A local court may order someone to be admitted to a hospital for treatment. This is only used when the person is suffering from a serious mental illness or is in immediate crisis. It is not to be used for someone with an intellectual disability, addiction, or dementia. The diagnosis of the George County woman was “major neurological disorder,” which is a broad term that covers dementia. Staff from the Community Mental Health Center recommended that she not be admitted to hospital in September 2021. She was nonetheless committed by the court twice. She was released from the George County jail after two weeks in October. In November, she was discharged after two weeks. The second time, she stayed in George County jail for at least six months. The state hospital eventually informed the county officials that she was not eligible for treatment. The court-appointed monitor, who was charged with evaluating Mississippi’s mental healthcare services at the community level, included her story without any identifying information. The U.S. Department of Justice sued Mississippi in 2016 for not providing community services to adults with mental illnesses. A judge appointed the monitor. The monitor discovered that the current picture of the services’ functioning is incomplete. Key data will not be available until later in the year. This data includes information about county commitment statistics, the number of people who receive services in different counties, as well as the results of calls to mobile crisis team and the results of those calls. It’s not unusual for people such as the one in George County to spend weeks or even days in jail due to inaccessible treatment. Michael Hogan, the monitor, stated that the state had reduced the number and length of hospital stays. It also funded services at the Community Mental Health Centers. However, not all programs are operational and it is unclear if the decreased hospitalizations mean that people are now accessing community services. He wrote that “Given this Report’s early timing and despite numerous efforts by the State for expansion and improvement of care, it is still not possible to make definitive determinations about compliance for many requirements under the Order.” He highlighted the problems with civil commitment, such as the practice of sending people into jail in order to wait for a bed in a state hospital. He described instances in which people with severe mental illnesses, such as dementia, addiction, and disabilities were executed. A federal court found Mississippi to have violated the rights people with mental illness by allowing them to be hospitalized instead of receiving services closer home. U.S. District Judge Carlton W. Reeves approved a state-wide remedial plan last year and assigned Hogan to prepare compliance reports every six month. Hogan described Friday’s first report as a stage setting report. It provided background information about the state’s mental system and preliminary information regarding the availability of services. The plan was halted in parts due to Mississippi’s appeal to Reeves’ decision at the U.S. 5th Circuit Court of Appeals. Mississippi Today was informed by Adam Moore, Director of Department of Mental Health Communications. He stated that the agency appreciated Dr. Hogan’s review and the ability to provide the requested data. Moore pointed out that Hogan found low hospital admission rates among the hundreds of people who were served by the state’s community treatment teams for severe mental illness. The agency will continue to review the programs included in the judge’s order. He wrote that the DMH is determined to continue to improve the system. Hogan visited six of the 13 CMHCs in the state, as well as three state hospitals, to prepare his report. These CMHCs are the centers for local-based mental health services. Before considering civil commitment, the Department of Mental Health urges families to contact their local CMHC in order to help a loved one who is in crisis. A person can submit an affidavit to the local chancery clerk if they believe a relative or loved one is in danger. A judge will then decide if the person should be admitted to hospital. If the judge determines that the person should be committed they are supposed to receive treatment at a state or crisis stabilization unit (CSU) where they can receive mental health care. This may reduce the need for hospitalization. Of course, there may not be a bed available immediately. Hogan examined records of 21 patients that contained information about their stays before they were admitted to hospital. Nine of the nine people waited in jail while others waited at hospitals or CSUs. The longest time waited was 18 days. He wrote that “We don’t know if the statewide data about this is reviewed and that the pattern requires attention.” Hogan’s report does not include information about the number of people who are killed each year in Massachusetts. Hogan examined 25 patient records, which included a discharge diagnosis. Eight cases, or nearly a third of the total, were not diagnosed with serious mental illness. Instead, Hogan reviewed 25 sets of patient records that included a discharge diagnosis. Hogan stated that inpatient treatment for such conditions is not usually available at psychiatric hospitals. He wrote that their admission to Hospitals was stressful for them and a challenge to staff. “Their interactions with people suffering from SMI [serious mental illnesses] may be problematic.” He noted that his sample size was too small for him to draw any conclusions. Moore stated that DMH provided training for local judicial officers on mental health and civil commitment alternatives. According to court orders, the planning for patient discharge and continued care in the community must begin within 24 hours of hospitalization. Hogan concluded that “progress was evident”. Hospital staff routinely arrange post-discharge appointments, and send patients home with medication and prescriptions. Hogan found some flaws. Before a patient is discharged from the hospital, local mental health staff must meet with them. There was no evidence to suggest that this was actually happening. There are many people who commit multiple times: In Harrison County, one in 16 of the 338 individuals who were committed in 2020 was a repeat offenders. For people who have been committed within the past year, the court-ordered remedial plan requires discharge planning to include a review of previous plans and treatment so the new plan can be improved to reduce the likelihood of repeated institutionalization. Hogan did not see this happening at South Mississippi State Hospital. Hogan noted that two people were readmitted after a period of two months. Both had legal issues and there was pressure to “do something” with them. This review, along with DMH’s expansion of community mental health services, took place in the context of the COVID-19 epidemic, which has caused a staff shortage at Department of Mental Health hospitals. Some of Hogan’s scheduled visits to CMHCs or state hospitals were cancelled due to a rise in COVID-19 cases. Hogan praised the “valiant efforts” of local and state staff to provide care despite the difficulties of funding, staff shortages and health risks. In an acknowledgment at the end of the report, he said that “this report comes at a moment when we all hoped for the pandemic to be over.” “The monitoring team recognizes these challenges and the burden on those who depend on and provide care. We salute the perseverance of those who fight on, and we grieve those who have lost their battle.” Hogan’s next report is due to be published in September.