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Budget cuts stress mental health agencies

Northeast Mississippi Daily Journal (Tupelo) - 7/24/2016

July 24--The mental health safety net across North Mississippi is stressed out.

North Mississippi State Hospital didn't lose any beds in the last round of budget cuts, but it has been pushed to the brink to maintain services.

"We are on the edge of the cliff," said Dr. Paul Callens, director of the 50-bed inpatient psychiatric hospital located in East Tupelo that handled more than 600 admissions in the last fiscal year. "If there are any more cuts, we're going to be forced to close beds and lay off staff."

Communicare, which provides community mental health services in Oxford and five surrounding counties, served 4,000 individuals in the 2015 fiscal year. It anticipates final figures will show it served nearly 5,000 in the 2016 fiscal year that just ended.

"Funding has remained flat in several areas, but the demand has increased," said Communicare director Sandy Rogers. "The need for substance abuse treatment has increased tremendously."

Fewer open beds means that people who are a danger to themselves and others often end up waiting in jail, said Prentiss County Chancery Court Clerk Bubba Pounds. Because of heavy lifting by community mental health, crisis services and the state hospital, people who have been committed in Prentiss County usually don't stay more than a few days in jail. But even short stays are not acceptable for people who have committed no crime, he said.

"It's a cost for the county, but it's the families that really suffer," Pounds said. "I wish mental health was truly a priority for leaders in this state, not just a line in the budget."

National crisis

Mississippi isn't alone in the erosion of capacity in its mental health safety net. According to a June 2016 report issued by the Treatment Advocacy Center, there's been a 17 percent drop in the number of inpatient psychiatric beds per capita. As a country, the United States has 11.7 beds per 100,000 population, but almost half are occupied by people who are also in the criminal justice system.

Mississippi used to be in an enviable position with more than 40 inpatient psychiatric beds per 100,000 population -- a level that's considered adequate to care for the severely mentally ill, Callens said.

"Mississippi was No. 1 in the nation for having the best ratio of inpatient psychiatric beds per capita," Callens said.

Now, the state is down to 16.2 beds per 100,000 population.

"Mississippi is second only to Alabama in the percentage of beds lost since 2010," said John Snook, executive director of Treatment Advocacy Center, a Virginia-based nonprofit organization that advocates for timely, effective treatment of severe mental illness.

Compounding the problem, Mississippi has the highest rate of mental illness in the country with more than 400,000 seeking mental health care.

"And there's a bunch more who won't seek it," Callens said.

High rates of poverty and lack of health insurance mean that families often have limited resources when mental illness strikes.

"In a fragile system like Mississippi, you don't have a lot of room for error," Snook said.

Intensive care

The role of the state's mental health hospitals is to serve as an intensive care unit, stabilizing the most severely ill who are so sick they are a threat to themselves.

"We've got 30 days or less to get that done," Callens said.

When they are stabilized, they can be discharged back home, or to a group home or personal care home. They usually need intensive outpatient counseling and case management services through community mental health centers.

"The tighter budgets have left individuals with a greater level of illness acuity to be treated in the community with little or no support system," Rogers said.

Even in the stressed systems, the mental health professionals are looking for innovative ways to help the people they serve live healthier lives.

The North Mississippi State Hospital received a federal grant last October to hire two peer counselors to help patients move from the hospital back to the community.

The peer counselors, who have gone through a mental health hospitalization and successfully rebuilt their lives, meet with patients before they leave the hospital, help make sure the patients get to follow up appointments and provide a sounding board.

"I think things are going well," said Debbie Hall, North Mississippi State Hospital communications director. "The rates for keeping appointments has gone up."

Communicare has multiple efforts, including Project Thrive, which provides some limited assistance to individuals who are homeless and have mental illness, and youth programs, which are focused on helping them learn skills to be successful as adults, Rogers said.

"There are always opportunities, if you have the support of the community, space and funds to pay the staff," Rogers said.

Tightening up

Because there have been multiple cuts over the past three years, North Mississippi State Hospital leadership began preparing for the worst in January and froze hiring. They passed on filling 11 positions, spreading responsibilities out over the rest of the staff. Housekeeping has become a shared job.

"Everybody is helping everybody," Callens said.

The state mental hospitals are coordinating so that open beds are filled quickly and wait times minimized.

Communicare is making do by squeezing three or four staff members into offices meant for one or two and leveraging patient assistance programs to find medications for clients, Rogers said. Haven House, a residential substance abuse program for women, is full and has a waiting list for several months.

"The number of new patients we see, as well as the number of services we provide continue to escalate," Rogers said. "We continue to do more with less, but we have reached the point where that is no longer an option."

michaela.morris@journalinc.com

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(c)2016 the Northeast Mississippi Daily Journal (Tupelo, Miss.)

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