In a year’s time, more than 100 people stayed in cells at the Lauderdale County Detention Facility, serving time only because they needed mental healthcare. 

Many had committed no crime and simply needed a place to wait for an available bed at one of the region’s psychiatric care centers. With no other place to house these individuals, and so few beds available, Lauderdale County turned to its only remaining housing option – the county jail.

“If you look at local government, the place that’s open 24/7 and the person who basically gets told to handle all the problems that nobody else can figure out is the sheriff,” said Ward Calhoun, chief deputy of the Lauderdale County Sheriff’s Department. “Because there is no other place to hold that individual, the courts order jails to hold that individual until a bed’s made available at a state hospital.”

In 2011, the United States Department of Justice investigated Mississippi and concluded the state’s mental health services violated the Americans with Disabilities Act by segregating people with disabilities – defined as mental, developmental and physical disabilities – in state institutions away from their communities.

According to Olmstead, a Supreme Court decision from 1999, isolating those with disabilities from the community is discrimination. People with disabilities should be allowed to live in the most integrated – disabled and non-disabled together – setting possible. At least two dozen other states have had Olmstead complaints filed against them.

Providing mental healthcare in state institutions – such as East Mississippi State Hospital – illegally isolated the mentally ill from the rest of the community.

In August, the DOJ sued Mississippi for discriminating against adults with mental illnesses by not adequately providing community-based services and forcing them to seek institutional care. 

“For far too long, Mississippi has failed people with mental illness, violating their civil rights by confining them in isolating institutions,” Attorney General Loretta E. Lynch said in a DOJ news release. 

Shortage of beds

Correcting the problem has been a challenge.

East Mississippi State Hospital has approximately 100 beds for patients, 80 for men and 20 for women. These beds serve 18 different counties, including Lauderdale.

But the waiting list bars some from getting the help they need. Earlier this month, more than a dozen people waited – at short-term psychiatric care centers, at home or in jail – for an available bed at EMSH, with more people regularly added to the waiting list from different counties.

EMSH admits only those with a County Chancery Court Order. Family members, friends or doctors petition the court to obtain an order, sentencing the individual to seek treatment. A physician, an attorney, a counselor from Weems, the region’s community mental health center, and a psychiatrist evaluate the individual and submit their findings to a judge, who makes the final decision.

In what the Chancery Court described as the “unusually busy” month of September, the court received 20 petitions, committing all but three. 

If committed to seek treatment, each person must arrange short-term care at the private Alliance Health Center, secure one of 16 beds at the Crisis Stabilization Unit at the Central Mississippi Residential Center in Newton, or, if the family is capable and willing, the individual can stay home.

Otherwise, they go to jail.

Sent to jail

Last year, the Lauderdale County Detention Facility held 106 Chancery Court-committed individuals for EMSH for a combined 884 days, roughly two individuals per week. Stays ranged from one day to 23 days, with an average hold of eight days, Calhoun said.

Roughly 20 percent of these people had been previously diagnosed, Calhoun said, and only some of them had any medication. Designed to house inmates, and not to provide mental healthcare, the detention facility still offers weekly therapy from a Weems counselor and has nurses on-staff.

“Holding people… who have been found to have severe mental health disabilities, is particularly egregious because there is a long and deep well of academic literature that makes it clear that the conditions of confinement that you find in jail exacerbate mental illness,” said Paloma Wu, legal director of the ACLU of Mississippi.

According to Wu, jailing punishes the mentally ill, who have done nothing wrong, in two ways: by failing to deliver treatment and through confinement.

“No county can afford to try to deliver in-patient, quality care in jail,” Wu said. “The burden of adequately delivering mental health treatment falls unfairly on the counties because the state has failed to deliver these kinds of resources.”

“(Adults) with mental illness who experience a crisis in Mississippi often spend days in local emergency rooms and jail holding facilities that are ill-equipped to address their needs, before ultimately being taken to the state’s psychiatric hospitals,” said the DOJ news release about the 2016 lawsuit. 

Cycle of trauma

The mentally ill experience unnecessary trauma because the current system forces them into a cycle of state hospitals, emergency rooms and jails, lengthening their time away from their communities, according to the DOJ. 

Recividism, or re-admittance, rates are high for the mentally ill in this area, as confirmed by Charles Carlisle, director of EMSH, Calhoun and Weems. Though they might go to jail, receive treatment at EMSH and schedule their follow-up appointment with a counselor at Weems, individuals often fall back into the same patterns, repeating the process again.

The DOJ blames the dysfunctional system.

“Readmissions typically result from insufficient services in the community and inadequate coordination between treating professionals in facilities and those who support the individuals when they are in the community,” said the DOJ complaint.

In a Department of Mental Health progress report from 2015, the state appropriated funds for the DMH in both 2013 and 2014. This elevated the role of regional Community Mental Health Centers such as Weems Community Mental Health Center, whose nine-county coverage area includes Lauderdale.

Crisis intervention

In response to the 2011 investigation, Weems approached law enforcement agencies in the area to form a Crisis Intervention Team. This program emphasized diverting individuals in a mental health crisis away from the criminal justice system and toward community resources.

According to a progress report, the Meridian Police Department and Lauderdale County Sheriff’s Department diverted 97 percent of 189 mental health crisis calls in 2014. Only five of those calls resulted in arrests.

The CIT program tries to convince people experiencing a mental health crisis to voluntarily commit to treatment at the Crisis Stabilization Unit in Newton. This unit, part of the state-operated Central Mississippi Residential Center, has 16 beds available for short-term crisis intervention care.

Most of the 550-600 served in the last year volunteer for the unit, according to Debbie Ferguson, director of the center. Stays usually range from 5 to 7 days and Ferguson said she tries to leave one bed open for CIT admissions.

The other nine counties that the center serves do not have fully developed CIT programs yet. If they did, Ferguson would have to reserve even more beds for law enforcement.

“(CIT) has really increased the number of people that we’re serving,” Ferguson said. “We’re managing with our resources right now but ideally, all of those counties – their sheriff’s departments and their police departments – would have people trained in CIT and would be utilizing our crisis center for those emergencies. 

“And at this point… there’s no way we could meet that demand.” 

Community need

The DOJ complaint against Mississippi, however, called the “isolated” center “a state-funded residential behavioral health program… that looks much like the state hospitals.” It states that in the fiscal year 2015, the DMH spent $202.5 million on the four state hospitals and $5.8 million on the center, versus the $25 million in grants provided to community-based services.

“The State’s recent spending on new facilities at the East Mississippi Sate Hospital is another example of its significant investment in the State Hospitals,” said the complaint, noting the new $7 million dining facility and the current $14 million 60-bed building currently under construction.

The DOJ said these funds could be spent on community services and not on hospital expansions.

“Mississippi could serve individuals with mental illness in the community… by redirecting spending from segregated, institutional settings to community-based programs,” the complaint stated.

According to an email from the DMH, the department seeks to “allow people to be served in the most independent environments possible.

“Additional funding is needed to build community capacity while at the same time ensuring the health and welfare of people currently being served.”

The Mississippi Legislature’s Joint Committee on Performance Evaluation and Expenditure Review (PEER) disagreed and stated that the DMH doesn’t appropriately utilize its existing funds, blaming this on a lack of centralized planning.

A 2015 PEER report recommends the DMH use Medicaid funds and current funding to move away from intermediate care facilities toward community settings. This would create affordable housing, easing the tension on other psychiatric care centers, and allow those with mental, developmental and physical disabilities the chance to live independently outside of an institution. 

The Technical Assistance Collaborative (TAC), a non-profit organization that offered a housing consultation to the DMH, also stated in its report the need for affordable housing for the disabled. It also suggested creating housing that allowed individuals to “live, work and socialize primarily with other people who do not have disabilities” to comply with Olmstead.

To be Olmstead-approved housing, individuals should be free to choose their housing options and whether they live alone. Services can be offered, but the individual can choose to remain in the affordable housing without utilizing the services of the DMH, according to the TAC report. 

The DOJ said in its complaint that affordable housing needed to be included in the community-based mental health services of Mississippi, in addition to supported employment services and ensuring the availability of programs, such as CIT, across the state.

These reports agree that community-based services would drive down the costs of mental healthcare in Mississippi while improving the lives of those with a mental illness. 

“I think it’s a very complex issue. And I don’t think there’s any one thing that caused it and any one thing that will fix it,”  Calhoun said. “This is a community issue that we as a community will have to work on. It’ll be messy and it’s not always easy. But we as a community have to address these problems. Because they’re not going away.”