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Mississippi Madness: How do States Best Serve the Mentally Ill?

One Flew Over the Cuckoo's Nest

On Thursday this week, ABC News reported that the U.S. Department of Justice sued the State of Mississippi for what DOJ is calling a violation of the American with Disabilities Act – the state’s mandated institutionalization for people with mental illness.

“For far too long, Mississippi has failed people with mental illness, violating their civil rights by confining them in isolating institutions,” said Attorney General Loretta Lynch Thursday. “Our lawsuit seeks to end these injustices, and it sends a clear signal that we will continue to fight for the full rights and liberties of Americans with mental illness.”

Mississippi Governor Phi Bryan called the lawsuit “another attempt by the federal government to dictate policy to the states through the courts” according to ABC.

This is not the first time Mississippi has been scolded for it’s handling of mental health services. “The Southern Poverty Law Center sued Mississippi in 2010, claiming the state illegally sends mentally ill children to institutions instead of caring for them at home, violating the Medicaid Act and the Americans with Disabilities Act” ABC reports. Then again five years ago, “the Justice Department issued a report accusing Mississippi of widespread violations”

Needless to say, the Magnolia State is in hot water when it comes to how it handles the mental health of its residents. Is it because Mississippi, much like the rest of the South, is just the back woods of America, out of date and out of touch with reality? While it may be tempting to chalk it up to that, I don’t think that’s entirely fair. One thing that comes up in the report, is that the state’s own Attorney General, Jim Hood – the state’s only statewide Democratic elected official – “ called the suit a challenge for the Republican-led Legislature to find money to expand services”. In other words, it sounds like the budget may be playing a role, as we’ve seen even here in “progressive” Connecticut. Despite our governor’s Democratic affiliation, mental health services still manage to be taking a severe cut in the current budget crisis.

In a nationwide ranking of states by WalletHub, Mississippi came in DEAD LAST – 51st out of 50 states + the District of Columbia. Money plays a role. You can’t provide adequate and proper services when you don’t have the budget to do so.

That being said, I do not think budget is the sole factor, whether in Mississippi or here in Connecticut. In the end it comes down to priorities. We, as a nation, spend over half of our discretionary federal budget on the military. Here in Connecticut, when budget cuts were announced, one of the first programs to get the ax was mental health services – to veterans of all people. Each American household pays approximately $75,000 per household to fight the wars, but we can’t come up with the cash to provide returning veterans with adequate mental health care? Give me a break. Don’t believe anyone when they tell you there aren’t enough funds to care for the mentally ill – there simply isn’t the political will to do so.

Again, it comes down to priorities. If Mississippi does not have the economic incentive to assist what is likely to be anywhere from 20-25% of its own residents, then they will have to find another incentive to do so – perhaps social justice?

I personally am conflicted on the issue of institutionalization. I grew up in Massachusetts, just one town over from a large state mental health hospital campus (Foxborough State Hospital) which closed in the 1970’s, remaining only partially utilized (think CVH in Middletown) through the mid 90’s and then vacant (and decaying) ever since, used only for the local haunted houses once a year (because mental illness is the stuff of nightmares apparently – more on that when we get to Halloween).

I also heard stories from my family. My mother studied psychology in college and was shown Titticut Follies, a raw documentary about another Massachusetts mental hospital – Bridgewater State Hospital – less than an hour’s drive from her hometown. The film was banned in Massachusetts at the time – the only reason she was able to view it was because she was going to school over the border in Rhode Island. In one of her internships, my mother visited the Wrentham State School. Another state facility, this one for the developmentally disabled, was just one town over from her hometown. It was there that she was shown a case which apalled her – a full grown adult, living in a crib, like an infant. The patient was deaf, but wasn’t properly diagnosed and so was given to the school at a young age and never developed as a neurotypical person would, thanks to her environment. This was also around the time of One Flew Over The Cuckoo’s Nest, based on Kesey’s groundbreaking novel about the abuses of institutions. So lthe case was clear – institutionalization not only wasn’t helping, it was hurting people. The solution – de-institutionalization – was the obvious solution at the time. But was it the best one?

I’ve also heard how following the outrage from media coverage of the abuse (and the winnowing away of state budgets for public health services over the following 30 years, I’m sure) how everything transitioned to community care. People were discharged from institutions, were no longer mandated to receive treatment and were now in charge of their own care. Yay Freedom!

But not so fast. The problem with this new scenario is that mental illness, by its very nature, incapacitates people from being able to manage their lives the way that people who enjoy good mental health are able to. So by allowing the pendulum to swing so far in the opposite direction, I feel we did a major disservice not only to those living with mental illness but the community as a whole. Chronic homelessness, rampant addiction, sky rocketing incarceration – while all of these community symptoms have complex and variable causes, I suspect that some of these are due in large part to an unsuccessful transition from institutionalization to community care for people with mental illness. I should be clear and state that I say all this from anecdotal information only – I haven’t studied the literature or statistics to speak with confidence or certainty on the historical impacts of de-institutionalization of mental health services, whether from a mental health advocay or public health perspective. But it it clear to me today from working in the field that more services need to be available than currently exist, while not returning to the previous institutional model(s).

So my hope for Mississippi is that they will take this lawsuit as an opportunity to take a failure and use it to drive them to excellence. If they lose the suit, I assume that they will not only be penalized financially but will be required to rectify their current mental health system. What better opportunity to make substantial changes which will provide Mississippi residents with top level care using the most up-to-date models and practices? The state enjoys a certain purview that other healthcare agencies (both non-profit and corporate) don’t. The state is being given a golden opportunity to rewrite the rules for how mental healthcare is conducted within it’s boundaries. I really hope tha this does not turn out to be a lost opportunity.

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