THE MISSISSIPPI LEGISLATURE

The Joint Committee on

Performance Evaluation and Expenditure Review

Report # 511

Planning for the Delivery of Mental Health Services in Mississippi: A Policy Analysis

Executive Summary

Historically, Mississippi has made a major financial commitment to mental health that has primarily been focused on funding institution-based services, ranking high regionally and nationally in mental health expenditures. Although the mental health environment in the United States has dramatically changed from an institution-based system to a community-based system in recent years, Mississippi’s mental health system has not reflected the shift in service delivery methods.

Due to implications of the U. S. Supreme Court’s 1999 Olmstead decision, which supports the drive toward integrating people with disabilities into the least restrictive settings, the state will be forced to move toward providing more community-based care in the near future. Also, the state’s Board of Mental Health and Department of Mental Health will face critical issues that will continue to impact their roles in providing and regulating mental health services in Mississippi.

Based on PEER’s analysis of the current state mental health planning effort, strategic planning does not appear to be at the core of the Board of Mental Health’s management strategy, nor could it be without key changes in orientation and available information. There is little evidence that the planning process properly focuses the board on data needed to identify and prioritize critical issues and policy challenges. Rather, according to PEER’s analysis of three years of the board’s meeting minutes, the board’s focus is on administrative details and issues of program implementation.

While the board’s minutes properly reflect a concern with the stability and health of current programs, there is less evidence of visionary, future-focused concerns. The board has not aggressively sought plans for reallocation of resources to meet emerging needs in addition to efforts to seek additional funding to meet those needs. While the current process may ensure that the Department of Mental Health will reach the community it intends to serve in the ways that have been established and are traditional, it does not question the composition or mode of service for possible needed change.

Also, it appears that the board has authorized programs that could be marginal to its mission while allowing the development of community-oriented programs to fall behind. This seems to evidence the possibility that the board currently has no identifiable process for deciding whether current or proposed programs and services fall within its mission, allowing the department to be pushed in directions that fragment its mission and increase competition for critical resources.

Recommendations

The Legislature’s commitment to the mental health needs of the citizens of Mississippi is evident by the financial support the Department of Mental Health has historically received. The commitment of the board members, DMH officials and staff, CMHC officials and staff, and advisory council members to providing mental health services to the citizens of Mississippi have been evident throughout this review.

PEER believes that through strategic planning the resources of the state and the knowledge and commitment of mental health officials and staff could be enhanced to better serve the mental health needs of the state’s citizens. To this end, PEER offers the following recommendations.

1. The Board of Mental Health should implement a strategic planning process to address the current and future mental health needs of the state. The strategic planning process should incorporate clear missions and goals for the state’s mental health system and contain clear performance measures to evaluate the effectiveness of the strategic plan in meeting the mental health needs of the citizens of the state.
2. The Board of Mental Health should conduct a self-assessment, taking into consideration performing:
   
   
   • an evaluation of the management information currently received by the board and how such management information could be improved to facilitate the board’s planning and oversight capacities; and,
   • a review of the current board requirements under MISS. CODE ANN. § 41-4-7 (1972) for the purpose of identifying current duties that hinder the board’s ability to address broader departmental issues (such as strategic planning) and those that could be satisfactorily handled by the Department of Mental Health’s administrative staff. The board should submit proposed revisions to the law to the appropriate committees for consideration during the 2009 legislative session.
3. The Legislature should amend MISS. CODE ANN. Section 41-4-3 (1972) to establish a nonvoting advisory position on the Board of Mental Health for a designee of the Mississippi Association of Community Mental Health Centers.
4. The Board of Mental Health should consider developing a patient tracking and management information system, in conjunction with the fifteen regional community mental health centers, to track patients within the state mental health system and to yield usable performance information for managing the Department of Mental Health and for providing mental health services throughout the state.
5. In order to ensure clear observation and measurement of progress toward the agency’s and individual bureaus’ goals, the Board of Mental Health should develop a comprehensive set of program-specific quantitative performance measures and goals as part of its strategic planning effort. As a model, the board should consider the National Outcome Measures required by the Substance Abuse and Mental Health Services Administration as a part of its grant accountability process.
6. The Board of Mental Health should develop a well-defined agency-wide mission statement that provides guidance for the agency in its decisionmaking process. Further, the Board of Mental Health should develop a complete vision statement that provides a realistic benchmark for the agency’s long-term success.
   
   Following is an example of what a well-defined mission statement for the department might be:
   
   Our mission as the state’s lead agency in charge of regulating and providing mental health services to the people of Mississippi is five-fold:
   
   
   • To provide a comprehensive system of care to people affected by mental illness, mental retardation/ developmental disabilities, alcohol and drug abuse, and Alzheimer’s Disease and other dementia in both community and institutional settings;
   • To regulate mental health services within the state of Mississippi;
   • To educate the people of Mississippi about mental health issues within the state and to reduce the stigma associated with mental health issues;
   • To continually explore new means in which to better improve the lives of those affected by mental health issues; and,
   • To maximize the benefit of the taxpayer’s dollars by meeting the state’s mental health needs in the most efficient and effective means possible.
   
   
   Following is an example of what a well-defined vision statement for the department might be:
   
   The Mississippi Department of Mental Health will provide its clients the opportunity for a better tomorrow by providing the highest quality of life possible via a community-based system of care, where feasible. Our system will be a person-centered environment that is built on the strengths of individuals and their families while meeting their needs for special services and supports.

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