Doug, 73 years old, is a Mississippian suffering from mental illness. He has been in and out of state facilities and group homes for 50 years. His illness and violent outbursts have broken down all barriers between him and those who tried to help him. Recently, he was admitted to Purvis’ group home. Doug was in Laurel’s crisis stabilization unit after 18 months of deteriorating his mental health. One week into O’Brian’s stay, a nurse told O’Brian that she would drop him off at the nearest Salvation Army if she couldn’t find staff. This effectively made him homeless. Pat Abernathy, Doug’s sister, said that they said he was no longer able to be placed. “Nobody with his record is able to get into a (group home), so they’re going have to put Doug on the street.” Doug’s life was a series of visits to state mental health facilities. Out of concern that their criticisms of the state mental system might be retaliated against Doug, his sisters requested that his last name not printed. They claim that Doug has lost track of all his visits to crisis stabilization units, state hospitals and group homes. Doug’s case is one reason why the federal Department of Justice is suing Mississippi for its mental health system. Wednesday marked the 12th day of U.S. District Court’s trial that is expected to continue into mid-July. The federal government accuses the state of either housing patients in state hospitals or turning them away on the streets with limited resources. This creates a vicious cycle where patients, like Doug, bounce between institutions, temporary housing, and short-term treatment centres. This is not about people falling through the cracks. In her opening statement, Deena Fox, an attorney representing the Department of Justice said that this was a case of thousands of people falling through cracks in the state system. One of Mississippi’s community mental hospitals provides mental health care for patients who are not in state institutions or hospitals. Doug was taken in by the crisis stabilization unit. CSUs are short-term solutions that can be used to stabilize patients in mental crisis. O’Brian stated that staff told him they needed beds for another patient. “I asked if you had a social worker who could help him with this, and (the nurse), said no.” The Department of Mental Health oversees community mental hospitals. It did not respond to my question about whether there was a policy in place to prevent patients becoming homeless. But, Adam Moore, Director of Communications, suggested that O’Brian contact the Office of Consumer Report of the agency. He said it works to “resolve grievances related access services and provision.” The state has not denied that there are significant gaps in support. Instead, Mississippi is asking the judge for Mississippi to fix its system according to its own timeline. James Shelson representing Mississippi, a private attorney, said that Mississippi’s win in the case was simply “time to finish the job”. However, some patients are running out time. Doug is in poor health. He has a serious limp and emphysema as a result of his mental health struggles. O’Brian stated, “And I’m thinking,” “Oh Lord, my brother is about be left out on the street and can’t move and can’t breath.” Doug’s sisters don’t remember how many times Doug had been to Mississippi State Hospital. Abernathy can however recall Doug’s first visit there in 1997, just after Doug turned 22. He grabbed a gun from his mother’s backyard and shot indiscriminately, refusing to go down. The first visit to Whitfield lasted more than a year. He was able to respond well to his medication and his treatment plan. A year later, he looked much better. Doug had trouble keeping a schedule outside of the hospital. He stopped taking his medication, and one year later he was back in Whitfield. This would be the beginning of the cycle that would determine the next fifty years of his life. His last group home in Purvis was a cautiously optimistic prospect for Doug’s sister. O’Brian stated that Jerry, the man running it, would do everything for Doug. He would pick up his things and run errands alongside him. It was 18 months long, and Abernathy cannot remember Doug ever staying outside of a state institution. Jerry was not interested in Doug’s presence. Tensions rose in the home when he stopped taking his medication again. “He’s difficult. Abernathy stated that he is not an easy patient. Poor Doug is going to be devastated. We tried to talk to Doug and said, “You’ve got have to be good.” He can’t be kicked out again. He can’t help but do it. In two weeks, he’s gone. It’s been a nightmare since the government passed their law.” Olmstead is the reference to the Department of Justice’s lawsuit against Mississippi. The U.S. Supreme Court ruled in 1999 that relying on state hospitals to provide mental health care, as Mississippi and other states were doing, stigmatized and isolated patients and violated the Americans with Disabilities Act. The federal standard changed to allow patients to receive care in their own homes. According to the Justice Department, Mississippi did not start transferring patients from hospitals until a few years ago. It also did this without creating a community-based system. Instead of hospital care becoming community care as it was intended, it became very little or no care. According to O’Brian, Abernathy, Doug’s six-month stay that would have been able to treat him during ongoing crises turned into two-week trips. He went to group homes in the interim, but when that didn’t work, he has taken care of himself. He once took up residence in a storage unit. They found him wandering the streets of Memphis, frostbitten, another time. Abernathy stated, “It’s disgusting.” “They have taken Doug out so many times, without any money or medicine. They just turn Doug out.” Expert testimony at the trial has repeatedly referred to Programs of Assertive Communities Treatment, which is a pillar of the system in Mississippi. These teams employ specialists in a variety of areas, including psychology, medication and housing. This is done to help severely mentally ill patients stay stable and avoid being recommitted to hospitals. Dr. Carol Vanderzwaag is an expert witness for the Department of Justice on community mental healthcare. “It reduces the risk of being hospitalized.” “A PACT team will not allow someone to disappear from treatment for any length of time. Abernathy stated that Doug often responds well to structure. He excelled in high school and was recruited by a coach to join the basketball team. After he fell ill, he experienced a brief period in stability around 2004. He was able to get his own apartment and a truck with regular visits from a social worker. He continued to take his medication. O’Brian stated that Katrina struck and then O’Brian reacted. “The apartment, everything fell apart.” O’Brian and Abernathy denied having heard of Mississippi’s PACT team. They said Doug had never been connected to such services even though Harrison is one the 18 Mississippi counties that have PACT access. O’Brian stated that she isn’t sure if a PACT team could work for Doug right now. He probably needs to be in an institution setting at this stage, she said. “He’s not going to get back to being a normal citizen after all these years of institutionalization. O’Brian stated that he is not going to be a productive citizen of society. She admits that Doug is fortunate in some ways. He has his family who are willing to spend their time and resources to find him a place to live. Abernathy would be dead without them. On Monday, she got a call from the crisis centre. They had found Doug a home in a personal care facility. It was a step up from the group home, explained the person. Doug would need a nurse to help him with his medication. O’Brian stated that this would only be a temporary solution for Doug. It’s what he’s been doing his whole life. So depending on how long he lives, I’m sure he’ll go back to another hospital. It will happen again, I think.” Editor’s Note: This article is part of Mississippi Today’s ongoing coverage of the lawsuit by the U.S. Department of Justice alleging that Mississippi’s mental healthcare system violates the Americans with Disabilities Act. Readers can share their stories with Mississippi Today by emailing us at tips@mississippitoday.org.