for months waiting for a mental competency evaluation or a bed at a psychiatric facility.
“The main problem is when they get incarcerated all their Medicaid and Medicare benefits are cut off and that leaves the burden for paying for treatment on the backs of counties, and we can’t afford to do that,” Patten said. He said he is working on a pilot program with the University of Southern Mississippi to do telemental, which would provide psychological counseling via the internet.
‘Mississippi must have a combination of treatment options’
In some cases, people with mental illness, who have not been found guilty of a crime, languish in jails for years.
“A lot of them are indigent and can’t afford a proper defense so they get locked up, and they get lost in the system,” said Lawrence Blackmon, as he recounts what happened to Antonio Brown of Canton, one of his clients.
Brown, 35, whom Blackmon began representing in October 2018, was arrested in January 2014 on a voyeurism charge.
“On June 24, 2015, he was found to be incompetent and unrestorable based on a mental competency evaluation,” Blackmon said. “Based on his IQ, he was technically mentally retarded, but he never was sent to any of the mental health facilities here in the state. Instead, he was held in the Madison County Detention Center for a little over five years. He never had a trial, so he was never convicted.”
Although an order was issued on Nov. 9, 2015, to initiate civil commitment proceedings to place Brown in a psychiatric facility, no one followed through, so he just sat in jail and did not receive appropriate treatment.
Blackmon got Brown released in March and the charges against him dropped.
But Brown was re-arrested in June on another voyeurism charge. Blackmon said Brown, whose no longer his client, has a long history of mental illness and a speech impediment. Although Brown has received some outpatient treatment, “he wasn’t receiving adequate care in terms of supervision and possibly medication.”
“Here on the outside he doesn’t have much support from his family, and he has been incarcerated for so much of his adult life that he has a problem readjusting when he is on the outside,” said Blackmon, who grew up with Brown. Brown’s difficulty adjusting to life outside combined with the lack of sufficient community mental health services make it almost certain he is going to re-offend, he said.
“Like every state in the nation, Mississippi incarcerates more individuals with severe mental illness than it hospitalizes,” according to the Treatment Advocacy Center, a Virginia-based nonprofit that works to eliminate barriers to treatment for people with severe mental illness.
In 2016, the center estimated that the number of incarcerated people in Mississippi with serious mental illness was 5,159.
The nationwide trend toward deinstitutionalization began in the 1950s and 1960s to reduce the warehousing of people for years under undesirable conditions, but officials at the Treatment Advocacy Center say the drastic reduction of psychiatric beds has adversely affected people with severe mental illness who need intensive, inpatient treatment. They say the shortage of beds coupled with insufficient community services has led to more people with severe mental illness being held in jails as well as increased homelessness and suicides.
In 1955, research shows there were 558,922 inpatient psychiatric beds in state hospitals. In the first half of 2016, the center reported that number had plummeted to 37,679.
“Mississippi must have a combination of treatment options, both inpatient and community services,” said John Snook, the center’s executive director. “Unfortunately, the Department of Justice too often ignores that reality in favor of their own misguided personal philosophies.”
The organization has recommended Mississippi “stop eliminating public psychiatric beds,” because there are not enough beds to meet the demand of people who need them. But the DOJ asserted during the litigation that if the state focused more of its resources on expanding community services, the need for additional psychiatric beds would be reduced.
Scott Crawford of Jackson, a disability advocate and retired clinical neuropsychologist, said psychiatric hospitals are needed because some people with severe mental illness cannot live independently and need long-term treatment; others may present an ongoing risk of violent behavior. However, he said: “We as a society have never fully funded home and community-based services and supports for individuals with any disability, but particularly people with mental health conditions. Until we do that, I’m not willing to say the problem is not enough inpatient beds.
Report for America corps member Shirley L. Smith is an investigative reporter for the Mississippi Center for Investigative Reporting, a nonprofit news organization that seeks to hold public officials accountable and empower citizens in their communities. Email her at [email protected].