JACKSON • A federal court ruled Mississippi can implement its own ideas for improving access to mental healthcare in the state, but an outside analyst must evaluate the effectiveness of those changes.
In a ruling that could have wide ranging implications for patients seeking mental health treatment in the state, U.S. District Judge Carlton Reeves on Wednesday issued a brief order that fully adopts the recommendations of a special master appointed by the court.
Special master Dr. Michael Hogan agreed with the state’s proposals about how mental health services should be delivered but sided with the federal government about the need for an outside monitor to assess how much progress the state is actually making.
“Mississippians with serious mental illness need help, and this Order seeks to give them the help they so desperately need,” Reeves wrote.
The state in its previous court filings vehemently opposed the appointment of an outside monitor, arguing that such a move would place an undue burden on the state.
Mississippi Attorney General Lynn Fitch previously told the Daily Journal that her office would consider appealing a ruling to the U.S. Court of Appeals for the 5th Circuit if it was unhappy with Reeves order.
However, it’s unclear if Fitch’s office believes the mere presence of a monitor is grounds for appeal. Colby Jordan, a spokesperson for Fitch’s office, said that the agency is reviewing the order and “evaluating our next steps.”
“The State argues that it should not be held accountable for the ‘performance’ of its mental health system,” Reeves wrote. “But the poor performance of its mental health system, in its over-institutionalization, is exactly what led it to violate the Americans with Disabilities Act.”
Reeves admitted that Hogan’s proposal is imperfect, but that’s because largely “the task assigned to him was impossible.”
The court’s initial desire was for Hogan to gain personal insights into the state system by talking to people on the ground who have been impacted by the broken system . But that changed because of the COVID-19 pandemic and because of objections from the state.
“Dr. Hogan was hamstrung by the State’s objection to him communicating with anyone on the ground–the non-party stakeholders in Mississippi’s mental health system,” Reeves wrote.
Even though many of Mississippi’s proposals won support from the court, Reeves’ order is far from a home run ruling for the state’s attorneys.
The order will require the mental health department to conduct a clinical review of its systems by interviewing around 100-200 patients a year to evaluate whether the mental health programs are adequately meeting their needs.
If the clinical review shows that patients are unhappy with programs or if an external monitor shows that gaps exist in the system, more litigation could ensue.
One of the major themes that Hogan and the justice department attorneys have repeated for the past year is that the state’s services on paper often didn’t match up with the reality services on the ground.
The federal government began investigating the state’s mental health system 10 years ago, and it concluded that Mississippi was unnecessarily segregating people with mental health into state-run hospitals for lengthy periods of time.
The state initially attempted to enter into a remediation process with the federal government, but that process eventually collapsed. The justice department then sued the state in 2016.
The state was forced to enter into a remedial process after Judge Reeves ruled in September 2019 that Mississippi was in violation of the federal Americans with Disabilities Act because there were inadequate resources in Mississippi communities to treat people with mental illnesses effectively.
Attorneys for the justice department and the state attorney general’s office will now have 30 days to submit two names of potential monitors to the court and what the role of the monitor should look like.
Unless either party in the case appeals its ruling, Reeves plans to enter his final order in the case if a monitor has been appointed.