The Mississippi Department of Mental Health (DMH) is out from under the fed’s thumb. For now.
Fifth Circuit Court of Appeals Federal Judge Leslie Southwick has overturned the ruling of south Mississippi District Federal Judge Carlton Reeves. New Orleans trumps Jackson.
This is a big deal. The MDH has about 7,000 full-time workers and 600 temporary full-timers, the most by far among state agencies. It represents about 25 percent of the state’s workforce of 27,000 or so.
This was a hometown legal battle. Southwick is a former Mississippi appeals court judge and partner at Jackson’s Brunini law firm. Reeves has been a federal judge in Jackson for 13 years and was a founding partner of Jackson law firm of Pigott Reeves Johnson.
Southwick was appointed to the Fifth Circuit by President George W. Bush in 2007. Reeves was appointed by President Barack Obama in 2010.
The 27-page legal opinion is intricate, as befits federal law, citing dozens of cases and delving into detailed facts and circumstances.
As a journalist, my job is to boil it down to a few simple, understandable concepts.
Here’s my summary of what really went down: Southwick’s opinion said Reeves’ opinion was federal overreach. Leave Mississippi alone to run mental health. This is not surprising since Southwick was appointed by a Republican and Reeves was appointed by a Democrat.
Some background: Federal courts start with the federal district courts. The Mississippi southern district is in the federal courthouse here in downtown Jackson. The feds sued Mississippi in Jackson’s federal district court and won. Mississippi then appealed the decision to the Fifth Circuit Court of Appeals in New Orleans and won.
A three-judge panel ruled along with Southwick. The feds can ask for a hearing before all 17 Fifth Circuit appellate judges. If they lose there, the feds can appeal to the U. S. Supreme Court.
So how do the feds get to sue Mississippi over mental health policy? The Americans with Disabilities Act (ADA) was passed in 1990 and signed into law by President George H.W. Bush. Title II of the ADA prohibits public entities, including state and local governments, from discriminating against “qualified individuals with disabilities” by excluding them from services and activities due to their disability.
In 1999, the United States Supreme Court, in the Olmstead Decision, ruled that failure to place mental health people in appropriate community-based treatment programs violates the ADA.
In 2016, the U. S. Department of Justice sued Mississippi’s Department of Mental Health accusing the state of failing to offer appropriate community-based treatment for mental health. Mississippi wasn’t alone in getting sued. The Justice Department sued 23 other states.
The fundamental issue is how best to treat mental illness. It’s a big deal. One out of five Mississippians will battle serious mental illness at some point in their lives. Managing these unfortunate and usually temporary mental breaks appropriately is vitally important to the wellbeing of our state.
Our nation, and Mississippi, is in the middle of a decades-long transition of mental illness treatment from hospitalization in big centralized facilities to out-patient treatment in a local setting.
Back in the old days, if someone snapped, we just locked them away in a big mental institution. Unfortunately, such trauma is the absolute worst thing you can do to someone undergoing the stress of a mental break. It takes a bad situation and makes it much worse, often causing permanent damage to the brain.
As society has progressed in its understanding of mental illness, treatments have improved. We’ve learned to gently nurse the mentally ill back to health with a minimum of trauma. Just like cancer, the recovery rate from mental illness has greatly improved over the years thanks to better treatment procedures.
Running a country through lawsuits is a strange way to go but it’s efficient. The United States government has three million employees. That’s minor compared to the 20 million people who work for local and state governments.
Yet federal laws are supreme and trump state laws. That’s part of our Constitution, article five.
The federal government exercises its supremacy through the federal judicial branch — federal lawsuits.
From a federal perspective, this is an efficient way to exercise power. The feds don’t have to hire a huge remote administrative force, they just sue the states and make them do as the feds tell them to. It’s quite a unique and interesting way to run a nation.
Southwick overruled Reeves on a fine point of the law: the risk of discrimination versus actual discrimination.
As the opinion stated: “As with its investigation of Mississippi, the United States’ suit was not based on individual instances of discrimination. Rather, the federal government charged that due to systemic deficiencies in the state’s operation of mental health programs, every person in Mississippi suffering from a serious mental illness was at risk of improper institutionalization in violation of Title II.”
Southwick said being at risk of institutionalization was not enough to violate Olmstead. Only actual discrimination met that standard. A study didn’t cut it. The feds needed real cases of actual discrimination.
So now this huge federal takeover of the DMH grinds to a halt. The special master loses his power. The DMH is free to operate as they see fit. Expect the feds to reload.
It’s not like the DMH doesn’t understand the need for community-based treatment. Indeed, DMH has long been moving in that direction, as the federal special master noted. The feds want a much faster transition.
Ironically, the state could save a huge amount of money if it transitioned to community-based treatment, which is often funded by federal dollars through Medicaid and other federal programs.
But the state mental health centers employ a lot of people. There’s a constituency that goes with that.
NIMBY (Not in My Backyard) is also a problem. Just where are you going to put these neighborhood treatment centers?
Meanwhile, while the bureaucrats battle, the judges overrule one another and the lawyers get rich, the financially challenged mentally ill wander aimlessly along the streets of Jackson or sit locked in prison.
