Opening arguments began in federal court in Jackson Tuesday as the U.S. Justice Department accused Mississippi of failing to provide adequate mental health services at the community level while too many people are confined in overcrowded state hospitals.
And Community Counseling Services — which serves a seven-county region in northeast Mississippi — says the push for a renewed focus on community mental health services is long overdue.
“It’s been a long time in the making and obviously, for people with mental health issues, at the end of the day we are talking about the people who receive our services,” said CCS Staff Development Officer Karen Frye. “People have had to rely on more restrictive care for longer periods of time than they have to.”
The federal government argues that Mississippi’s current system is in violation of the Americans with Disabilities Act and the Justice Department is pushing for U.S. District Judge Carlton Reeves to identify eligible adults with mental illnesses who need the services.
What’s more, federal officials are pushing Reeves to help those eligible avoid confinement in hospitals while redirected them to community-based services.
Community Counseling Services — headquartered in West Point on the former Mary Holmes College campus — is among the regional leaders in regards to community services, with offices in Choctaw, Clay, Noxubee, Lowndes, Oktibbeha, Webster and Winston counties.
“We have been able to grow as an agency but there is a point in how long you can sustain things with limited funding,” Frye said. “There have been articles recently about … pursuing some kind of medicaid expansion because [Mississippi] has such a large indigent population.”
She then said the ideal outcome for CCS would see the state shift money traditionally used for institutional care to serve people in the community.
“Some of that would also be Medicaid, whether through Medicaid expansion or other services Medicaid could authorize for community based services,” Frye said.
Frye pointed to Mississippi having the highest Federal Medical Assistance Percentage (FMAP) rate of any state at 76.98%, with every roughly every 25 cents being paid by the state while the rest is covered by the federal government. The next highest is West Virginia at nearly 75%.
Medicaid data shows Mississippi’s FMAP rate has increased every year since 2014 when it was reported at 73.05%.
And in a state ranked near the bottom by Mental Health America among states with the highest prevalence of mental illness, groups like Community Counseling have been calling for increased support for years.
In the same report, Mississippi also ranked last among U.S. states in access to care, further highlighting a system CCS views as broken. But fears also persist at the possibility of further cutbacks and decreased funding.
“We see those individuals who don’t have a prayer and if the lawsuit does not end up in favor of community-based care and the state doing something, it could have an impact on community mental health centers,” Frye said.
But as the courtroom drama is sure to continue, Frye said the argument is one that has been made at CCS for the last 25 years as state hospitals have filled to capacity.
“The community mental health centers collectively, which are the largest provider of mental health services in the state, have collectively over 100,000 people served,” Frye said. “[The state] serves 4-5,000 in state institutions, so when you think about the agencies that have the abilities to provide services in all 82 counties, that will be your community health centers.”
According to the Mississippi Department of Mental Health, an estimated 165,000 Mississippians need some kind of mental health services, including nearly 35,000 children and youth who have severe and persistent mental health needs.
She then explained the structure of community health organizations, saying each center has a board of commissioners, appointed by the county’s board of supervisors, which receives funding through millage set in each county.
“What we get in millage in less than 1% of our total agency budget, so there is a misconception that counties give us money,” Frye lamented. “But that funding stream has to come from somewhere.”
Frye said the federal courtroom in Jackson was booked for the next six weeks and it could be even longer before a conclusive decision is reached. But the hope of CCS and its Executive Director Jackie Edwards is that the outcome will see an expansion of services for the organization and the communities it serves.
“People can be maintained in the community, but if you don’t have that funding it becomes a fragmented system,” Frye said. “[A favorable outcome] would be a great impact on us and an astronomical impact on the people we serve.”