The Mississippi Department of Mental Health tried to bury a report that blasted its shortcomings from the public. However, the good guys won a round last week as the Clarion-Ledger's won it's fight to obtain a copy of the report. The report said Mississippi spent much less per child on mental health services than the national average while it spent more of its budget on expensive institutionalized care than did other states. The Justice Department weighed Mississippi's delivery of mental health services to it's children and found it to be very wanting. The state naturally followed it's natural inclination to keep it all a secret and fought the newspaper in court over releasing a report ordered by the state. Some highlights of the report are:
*In FY 2014, Mississippi Medicaid spent a total of $184,485,255 on children health services, or $1,183 per child receiving behavioral health care. Nationally, mean expenditure for children in Medicaid using behavioral health services was $4,400 in 2008.
*Forty-nine percent (49%) of Medicaid child behavioral health dollars in FY 14 were spent on services provided in institutional settings. Nationally, in 2008, 28.3% of child behavioral health dollars spent by Medicaid were spent on inpatient or psychiatric residential services.
*Among the institutional services, inpatient psychiatric hospitals experienced the greatest increases in the number of unduplicated utilizers. There was an increase of approximately 22% in the number of youth who utilized inpatient psychiatric hospitals from FY 10 to FY 14.
*The workforce shortage issues facing Mississippi have limited the capacity of community providers to serve youth and families. Child psychiatrists and mental health professionals with child-specific training and expertise were cited as factors contributing to access to care issues for youth and families in community settings. This is further hampered by the rural nature of the state, making it difficult to provide care and reach certain geographic locations.
*Telehealth in Mississippi has grown with respect to its use in primary care and other medical specialties, yet was used by few behavioral health providers. There was a lack of information and awareness about available opportunities to expand tele-psychiatry among the CMHCsand IOP providers.
*Physicians are prohibited from entering into a collaborative agreement with an advance practice registered nurse (APRN) whose practice location is greater than 40 miles from the physician's practice site, and physicians may not enter into collaborative agreements with more than four APRNs at any one time. Given the rural nature of Mississippi, these requirements may limit the potential of APRNs to provide psychopharmacology to youth who may require it. (KF Note: This lies at the feet of the Mississippi Board of Medical Licensure although the radius was increased to 75 miles last year.)
*Uncompensated care is another issue constraining provider capacity in Mississippi. While the state's network of CM(Cs are required by DM( to deliver a number of "core" services, providers report that the funding contributed by the state and the counties do not adequately cover the costs of delivering these services. DOM and DMH have offered to conduct a rate study on services this offer was reportedly declined by the Mississippi Association of Community Mental Health Centers.
*The average cost per user of residential was $49,000 in SFY 2014, more than double the national average. Spending on inpatient psychiatric services (including inpatient medical surgical) was greater than the national average, accounting for 24 percent of total mental health Medicaid expenditures in SFY 2014 (compared to 5 percent nationally).
*DMH spent $28.6 million on state mental health hospitals for children and youth, compared to a national average of $11 million. Per capita spending for state hospitals was the second highest in the country. In contrast, only $69 million was spent on community-based programs, compared to a national average of $179 million.
The report is posted below and cost Mississippi taxpayers $300,000.
Tuesday, June 20, 2017
Secret mental health report: State locks up too many kids.
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18 comments:
In a day when everything is judged based on averages, don't some states have to spend more and some less than others?
When all states are identical and there is no such thing as average, we will have witnessed total federal control. And the ACLU will have no reason to exist.
Jim Hood did the guarding for them. Guess the gestapo at mental health is a "friend".
If I interpret this correctly, it appears we are spending so much more than other states on expensive institutional care, and less on less expensive outpatient care. There is a lot wrong with that picture.
And who just happens to have a lobby?
Fitting comeuppance for the control freak known as Richard Barry.
Enjoy your budget cuts Rick!
Your incorrect use of "it's" is appalling.
Taken by itself, the fact that we spend more on inpatient care than other states alone doesn't convince me that we're doing things wrong when it comes to mental health. We may be, but I can't draw that conclusion from this.
I have a relative in a neighboring state who is a youth mental healthcare professional and he strongly believes that the recent migration away from inpatient care to less expensive outpatient care (due to budget cuts, not best practice) is going to catch up to us. He tells me there are now a lot of patients that probably should be in a facility but he's supposed to cure their issues with 45 minutes a week and some meds they may or may not take and then send them out on the street. Other states may be treating more patients for less, but this report gives no indication as to the success of this high volume low cost treatment methodology.
The level of corruption at the highest levels of Mississippi government are staggering. No transparency, good ole' boys/girls from "Ole Miss" running most of the state into the ground while fattening their pockets. Follow the money and how many UM alumni are behind it and you'll see the toxic picture clearly.
Anyone who is appalled by comma placement probably needs to be institutionalized.
When you have a minor who bounces off the wall of unbridled bad behavior, what good is served by day 'treatment' and sending him home at night?
"level...are...staggering". That too.
9:06 am OMG You don't understand averages. An average is done to account for differences between states! Didn't you average your grades in school?
In a state with a smaller population than most states and where mental health professionals are paid less, you'd expect our costs to be much lower not higher than average.
What is likely a factor is that we are sending children to be institutionalized in other states and that is costly!
What this report is intended to do is help Mississippi identify and solve problems as these children become a greater expense to society as adults if untreated. It's not about federal control! Worry about federal control when one political party controls the government completely!
1:25 pm As a retired mental health professional, I don't disagree with your relative when it comes to adult mental health care.
I expect we'd agree that the environment in which the patient resides when they leave the office matters.
But, when it comes to children, institutional care is a last resort. No institution can provide a the security and sense of permanence of a parental figure.
Often the child's family will need a great deal of help in learning how to deal with difficult behavioral problems. And, they may need financial support and home care support.
If parents are incapable of meeting the child's needs , then a surrogate parent who is a relative is second best .
Third best would be a well trained foster parent.
Ideally, institutional care should be a short term effort to give the parents emotional and financial relief and time to prepare to parent a troubled child.
Ask your relative. I'm sure he'll agree.
I'm familiar with a facility in a nearby County that warehouses children for years at a time and the children are said to view that facility as 'home'. Some respect the staff and some are combative and constantly cause behavioral problems, which obviously is why they're there. Some of the children had issues related to inappropriate sexual contact while others range from A to Z. I say this to say I can't imagine these children being sent home every night or being kept at home in a community based out-patient situation. They are under lock and key and frequently 'run' and the entire staff have assignments when that 'horn' sounds.
What is the answer for these children? We're not talking about a kid with a nervous tick or one who is simply rebellious in the presence of authority. Are you people (the professionals among you) of the opinion that they will be 'cured' and returned to general society or will they always be wards of the state? Obviously we will care for them and we want to do that, but what the heck is the answer.
Sadly some of the staff allow these children to fight while others watch, like a dog fight. Some children will have broken limbs as a result of staff attempting to restrain them. One little boy was dressed as a girl by a staff member because he had conflicting gender assignment issues. So, these institutional situations are not always what we hope they are, as the case in nursing homes and other facilities.
10:56 am We should be grateful that some humans are born with enough resilience and perception to survive horrendous childhoods and know how to get the attention they need.
Sadly, while there has been a lot of progress in treatment of mental illness, " cures" are rarer than one would wish. Neuroscience and genetic research is promising.
But, the short answer is yes, there are going to be adults and children who won't respond to treatment or won't cooperate with treatment.
As a society we were actually making progress in having fewer " warehouses" and more secure "residential" and treatment facilities. Congress over-reacted to some people being inappropriately placed in long term facilities in the early 70's. Indeed, in some highly shocking ,poorly investigated instances, the people who were thought not to have been appropriately placed. Time proved that while many of those did so well enough with supervised meds, they could actually work at the facilities, once released, they became homeless or worse.
Bad things happen when the public makes demands based on emotion and politicians take the easy quick fixes without knowing anything about the subject.
Now, any "fix" will far more complex and expensive. But, we are paying now , not just as this reports states, but in SSI payments and crime costs and loss of life.
And, frankly, though I'd be sued to break confidentiality, we have some mentally ill people in national positions of power and influence . Seriously mentally ill people can be very bright, attractive, well groomed, charming, persuasive and mask their paranoia or lack of conscience quite well.
I'm 10:56 and have read and re-read 1:20's post three times without reaching any conclusion as to what is being said. Other than rambling on, what the hell is your point?
You are obviously on the payroll of some mental health facility or program, but, I'll be damned if you make any sense at all. Are you lobbying for more money? Are you apologizing for years of poor process-management? Are you advocating releasing these people with a sackful of meds or are you in favor of medicating them to the point where they can be actually put on the residential psychiatric treatment facility payroll in some sort of therapy assistant role?
I listened to Gallo-Rewind this afternoon. The most distinguished representative Steve Holland rambled on for at least thirty minutes about 'community based services' and never once bothered to define what that means, what services are offered, what the facility does or looks like or who staffs it or what programs, if any, are offered at one, whatever it is.
So, is it like a day care where a high paid transportation official brings the mentally ill in each morning and takes them home in the afternoon, with a meal provided and maybe some group activities and a one-on-one session to determine (and document) how the patient is feeling today? Or what?
@ June 21, 2017 at 3:49 PM
Good and fair question.
Basically, it is like a day care.
The technical definition is "to provide inpatient, outpatient, partial hospitalization, emergency care, and consultation/education services on the local level - from the county on down.
Right now we are on the institutional model. In 1963 the Community Health Act was passed. Where states were instructed to start shutting down their state-run institutions and move to a community-based (county) model. Of course, there was a lot of blowback on this from the states across the country. So no one was in a hurry to go to that model.
Then in 1972 Geraldo Rivera comes along and does a documentary on Willowbrook State School in NYC. OMG - you talk about opening Pandora's Box! Big facility, a poorly trained staff, poorly ran, patients were not being cared for, it was one giant cluster f*ck. The Department of Justice comes in and starts investigating these big state-run institutions across the country and decides it's high time to get away from the institutional model and go to the community-based model.
But you know this is Mississippi and Mississippi will do what it wants to do - so we have maintained our current institutional model, regardless of the various brow warnings from the feds.
Now if you move to the community-based model, it will give mental health patients more intimate care, keep them in familiar settings and services could be provided on a smaller scale. There are 82 counties in Mississippi and each one is supposed to have its own facility to handle mental patients within that county. The problem with that - is how to fund it? How to properly staff it? Facilities? Transportation? Access?
Mississippi is still relatively a rural state, with a sparse population. To move to community-based system sounds great when the state's infrastructure is solid and accessible. But that is a road block for us here, considering the condition of the state - fiscally and logistically.
During Barbour's Administration he did lay down the ground work to start moving towards a community-based system, but for whatever reason, the funding went south and the 4 facilities the state started with were shut down.
Mississippi is painted into a corner on this because what is going to happen is that if the state does not take the initiative to fix this problem on its own; the Feds will come in, bring in who they want and just start charging Mississippi for the bill.
We have a long arduous road ahead when it comes funding and reshaping mental health in Mississippi
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