THE MISSISSIPPI LEGISLATURE

The Joint Committee on

Performance Evaluation and Expenditure Review

Report # 584

A Review of the Closure of the Mississippi State Hospital’s Community Services Division

Executive Summary

Introduction

The PEER Committee received a complaint from a citizen who was concerned about the Mississippi State Hospital’s contract with Key Behavior Essentials (doing business as Guided Steps Healthcare) to assume the responsibilities of the hospital’s Community Services Division on May 1, 2014. Subsequent to PEER’s receipt of the complaint and during the course of the review, the Mississippi State Hospital (MSH) voided its contract with Guided Steps Healthcare.

Because the hospital terminated the contract during the course of the review, PEER focused on the closure of the Mississippi State Hospital’s Community Services Division and the transition of those clients to other providers. Also, despite the voided contract, questions remained regarding the state’s community-based mental health care service structure.

Background

In Mississippi, the Board of Mental Health sets statewide mental health policy and the Department of Mental Health administers policies and implements programs. Behavioral health and intellectual and developmental disabilities programs are delivered statewide through state-operated programs and facilities, regional community mental health centers, and other non-profit service agencies and organizations. The Mississippi State Hospital is one of the state-operated facilities for delivery of behavioral health services.

Four events in recent years have had a significant impact on Mississippi’s public policy regarding delivery of mental health services:

the U. S. Supreme Court’s 1999 Olmstead v. L.C. decision regarding states’ obligations under the Americans with Disabilities Act to move toward a system of community-based care for persons with mental disabilities;
the 2001 Mississippi Access to Care (MAC) plan, which was Mississippi’s formal response to the Olmstead decision;
requirements of the Rose Isabel Williams Mental Health Reform Act of 2011 regarding strategic planning for delivery of mental health services; and,
results of a 2011 investigation by the United States Department of Justice of Mississippi’s mental health service delivery system.

Conclusions

Why did the Mississippi State Hospital close its Community Services Division?

For approximately thirty years, the MSH’s Community Services Division provided community mental health services to persons eighteen years and over residing in Mississippi who had a serious mental illness.

According to DMH officials, the following were primary reasons for closing the division:

the department’s and hospital’s staff perceived that the Community Services Division was outside the hospital’s primary mission; and,
MSH’s appropriations had experienced recurring annual decreases in recent years and the department believed that redirecting resources from community mental health services to acute inpatient care at MSH was the best use of resources for the department.

PEER notes that because MSH is not eliminating any of the division’s positions and plans to transfer its employees to MSH inpatient care positions, the department has forgone the opportunity to redirect the resources yielded from closure of the division into providing community-based mental health care.

How did the Department of Mental Health and the Mississippi State Hospital plan to handle the transitioning, tracking, and future care of clients formerly served by the Mississippi State Hospital’s Community Services Division?

In December 2013, MSH contracted with Guided Steps Healthcare to implement a transition of clients from the Community Services Division to other mental health care providers. However, the department did not ensure that Guided Steps complied with some of the requirements for certification as a provider and did not verify during the application process that Guided Steps’ Executive Director met the education requirements for a certified provider. Also, under the terms of the contract, Guided Steps received additional benefits or incentives beyond the actual value of the contract.

Neither DMH nor MSH could provide evidence to PEER that DMH staff or MSH Community Services Division staff were involved in the development, review, or approval of the plan Guided Steps created to facilitate the transition of MSH Community Services clients. Although MSH designated a staff member as being responsible for tracking the transition of MSH Community Services clients, MSH had no system in place to track these individuals and MSH could not readily determine where clients were located or where they were going.

Due to Guided Steps’ “failure to comply with DMH Operational Standards” and “inappropriate and unethical conduct,” the department terminated Guided Steps’ certification, which resulted in MSH terminating its contract with Guided Steps on April 12, 2014. PEER concurs that this was good cause for terminating the contract.

Regarding the transition of these clients after the contract with Guided Steps was terminated, DMH maintained that termination of the contract should not change the transition process. MSH Community Services staff would continue to perform their duties of providing placements for individuals.

How should the state provide community-based mental health services in the future?

In providing community-based mental health services in the future, the state should recognize the continuing significance and obligation of the Rose Isabel Williams Mental Health Reform Act of 2011 to involve representatives of all sectors of the state’s mental health system in planning for and delivering community-based mental health services. Also, when contracting with private providers for community-based services, the Department of Mental Health should exercise due diligence and prudent contracting practices.

Recommendations

Using existing resources, DMH should develop a client tracking and management information system, in conjunction with the community mental health centers, to track patients within the state’s mental health system.
DMH should adopt formal, written procedures that require department-certified mental health facilities and providers (e. g., MSH) to procure personal services contracts of $50,000 or less that, at a minimum, comport with best practices in order to ensure fair and open competition.
The Governor should make appointments to the Strategic Planning and Best Practices Committee created by MISS. CODE ANN. Section 41-4-10 (1972) so that the committee can continue the collaborative efforts of strategic planning with the Board of Mental Health, the community mental health centers, and other interested parties. To inform the Governor of the need for such appointments, the PEER Committee will forward a copy of this report to his office for review. Because certain minor, technical corrections are needed to perfect Section 41-4-10, the Legislature should consider making these changes during the 2015 session. Appointments need not wait for these changes to be made.
Any future decisions of the Department of Mental Health or the Board of Mental Health to realign agency services in light of the department’s and board’s concept of the department’s proper mission should be submitted to the Strategic Planning and Best Practices Committee for guidance on such recommendations and their impact on the operations of community mental health centers and other providers of mental health services in Mississippi.

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