Millions of adults in the U.S. suffer from mental health conditions. Many of those conditions start during teenage years. Treatment is attainable and vital.
A $300,000 taxpayer-funded report commissioned by the Mississippi Department of Mental Health confirmed U.S. Department of Justice findings that the state spent more on institutionalizing than community service for those with mental disabilities.
The report was released Saturday by the state after a settlement of a legal battle with The Clarion-Ledger, which fought to make the report public.
A major finding of the report: “While only a minority of claims is for institutional placements, these claims represent a disproportionately large share of expenditures.”
The Technical Assistance Collaborative, a nonprofit hired by the state, conducted an analysis of five years of Medicaid fee for service claims data (2010-2014) and two years of managed care data (2013-2014, coinciding with the implementation of managed care for behavioral health services in Mississippi).
“It is concerning that spending and utilization of institutional care have increased over the past few years,” the report stated. “Mississippi has the opportunity to serve many more youth in less restrictive and more integrated settings by promoting greater use of services, such as mobile crisis intervention, crisis stabilization, intensive outpatient
program (both MYPAC and as a step-down from MYPAC), and peer support. More effective use of these services could help divert youth from placement in costly institutional settings. While utilization and expenditure trends for HCBS services are largely in the right direction, continued work is needed to promote greater uptake of these services in Mississippi.”
In Fiscal Year 2014, Mississippi Medicaid spent a total of $184.4 million on children and youth behavior services.
Other study findings:
- Forty-nine percent of Medicaid child behavioral health dollars in FY 14 were spent on services provided in institutional settings. Nationally, in 2008, 28.3 percent of child behavioral health dollars spent by Medicaid were spent on inpatient or psychiatric residential services.
- Spending for psychiatric residential treatment facilities and inpatient psychiatric hospitals increased by 11 percent and 6 percent, respectively, from FY 2010 to FY 2014.
- Among the institutional services, inpatient psychiatric hospitals experienced the greatest increases in the number of unduplicated utilizers. There was an increase of approximately 22 percent in the number of youth who utilized inpatient psychiatric hospitals from FY 10 to FY 14.
- In FY 10, there was a 10 percent increase in the number of youth who utilized psychiatric residential treatment facilities. Utilization remained steady from FY 11 to FY 14.
Findings related to home- and community-based utilization and expenditures included:
- Significant amounts (over $1 million in a given year) are spent on assessment, community support, day treatment, individual therapy, intensive home-based treatment (MYPAC), and targeted case management; while relatively small amounts (under $1 million in a given year) is spent on services such as mobile crisis, crisis residential, peer support, and intensive outpatient.
- Despite declines in day treatment utilization, nearly a quarter of HCBS dollars continues to be spent on day treatment.
- There was a 64 percent increase in spending on MYPAC intensive home-based treatment from FY 10 to FY 14, with declines from FY 13 to FY 14, despite increases in claims and utilizers.
- In FY 14, there were almost $1 million in claims for crisis services, compared to approximately $250,000, a positive trend.
The state had refused to release the report until the settlement was reached last month.
Attorneys for the state had filed a motion asking federal Judge Henry Wingate to deny a plaintiff’s motion for him to privately review the March 2015 TAC Mississippi Children’s Behavioral Health Assessment report to determine if it should be classified as a public document.
Gov. Phil Bryant didn’t oppose making the report public.
“If the document meets the legal standards for public disclosure, and any issues surrounding litigation have been satisfied, the governor believes it should be available to the public,” Bryant spokesman Clay Chandler had said.
In 2015, the Department of Mental Health refused a Clarion-Ledger request to release the results of the evaluation of its child services, which have been under scrutiny by the U.S. Department of Justice for alleged numerous violations since at least 2010.
Child mental health advocate Joy Hogge said Saturday she had skimmed the report.
“It seems to say we spend more than other states on Institutional care, less on community-based, and it makes a number of recommendations,” Hogge said. “Many of the recommendations concerned me because if they are implemented without a unified vision and plan and true understanding of what it takes to have a responsive system, we may end up making a knock off silk purse out of a sow’s ear. I was happy to see the report begin by saying the most important thing is how the system is experienced by children and families, but very disappointed that it then did not appear to integrate many of the issues families brought to the attention of the interview team.”
Last year, the Department of Justice broke off settlement negotiations over 2011 findings the state was in violation of the Americans with Disabilities Act and filed a federal lawsuit against the state. Notably, the Justice Department alleged the state relied too heavily on the institutionalization of adults with mental health issues rather than helping them to live independently.
At the same time, there is a 2010 federal lawsuit over children’s mental health services in the state.
A federal judge combined the two lawsuits into one case, but plaintiffs in the original case have filed a motion asking Wingate to separate the cases, saying it would be 2019 at the earliest for the combined cases to come to trial. Wingate recently ruled against combining the lawsuits.
Advocates for the mentally ill and plaintiffs in the original case supported The Clarion-Ledger’s contention that the TAC report should be made public.
Department of Mental Health spokesman Adam Moore had said the agency termed “confidential” the results of the evaluation conducted by an independent consultant from the Boston-based Technical Assistance Collaborative, a nonprofit organization with extensive experience in the area of mental health.
The state hired TAC to assist it with ongoing negotiations with the U.S. Department of Justice, which in December 2011 had found the Department of Mental Health in violation of the Americans with Disabilities Act. According to its website, TAC focuses on “solutions to the housing and community support services needs of low-income people with disabilities and people who are homeless.”
After The Clarion-Ledger’s request for the report was denied by the Department of Mental Health, the state agency then filed an unopposed motion in federal court in April 2015 for a protective order to keep the TAC report confidential, arguing it was created to facilitate settlement discussions with the Justice Department.
The Clarion-Ledger then filed a motion in U.S. District Court to intervene in the case and to have the protective order lifted. A federal judge allowed the newspaper to intervene to challenge the protective order but denied the request to vacate the order.
The Clarion-Ledger renewed its motion in August of last year to vacate the protective order after the Department of Justice broke off settlement negotiations with the state.
“Settlement negotiations between the parties in this case have terminated,” the motion said. “Plaintiffs support the Clarion Ledger’s Renewed Motion to Vacate Protective Order. The First Amendment and common law principles create a presumption that judicial proceedings and their filings should be open to the public and the press as this access is critical to the proper functioning of a fair justice system.”
“Additionally, the Mississippi Public Records Act states “that public records shall be available for inspection by any person unless otherwise provided.
“Thus, plaintiffs support the Clarion Ledger’s assertion that the public’s interest in having the Technical Assistance Collaborative (“TAC”) Report, which was created with taxpayer money about public entities tasked with serving Mississippi citizens, outweighs the State’s interest in confidentiality.”
The Clarion-Ledger said the sole basis for the state’s opposition to The Clarion-Ledger’s original motion to keep the report confidential was the parties’ The Department of (Mental Health and the Justice Department ) ongoing settlement negotiations. Since the Justice Department ended the settlement negotiations, there was no need for keeping the report confidential, attorneys for The Clarion-Ledger argued.
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