What Mississippi does right in mental healthcare
Department of Justice rulings, legislative efforts make way for change in Mississippi
By Dr. Katherine Pannel, Medical Director
Right Track Medical Group
It’s not news that America is facing a mental health crisis. Suicide rates are the highest they have been in 50 years. The prevalence of anxiety and depression has skyrocketed and we are in the midst of an opioid epidemic. To complicate things even more, mental health services are lacking across America. While every state has its own shortcomings in their delivery of mental healthcare, Mississippi was most recently singled out for its failings. The Department of Justice determined that not giving people with mental illnesses the option of outpatient mental healthcare in their communities violated the Americans with Disabilities Act. Mississippi is lacking in outpatient mental health services. Patients are having to receive mental healthcare in inpatient psychiatric facilities because outpatient services are not available in their communities. But I am certain that if every state’s delivery of mental healthcare were to be investigated, they would also be found to be lacking in sufficient care. But it always seems like the negatives about Mississippi are what make national news. “Thank God for Mississippi” is a common quote amongst Americans when discussing various rankings. The presence of the state of Mississippi spares other states from finishing last among the rankings. It spares them the shame.
I am a lifelong Mississippian and have practiced psychiatry in the inpatient and outpatient settings in Mississippi for close to ten years. And while Mississippi does have areas of needed improvement in its mental healthcare, I am confident that it will improve. Why am I so confident? Because I have witnessed firsthand the positive strides that Mississippi has made in bettering mental healthcare for its residents. These changes were being made before the Department of Justice delivered its decision. I have personally been involved in making these changes. My patients have and will be affected by these changes. And they will be affected for the better.
The need for psychiatrists in Mississippi is large. The 2019 legislative session proved to be very successful for psychiatry. Earlier this year, lawmakers in our great state realized the need for psychiatrists and passed legislation to remedy this shortage. Senator Sally Doty introduced legislation to give medical students the option to choose psychiatry in the Mississippi Rural Physician Scholarship program. This would directly place psychiatrists in rural, underserved areas. This was the first year this legislation was introduced, and it passed smoothly. Senator Eugene Buck Clarke lives in the Mississippi Delta and has long seen the need for more psychiatrists. Senator Clarke, along with Representative John Read, led the effort to appropriate the necessary funding for the scholarship. Mississippi is already reaping the benefits from the passage and funding of the bill with a scholarship recently awarded to a medical student eager to practice psychiatry in an underserved area in Mississippi. We have begun to fill the void.
One change that I am most proud of as a physician is a change to the Board of Medicine’s physician license application. There is such a stigma surrounding mental illness and prior to this change in the application, it was very apparent in the questions that physicians had to answer a particular way. The original application asked, “Have you ever been diagnosed as having or have you ever been treated for pedophilia, exhibitionism or voyeurism, bipolar disorder, sexual disorder, schizophrenia, paranoia or other psychiatric disorder?” The wording of this question alone deterred physicians from seeking mental health treatment, thus reinforcing the stigma. Physicians have feared retribution if they sought treatment, which is likely why we have seen a rise in the physician suicide rate. Now, the question simply asks the applicant to acknowledge that if they had any illness that would impair their ability to treat patients that it has been effectively treated. I will no longer have to sneak physicians in the back door of my office because they are scared to be singled out for having gotten mental health treatment. Mississippi is among the few states that have made changes to ensure physicians take care of their mental health.
I am finally beginning to slowly see the stigma surrounding mental health treatment lessen. Psychiatrists in Mississippi have fought tirelessly to advocate for patients. They served as an integral part in getting HB-1352 passed this session. No longer are mental health courts and drug courts named as such. They have been renamed “Interventional Courts,” thus reducing the stigma further. These interventional courts will enhance the ability of crisis intervention teams to step in and aid those in mental health crisis and assist in their stabilization without having to go to jail. Mental illness is not criminal and should not be treated as such.
Mental health parity is also a national problem. The Mental Health Parity Act was passed almost 11 years ago. This act required that dollar limits for mental health benefits be no lower than the dollar limits for medical and surgical benefits offered by insurers. And while the intentions of this act were good, the implementation and enforcement of this act have been abysmal. The Mississippi State Medical Association and Mississippi Psychiatric Association realized this and have supported a federal bill that would enforce parity in our country and our state. The two associations approached Senator Roger Wicker with the bill and he gladly co-sponsored this important piece of legislation. And while this is a Senate bill, Representative Michael Guest recently met with the Mississippi State Medical Association and offered support should any similar bills make it to the House side.
The fight for mental health parity is also seen in the work that the Mississippi Insurance Department is doing to ensure parity. The department is reviewing insurer’s policies to ensure that they are in compliance with federal parity laws. Then, they will develop standards and parity requirements for future reviews of insurers.
The ruling of the Department of Justice was a tough but a needed one. It revealed a significant flaw in the mental healthcare delivery system in our state. We need more outpatient treatment options to reduce inpatient psychiatric hospital stays. And while most are probably shaking their heads and mumbling “Thank God for Mississippi,” I am not. I am proud of what Mississippi is doing to make mental healthcare better in our state. Lawmakers and physicians in our great state are not only aware of the mental health crisis but are committed to fixing this issue. This is Mississippi. We are known for coming together in times of crisis. And I am confident that now that we have been made aware of our deficiencies, we will respond and come together to remedy them. I have hope that one day other states will look at Mississippi and genuinely “Thank God” as they look to us as the model for exemplary mental healthcare.
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