June 22 was the 21st anniversary of the ruling in the landmark Supreme Court case, Olmstead v L.C., which established that people with disabilities, including mental illness, have the right to receive care in their homes and communities rather than in institutions if they choose to do so. This was a monumental decision that gave people with mental illness and their families a reason to celebrate.
On that same day last week, many of us were also reading the State of Mississippi’s latest filing in the United States Justice Department’s Olmstead lawsuit against Mississippi. The state of Mississippi has fought this legal action for over 10 years, repeatedly suppressing information and using strained logic, clever maneuvers and statements taken out of context to defend itself. The state’s legal filings also claim that Mississippi wasn’t and isn’t in violation of Olmstead. That is not true.
This is the truth: Many people with mental illness are not able to get the help they need in order to live in their communities. We urge the State of Mississippi to stop denying this reality and instead do these three things to honor the true spirit of the Olmstead decision:
1. Tell us who the State of Mississippi is: Typically when the federal government sues a state, it names the person or people ultimately responsible for the system being sued (for example, the governor or the executive director or board of a state system). The State of Mississippi itself is the named entity in the mental health lawsuit, perhaps because the United States Department of Justice, like many of us, doesn’t know who is ultimately accountable for Mississippi’s mental health system.
Families as Allies has asked administrators at the Department of Mental Health (DMH) several times over the past four years who is deciding the State’s response to this lawsuit. We were told each time that it is the Attorney General’s office and that the DMH has little influence over the direction of the case. Last month we asked the Attorney General’s office who within the office was making decisions about this case and were told that they could not share that information.
Mississippians deserve to know who the decision-maker is in this case. Mississippians deserve to know if that decision-maker has knowledge and expertise about Olmstead, and which, if any, state agencies this lawsuit includes beyond the DMH. And Mississippians deserve to know if the board and executive leadership of the DMH agree with the State of Mississippi’s recent assertion to the court that the State is in compliance with Olmstead.
2. Develop an Olmstead Plan: In the years immediately following the 1999 Olmstead decision, states began developing plans to assist people living in institutions to transition to the community if they so desired. Mississippi started, but never completed its plan. At the 2019 trial, the members of DMH’s executive management team could not agree if Mississippi has an Olmstead plan, or what it is if the State does have one. There is no plan listed on the DMH’s Olmstead resource page. It is puzzling how the State of Mississippi could claim to be in compliance with Olmstead if there is no plan against which to measure its progress.
We urge the State of Mississippi to stop defending its failures and instead develop a meaningful Olmstead plan in partnership with people with mental illness, their families, the agencies and organizations that touch them, policymakers and other interested community members. Families as Allies continues to recommend this Olmstead Risk Assessment and Planning Checklist from the National Association of State Mental Health Program Directors. This checklist was designed to help states develop robust plans and also possibly lessen the likelihood of Olmstead lawsuits.
3. Examine the use of institutional beds: Although the DMH remains the largest state employer with around 5,000 employees, it has decreased both its employees and admissions to state-run facilities over the past several years. Yet, all twelve of DMH’s facilities remain open, serving fewer people and staffed by fewer employees.
These facilities are scattered throughout the state, except in the Delta. Their presence appears to exert significant influence on legislators and other policymakers. The multiple and sometimes conflicting demands that this places on the DMH need to be openly and transparently examined with everyone involved, especially people receiving services, at the table.
It would seem in the best interest of people being served to explore closing and consolidating institutions, initially without decreasing beds or direct care staff. Cost savings from decreased overhead and administrative costs could then be directed into the community-based services that the state desperately needs. Contracting with private providers for acute care services within communities should be explored as well.
The Olmstead decision represents such hope for people with disabilities and their families – let’s keep that hope alive and demand that the State of Mississippi do so as well.
Joy Hogge is Executive Director of Families as Allies.