Mental health patients wait in ERs as Coast county, sheriff and hospitals look for a fix
Last week, 11 people in Harrison County were committed to receive mental health treatment.
But because of staffing issues at the region’s Crisis Stabilization Unit, six of them were sent to local emergency rooms instead.
Everyone — from Chancery Clerk John McAdams, who oversees the civil commitment process, to the leaders of local hospitals including Memorial and Singing River, to the county supervisors — agrees: It’s not supposed to be this way.
And yet it has become routine for many of the roughly 400 people who have commitment hearings each year in Harrison County.
“We’re putting pressure on the emergency rooms,” McAdams said at the meeting about the issue Tuesday morning. “And not only that, our obligation for treatment is not being fulfilled.”
State law gives counties the responsibility of locating and paying for “treatment before admission to a state-operated facility.”
At the meeting, the Harrison County Board of Supervisors embraced a possible solution. The county could pay for people to receive treatment at private hospitals Oceans Behavioral Health and Gulfport Behavioral Health, which have facilities to care for someone in psychiatric crisis, until a bed in the crisis unit or other state-funded facility becomes available.
The Crisis Stabilization Unit, now operated by Pine Belt Mental Health, is designed to treat 16 patients at a time. But because of recent staffing issues at Pine Belt, only 12 beds are available. The facility is supposed to serve Stone and Hancock counties as well as Harrison.
The supervisors asked board attorney Tim Holleman to prepare a draft contract with the two local hospitals. The details have not been finalized, but under the proposal discussed at the meeting, the county would pay the hospitals $800 per day for each patient’s treatment. If a bed becomes available at a state facility, the patient would be transferred there.
After seven days — which hospital administrators said is the average length of stay in a crisis unit — the facility treating the patient would have to return to the chancery court to extend the length of treatment if necessary.
McAdams said he was glad the board recognized the need for action.
“I think it’s a beginning,” he said.
‘Dialing for beds’
When McAdams was “dialing for beds” for the 11 Harrison County residents who were committed last week, he learned there was space at facilities in DeSoto and Tishomingo counties and in Grenada. But bringing patients to those facilities would require at least two sheriff’s deputies to make an hours-long trip, and Sheriff Troy Peterson said Tuesday he simply doesn’t have the staff for that.
The board also discussed allocating funds for Peterson to hire more deputies to ensure patients can be transported to treatment facilities around the state.
Peterson said he’d need to hire five additional employees.
“It would simply be a mental transport division,” he said.
According to statistics provided by McAdams, Harrison County has the largest number of hearings and actual commitments of any of the 13 counties in its region, which stretches north to Hattiesburg but does not include Jackson or Stone counties.
In 2020, of 999 commitments in the region, 338 were issued in Harrison County. In Forrest County, the next-highest figure, 145 people were committed last year.
Harrison County, the second-largest county in the state, is by far the largest in its region.
A chart McAdams provided showed that seven of the counties in the region list the same “pre-hearing holding facility:” Jail.
McAdams and Peterson said that’s not an option they can accept.
“I’m a firm believe that a mental health patient does not need to be kept in a six-by-six cell,” Peterson said.
But emergency rooms aren’t the best place for patients either. Memorial Hospital CEO Kent Nicaud said that yesterday the county finally found a bed for a patient who had spent 10 days waiting in Memorial’s ER.
“It is not a treatment,” he said. “It is keep them safe until we can put them in a treatment facility. That is not right.”
A complicated problem
In an interview after the meeting, Peterson said caring for people in the throes of a mental health crisis has been a challenge as long as he’s worked in Harrison County. Mississippi is ranked among the worst states in the country for access to mental health care. The state says it can’t pay for what local officials want. And sheriffs often end up housing and caring for the mentally ill, a role they know they’re not equipped for.
“Everyone blames the problem on everyone else,” Peterson said. “No one takes responsibility.”
Before this year, Gulf Coast Mental Health Center provided care, including crisis beds, for people in Harrison, Hancock and Stone counties. But the agency had nearly collapsed financially in 2019, and survived only with help from the state.
In November, Pine Belt Mental Health took over operations.
Peterson said their management has been an improvement, but the question of where to place patients waiting for a bed has remained a thorny one. And Pine Belt has made clear that it’s the county’s responsibility.
“The CSU is not responsible for finding a placement for individuals to be held while they are waiting for court proceedings,” Pine Belt’s director of adult services Rita Porter wrote in an April email to McAdams, which he distributed to attendees of Tuesday’s meeting. “That would be Chancery’s responsibilty.”
No Medicaid expansion and a troubled agency
Harrison County’s issues are only a piece of the state’s mental health care struggles.
At one point during Tuesday’s meeting, District 2 Supervisor Rebecca Powers asked if Medicaid couldn’t reimburse the county for paying for the care of indigent patients. District 5 Supervisor Connie Rocko pointed out that most adults under 65 aren’t eligible, because Mississippi is one of 12 states that hasn’t expanded Medicaid.
“Is there any chance the Legislature will open up Medicaid from 18 to 65 so that these people can be covered?” she asked.
Republican leaders including Gov. Tate Reeves oppose Medicaid expansion. A plan to put Medicaid expansion directly to voters was halted after the state Supreme Court ruled Mississippi’s ballot initiative process “inoperable.”
The state Department of Mental Health, which distributes funding for crisis units around the state but doesn’t run them, has had its own troubles.
In 2019, a federal judge ruled the department was unnecessarily institutionalizing people with mental illness, and failing to provide adequate community-based services that could help them get treatment near their family and friends. In 2020, the department said it shifted more than $13 million to community-based programs.
At Tuesday’s meeting, supervisors were incredulous that the department’s $576 million budget was insufficient to ensure Harrison County residents could get services.
Powers said her understanding of the department’s role over the crisis units was to determine how much funding each of them receive.
“Well, a computer could do that,” she said. “What are they doing... that we are struggling to find beds for our people?”
This story was originally published June 23, 2021 at 5:50 AM.
