JACKSON, Miss. — The U.S. Justice Department on Tuesday told a federal judge that Mississippi provides too few mental health services in the community and confines too many people in state mental hospitals.
In opening arguments, lawyer Deena Fox urged U.S. District Judge Carlton Reeves to intervene to force improvements in community services. Federal officials argue that Mississippi’s current system violates the Americans with Disabilities Act almost 30 years after it was enacted and that Mississippi has had plenty of time to improve.
“But here we are,” Fox said. “Mississippi has still not complied with the requirements and promise of the ADA.”
She said the federal government wants Reeves to order the state to identify eligible adults with serious mental illness who need services. The federal government wants Reeves to order the state to connect those people to community services and provide them with the aim of avoiding unnecessary hospital stays. And once someone is in the hospital, the federal government wants the state to make sure they have a seamless plan for care once they leave.
The federal government sued the state in 2016 after negotiations over a possible settlement broke down. The state says the federal government is overreaching. Mississippi is progressing on its own, lawyer James Shelson said, urging Reeves to give Mississippi time to continue improvements instead of burdening the state with an overly expensive court order that demands too many services.
“A win for Mississippi in this case is simply this: time to finish the job,” Shelson said. “Time to finish the job of downsizing state hospitals while increasing community services. Mississippi is much closer to finishing the job than (the Department of Justice) admits.”
Fox disputes that claim, saying Mississippi has barely started moving toward community-based services and does not even appear to have a comprehensive plan to comply with a 1999 U.S. Supreme Court decision that underlies the case.
“They didn’t begin to shift those services until 2018,” Fox said. “There’s still a long way to go.”
The state, though, says the federal government is overstepping the Supreme Court decision, seeking to force fundamental alterations to the state’s system. Shelson said the federal government hasn’t laid out a list of services it’s demanding or a budget.
“How much is enough?” Shelson asked. “DOJ won’t say.”
He also accused the federal government of trying to close all four of Mississippi’s state hospitals, although the federal government hasn’t made such a demand.
Fox, though, said the state’s defense of the hospitals points to underlying problems.
“It is difficult to understand why Mississippi’s system remains so focused on institutional care,” Fox said
She said that many community-based services are a patchwork, offered in some counties and not others, and said a demand for statewide coverage for all those services is entirely consistent with federal law.
“This is achievable. The state can do this,” Fox said. “The United States is not seeking new services here, merely the provision of services that the state has chosen and begun to provide.”
After opening arguments, the federal government’s first expert witness took the stand. Dr. Robert Drake of the Dartmouth medical school testified that a review found 154 current and former state hospital patients didn’t appear to receive community services, even though state documents called for such services.
“At least the 154 patients in our review did not receive many of those services, that we could detect,” Drake testified.
Reeves is hearing evidence in the case without a jury and the trial could go six weeks or longer. Each side will submit further written arguments and proposed outcomes when the trial is over, and a decision is unlikely before late this year.