Advocates demand changes in Mississippi mental health system

Published 10:29 am Tuesday, July 25, 2017

By Anna Wolfe

The Clarion-Ledger

JACKSON — At 6:30 p.m., he still wore his hospital wristbands from the night before — one on each arm.

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The patient, we’ll call him John, had been ping-ponged from hospital to hospital in the middle of a psychotic episode. At midnight, he took an ambulance ride strapped to a gurney from Columbus to Jackson, to the closest facility that could help stabilize him.

But instead of going to the psychiatric unit to be treated, he spent the night in the emergency room. The next morning, he was discharged onto the street more than two hours away from home, without medication and still suffering from delusions.

Two taxpayer-funded hospital visits and an expensive ambulance ride later, John got nothing. For the same amount, John could have received up to six months of community services care, saving taxpayers and providing him with actual care.

“It’s like they trap you inside the system instead of helping you,” he said.

Mississippi has known for years that its mental health system is broken. Over the last decade, the state has received advice for fixing it, most of which has gone ignored, advocates argue. It was no surprise when the U.S. Department of Justice filed suit against the state of Mississippi last August for failing to provide community-based services.

Advocates and state-commissioned reports criticize the state for not changing its attitude toward mental health and for continuing to focus on outdated models that favor institutionalization. They cite a lack of coordination between the different mental health agencies and organizations as one of the state’s biggest failures.

John, a casualty of the system, has fromered with mental illnesses for more than two decades. The 28-year-old has been diagnosed with bipolar disorder, psychosis, schizophrenia, anxiety, insomnia and attention deficit hyperactivity disorder, among others.

His mother recalled the difficulty John had growing up and in school, whether he was acting out or on medications that made him act like a “zombie.” He never passed ninth grade, though he did receive his GED.

As an adult, he’s found medication that works. But when he got a job last year, he lost the Medicaid benefits that allowed him to afford his prescription.

In the last few years, he’s vacillated between 1) not working and using Medicaid to pay for medication that helps him manage his conditions, or 2) having a low-paying construction job, making him ineligible for Medicaid and therefore not able to afford the $800-a-month prescription.

The latter presents a new problem: Folks suffering from untreated mental illness often turn to street drugs to self-medicate.

“Like a dog chasing his tail,” John’s mother said of his predicament.

John spent several years in prison after his 18th birthday on a drug-related charge. Drug abuse ultimately led to his recent crisis.

Mental health ping-pong

After being discharged from the hospital in Jackson, there was one program keeping John from falling through the cracks entirely: the Mobile Crisis Emergency Response Team for the region in which he lives.

John’s mom picked him up from Jackson and, on the direction of a Region 7 counselor, took him straight back to Starkville Community Counseling Services where he first had sought help the day before.

“I’ve never been to two hospitals in one day. I have been arrested twice in 24 hours, though,” he said with a laugh, his sharp gray eyes directed at the linoleum floor in the counseling center meeting room.

In John’s case, the intervention from the crisis team prevented the need for law enforcement’s involvement and an unnecessary jailing.

In red pen, somebody had scratched out the “University of Mississippi Health Care” logo on John’s blue scrub top, replacing it with “Patient.” His bony knee poked out from a large hole in his jeans.

He joked that a list of his diagnoses could fill up one of the large black binders sitting on his counselor’s desk. He was in good spirits considering the night he’d had, starting with a call to Region 7’s crisis hotline he placed the afternoon of July 5 while withdrawing from crystal meth.

Veronica Harrison, coordinator for the region’s mobile crisis response team, answered John’s call, met with him and counseled him for hours until he agreed to go to a hospital. John is currently enrolled in Medicaid. He stopped working last spring and only recently became Medicaid eligible because he has a wife and stepson for whom he provides.

After receiving counseling, John initially traveled from Starkville to Columbus to be admitted to Baptist Memorial Hospital-Golden Triangle. There was no room in the hospital’s 30-bed inpatient psychiatric unit when he arrived.

Harrison said Baptist recognized John’s need to receive psychiatric care — his delusions were ultimately attributable to an untreated mental illness — and the hospital arranged a transfer to the University of Mississippi Medical Center.

When Harrison left John at Baptist at 9 p.m., the plan was for him to receive 72-hour treatment and medication from UMMC’s 21-bed psychiatric unit.

He received neither.

“I wish this was an unusual occurrence,” said Harrison, whose crisis team covers a seven-county region in north Mississippi. “But somebody got greedy and (admitted) him instead of saying, ‘We don’t have a place for him either.’

“To me, that’s raping Medicaid.”

A UMMC spokesperson said HIPPA laws prevent the hospital from commenting on any patient visit.

Generally, if a doctor determines a patient should be admitted to the psychiatric unit and no beds are available, UMMC policy says the patient should be cared for in the emergency department until he or she is transferred.

UMMC does not, however, admit patients “for the primary diagnosis of drug and/or alcohol dependency,” according to the spokesperson.

‘Pointless process’

The Clarion-Ledger did not have access to John’s medical bill, which was sent to Medicaid, but his 24-hour journey through Mississippi’s mental health system easily cost thousands in taxpayer dollars, whether paid by Medicaid or eaten by the public hospital.

Based on 2017 rates, Medicaid would pay more than $1,000 for the 152-mile ambulance ride alone.

Had it been spent on community services, $1,000 could have paid for five psychological evaluations, 13 days of day treatment and 10 group therapy sessions for a patient, based on Medicaid rates.

For less than $6,000, community centers could provide a patient with day treatment every day for six months.

“This is just another example of dollars wasted for somebody to not get the help they needed because of a breakdown in communication and coordination of care,” said Region 7 Executive Director Jackie Edwards.

At 9:30 a.m. the day after his hospital stay, UMMC released John without giving him so much as an aspirin, Harrison said, leaving him to wait outside for several hours until his mom arrived to pick him up.

UMMC recommended John continue taking the medication he stopped taking last year when he started working and lost his Medicaid benefits, Harrison said. But the hospital did not give him a prescription for it.

“He wants his meds back,” Harrison said. “He knows he needs them, but street drugs are a whole lot cheaper.”

In seeking help that Wednesday, John followed through on his part. The system failed him.

“I feel like I just went through a process for a pointless reason,” John said. “Everyone trying to help just got spit on in the process.”

Harrison was one of those people.

Because her job includes following up with her clients, Harrison discovered John had been released from the hospital instead of being held for treatment. Harrison then scheduled him a doctor’s appointment the next morning with Region 7’s psychiatrist in nearby West Point, who was able to prescribe the needed medication.

“I sure wish he would have stayed in the hospital,” the psychiatrist told Harrison after seeing him.