James Shelson, lead attorney representing the state, carries documents as he and his colleagues exit the federal courthouse in Jackson, following a hearing on updates about the status of the lawsuit over mental health services in Mississippi, Monday, July 12, 2021. The U.S. Justice Department claims the state has failed to provide adequate services in the community for adults with mental illness. Credit: AP Photo/Rogelio V. Solis

The state of Mississippi appealed a federal judge’s ruling that would shape the future of the state’s mental health system to the U.S. 5th Circuit Court of Appeals on Wednesday. 

The state’s appeal is the latest development in a more than decade-long battle between the federal government and the state of Mississippi. In 2011, the U.S. Department of Justice issued a letter to the state saying Mississippi was not doing enough to provide mental health services outside of institutional settings. After five years of the state doing little to offer more community-based services, the DOJ sued in 2016, and District Judge Carlton Reeves later ruled that the state was in violation of the Americans with Disabilities Act.

Reeves told the state on Sept. 7 that it had four months to develop a plan to prevent the unnecessary institutionalization of people experiencing mental illness in state hospitals, and submit that plan to the DOJ. Lawyers for the state then asked for the deadline to be postponed because of its plan to appeal the ruling. 

The state not only opposes having to develop the plan ordered by Reeves, but also specific services and accountability measures required by the order.

One order the state opposes is a requirement to implement peer support services at community mental health centers across the state’s 15 mental health regions by the end of the 2022 fiscal year. 

The state also opposes a requirement to fund an additional 250 CHOICE housing vouchers for the 2022 fiscal year, another 250 during the 2023 fiscal year and then sustain that level of funding going forward. The CHOICE housing voucher program provides rental assistance for Mississippians with severe mental illness.

The Mississippi Legislature increased funding for CHOICE by $400,000 in 2021, but as the state’s record of distributing pandemic-related rental assistance shows, just because funding is appropriated for a worthy cause doesn’t mean it will get to the people who need it. Mississippi’s CHOICE program has never spent the full amount appropriated by the Legislature. 

The state also opposes a requirement that the Mississippi Department of Mental Health conduct clinical reviews with 100 to 200 patients per year “to assure that services are working as intended to address the needs of people with serious mental illness.”

Joy Hogge, executive director of the mental health advocacy organization Families as Allies, doesn’t buy the lawyers’ argument that these requirements would cause “irreparable injuries” to the state. 

“I think the only explanation (for the state’s appeal) is that they don’t want to be accountable,” Hogge said. “What they have really objected to all along is anybody having any input or oversight. They don’t want our mental health system to be accountable to anything outside itself.”

Reeves’ order also requires the state to begin collecting a vast amount of data on the people interacting with the state’s mental health system. This includes tracking who is receiving core services at community mental health centers, calls to mobile crisis teams, and state hospital stays that last longer than 180 days, among others. 

This data collection would give the state Department of Mental Health a more complete picture of which services are working and which aren’t. The department develops a “strategic plan” every four years that includes statewide goals and benchmarks for improving services. However, these “living documents” never include quantifiable measurements for identifying if these desired outcomes are achieved. 

“I don’t know where the evidence is that the people who most need the services are getting them. Do we know if those services are helping them live in the community and reach the goals that they want to reach? We don’t know that because they aren’t collecting that data,” Hogge said. 

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Will Stribling covered healthcare and breaking news for Mississippi Today.