/Department of Mental Health dramatically increases forensic beds at State Hospital

Department of Mental Health dramatically increases forensic beds at State Hospital

Carver’s story, however, is not unique. Mississippians who have been waiting for a forensic mental evaluation for years languished in jails. These vulnerable people require resources that the Sheriffs and their Deputies don’t have. Lawyers argue that vulnerable people being held indefinitely in jail is a violation of their rights. Federal law restricts the time it takes to receive these evaluations. These evaluations are where a psychologist determines if someone is competent to stand trial for an accused of a crime or suspected of having mental illness. The average wait for these evaluations in Mississippi was over a year by Carver’s release in the fall 2017. Paloma Wu (a senior staff attorney at the Southern Poverty Law Center) stated that “It’s probably one of the most important criminal justice issues where everyone has been in complete agreement that this is an first order problem, regardless of whether you call it Constitutional, Humanitarian, or Public Safety.” “How we dealt with these people as states wasn’t working for anyone,” Paloma Wu, a senior staff attorney at the Southern Poverty Law Center, said. But the Department of Mental Health, which oversees the forensics unit of Mississippi State Hospital, has repeatedly stated that it is powerless to make any changes without additional money. In 2016, Diana Mikula, the executive director of the agency, testified before a legislative budget panel. She stated that these patients were a high-risk security threat. Mikula stated that the forensic unit was the most secure. “We could retrofit a building but it would cost the state a lot,” Mikula said. That money didn’t come, at least not directly. The agency’s budget has been cut by $20 million over the past three years, according to lawmakers. However, dramatic changes have been made. The Department of Mental Health quietly worked on ways to decrease its waiting list for forensic services, even as the state was defending itself in federal court. 2017 saw the piloting of a competency program in county jails. Most patients would have to wait until a bed at Mississippi State Hospital opens up. The agency spent $30,000 last year to convert a 21-bed unit at the campus into forensic beds. This gave rise to 56 beds across the state. The waiting list has decreased to six people who are now waiting on average 19 days for their initial evaluations. In February, the agency announced that it would break ground on an $19.3 million unit with 83 beds. “The Department of Mental Health had asked for funding for many years to expand the forensic unit and reduce wait times. Adam Moore, the director of communications at DMH, said that this topic has been on DMH’s mind for many years. The agency stated that the $20 million was a “blending of financing” from several sources. It included a $1 million bond from Congress, consolidation of agencies and services within the agency and reprioritizing projects. One-time money from Division of Medicaid. Mississippi Today was not able to get a detailed breakdown of the funds used by the agency. Instead of a legislative appropriation being used, the impetus was a unique collaboration that began in 2017 with attorneys at MacArthur Justice Center (and the Southern Poverty Law Center)-and an idea that may seem strange to organizations more used to suing the state rather than working with it: avoiding lawsuits. In an email statement, Wendy Bailey, Chief of Staff at the Department of Mental Health stated that “Because of the partnership, we are moving ahead and hopeful Mississippi can be a model for forensic services for others.” Advocates say that it is not surprising that such rapid change can occur without a court mandate. Lawsuits can be notoriously complicated. It took three years for the Department of Justice to bring a lawsuit against Mississippi regarding its community mental health services. Cliff Johnson, MacArthur’s chief executive officer, and Wu were both among the two lawyers who approached the agency regarding its forensics unit. They said that they wanted speed to avoid the courtroom. Johnson stated that they had tried the litigation route in other states. Johnson acknowledged that he had traded certainty for flexibility. “The litigation took a long time, and many of these states weren’t in a significantly worse position after it went through courts.” The law is binding when a court orders. He admits that the Department of Mental Health can only make verbal agreements to implement these changes. It is possible to bring suit if this happens. Johnson stated that Johnson and Johnson have not agreed or been asked to agree to file litigation. Johnson said, “But as long we’re working towards a remedy, we want to continue moving in that direction.” The Department of Mental Health can stop working on this at any time, but that has not been the tone of this conversation. Mississippi State Hospital’s Forensics Unit sits at the intersection of both the criminal justice and mental health systems. It has experienced the same shortage of resources for years. The unit’s staff turnover is high and those who are left are often stretched thin. Mikula, in her legislative testimony of 2016, described a crumbling facility that was built in the middle of the century. It was last renovated under the Reagan Administration. “Eventually, it should be demolished. It’s not a good space, it is not very therapeutic and, at least from what it could be told, it wasn’t adequately staffed to offer treatment,” Dr. Joel Dvoskin said, the forensic psychologist who was hired by MacArthur, the Southern Poverty Law Center, to consult with the Department of Mental Health. “(Patients were) just sitting around a lot.” Although the Department of Mental Health stated that the 35-bed unit will be demolished when the new 83 bed unit opens, it didn’t provide any projected completion date. Before a trial, the forensic unit serves two functions. The forensic unit evaluates people accused of a crime to determine if they can understand the charges and assist their lawyers in their defense. If they are competent, they can proceed to trial. The state offers “restoration” services to help them get to a place where they are able to stand trial. This can include medication for someone suffering from severe mental illness. It may also involve education about the court system for someone with intellectual disabilities. It can be difficult no matter what. Many people were returned to county jail after restoration services had been made available on a smaller scale. Adams County Sheriff Travis Patten said, “It puts a tremendous strain on me as well as on my agency.” “That’s more staff we need to monitor people and that means a lot more overtime hours. It’s easy to see the cost.” Johnson and Wu had initially discussed the possibility of a lawsuit. The Constitution guarantees the right to a speedy trial and guarantees that innocent people will not be convicted. Both of these guarantees were violated by the years-old backlog created by the forensics unit. Johnson stated that “So we were in this position where we were broke, and people with mental illness were paying the penalty and local jails were literally paying the price.” Johnson stated that Mississippi was unable to defend itself in a lawsuit. It was clear that Mississippi was violating the Constitution. This conversation would focus solely on remedy. Wu and Johnson decided to move on to the solution. Dvoskin, an outside consultant with extensive experience in forensic mental healthcare systems in other states, was brought in by Wu and Johnson. Johnson stated that the lawyers were able to get out of the way. We let the clinicians talk it out.” The lack of beds was quickly solved by the clinical staff, specifically Dvoskin (a Mississippi State Hospital forensic psychiatrist) and Dr. Thomas Recore (a Mississippi State Hospital forensic psychiatrist). They were then back at the original problem of funding. According to the Department of Mental Health, the Legislature’s decision in providing level funding for the past two years following back-to-back cut in 2017 and 2018, helped. “Our agency is committed to being good stewards of the resources available. We have been able shift resources and achieved successful outcomes thanks to level funding in the past two years. “We met with state leaders to assure them that we would find the best cost-effective way of improving Forensic Services, and that’s exactly what we did,” Bailey stated in an email. Lt. Gov. Tate Reeves was the chair of that 2016 budget hearing and has long exhorted states agencies to “do it more with less funding”. He praised the Department of Mental Health for its ability to find almost $20 million in its budget. Lt. Gov. said that the decision to upgrade an existing building using existing resources for a critical need was exactly what he wanted. Reeves wanted agencies to follow his lead,” stated Laura Hipp, his Director of Communications. “Mississippi taxpayers cannot afford to send more money Jackson, so state agencies should rely upon the tax dollars budgeted for their needs.” Johnson stated that he was happy with the way the agency addressed the problem. However, he also mentioned the Justice Department lawsuit from this summer and noted that the agency still requires funding. They still need a lot. Johnson stated that it would take significant investment and creative solutions. However, the idea that they can fix every issue raised during the trial because they have fixed a discrete problem is absurd.