By Larrison Campbell

Mississippi Today

The Department of Mental Health and the Division of Medicaid need more financial resources, according to a study from nonprofit consulting firm Technical Assistance Collaborative.

The results of the $300,000 taxpayer-funded study, sealed since 2015, were ordered released by a federal judge on Saturday.

The state originally commissioned TAC to study its mental health care system in 2014 as part of ongoing negotiations with the U.S. Department of Justice, which in December 2011 had found the Department of Mental Health in violation of the Americans with Disabilities Act.

The TAC report concentrated on the Department of Mental Health as well as the Division of Medicaid, which provides funding for many mental health programs within the state. According to the report, these two departments cannot be expected to provide for vulnerable Mississippians without better funding.

“While our recommendations do address the need to redirect certain resources from high cost and less-effective care, redirection of funding alone will not provide the resources needed. Both DMH and DOM need the ability to be more nimble, to be able to more rapidly identify system gaps and deploy resources to solve problems. This requires access to data, quality indicators, staff to conduct joint reviews and analysis of outputs and internal flexibility to respond to indicators for needed change,” the report says.

The Department of Justice has long argued the state relies too heavily on the institutionalization of individuals with mental health needs and advocated the state shift resources to community-based services, helping individuals to live independently.

The TAC report also supports the Justice Department’s assessment.

“Most children and youth can be served effectively and appropriately within their own homes and communities if the right mix and intensity of services are available. Family choice is crucial, but families are not making a true choice when their only option is institutional care or no care,” the report says.

TAC completed the Mississippi Children’s Behavioral Health Assessment report in March of 2015, but Attorney General Jim Hood sealed the findings and has repeatedly opposed requests to make the report public.

On Sunday, Hood released a statement supporting the report’s findings and stressing the need for additional mental health funding.

“Many times I have stressed the importance of funding for and solving the problems of our outdated mental health system. Now that this report is public, I hope that other elected officials who are in a position to make a positive change will follow suit for those in our state who need their leadership the most, and need it now,” Hood said in a statement.

And while some mental health advocates praised the report’s release, they have also lamented the time it took to make its findings public.

“We are very happy this report is finally public but so sad at the opportunities that were missed by not having this information for over two years.  It is puzzling why the state went to such lengths to hide this report from families and the taxpayers who paid for it.  We could have spent the past two years working together to make things better for our children,” said Joy Hogge, executive director of Families as Allies.

The saga over the report’s release began shortly after it was completed in 2015. Immediately, media and mental health advocates pushed the state to make public the evaluation’s findings.

That spring, the Clarion-Ledger challenged the protective order on the results, but a judge denied its request. Then last August, the Clarion-Ledger filed a renewed motion to vacate. The TAC report’s release Saturday is the result of a settlement between the plaintiffs and the state, which voluntarily agreed to release the report.

“The report was considered confidential in that it was produced in order to guide negotiations and hopefully help reach a settlement agreement, but it was generally always expected to be released and distributed when the case reached its conclusion,” said Department of Mental Health spokesperson Adam Moore on Saturday.

In its conclusions, the TAC report outlines strengths and weaknesses of Mississippi’s children’s mental health and substance use service systems.

SYSTEM CHALLENGES

•Resources: The Department of Mental Health and the Division of Medicaid “need additional resources in order to be prudent purchasers of mental health and substance use services. These resources are needed for service delivery and for infrastructure, particularly in the areas of data, quality improvement, and inter-agency collaboration.”

•Coordinated purchasing and policy strategy: The report states that the systems of care in place in Mississippi are spread out among too many departments and require better coordination. “Mississippi is hampered by the disparate administration and financing of major components of their children’s behavioral health system. (DMH), DOM, child welfare, juvenile justice, the courts, education and public health all play a significant role in children’s behavioral health. … A common planning and purchasing approach that addresses critical system functions … (is) needed to improve the behavioral health system.”

•Partnership with youth and families: The TAC report says that “there is a voiced perception among some stakeholders that Mississippi leadership is disengaged from the voice and will of youth and families. Consequently, there is little trust of efforts for system transformation … decisions by leadership at DMH and other state agencies must align with the goals and values of youth and families. This can only be achieved through sustained outreach, engagement and collaboration with families and advocacy organizations.”

•Reduce reliance on institutions: The TAC report commends current efforts by Mississippi leadership to improve home and community-based services, however, “considerable work remains to fully transform a system historically oriented towards institutional care.”

NOTABLE STRENGTHS

•Home and community-based benefits already available: The report commends the state for expanding its home and community-based benefit system in 2012 to include “nationally recognized” services for children and youth with intensive behavioral health needs.

•Evidence-based therapies In 2008, the Department of Mental Health joined forces with the National Center for Child Traumatic Stress to start a statewide Learning Collaborative in Mississippi designed to enhance the implementation of TF-CBT. Since then it has trained staff in this approach and promotes its use in state institutions.

•Compliance-review process The Division of Medicaid’s on-site compliance review process is a “highlight of Mississippi’s quality monitoring system (and) very thorough in its scope.” TAC found that this tool allows compliance reviewers to “provide clear, specific feedback regarding findings to provider staff.”

•Peer support training The TAC report commends the Department of Mental Health for “considerable investments” in training Certified Peer Support Specialists, which the report said, “prepares specialists for helping families enhance community living skills, community integration, rehabilitation, resiliency, and recovery.”

•State training infrastructure In 2012, a State Wraparound Council was formed with the University of Southern Mississippi School of Social Work, the Department of Mental Health and the Division of Medicaid to plan for sustainable wraparound training infrastructure. The report says, “Mississippi is well on their way to building a network of certified coaches and trainers as a result of state-level investments and support, which will be vital to ensure adequate capacity for meeting growing demand for wraparound services.”

•Map teams These local multi-disciplinary teams meet monthly to review at-risk children and youth and identify community-based services that “may divert children away from inappropriate out-of-home placements.” According to the report, families have reportedly been satisfied with the MAP team process, and they can “serve an expanded role to address local system level gaps and issues.”

•Inter-agency Coordinating Council for Children and Youth and Interagency System of Care Council: The report states that these systems of care provide a clear and impressive framework for establishing an inter-agency governance structure and appropriately delineates how a statewide coordinated system of care should function. But it cautions that while the inter-agency council meets regularly and elicits commitment from mid-level agency staff, “the Interagency Coordinating Council for Children and Youth  has not been implemented as intended.”