What is insanity? What is mental illness? How do we deal with those believed to be “mentally ill?”

Those questions have baffled medical professionals, law enforcement officers, political leaders, the clergy and laymen for hundreds of years.

District 14 State Representative Sam Creekmore of New Albany.

District 14 State Representative Sam Creekmore IV of Union County has been asked to investigate the burden placed on law enforcement agencies in Mississippi by the growing number of people with mental health problems.

State Representative Nick Bain of Corinth is Chairman of the Judiciary B Committee of the Mississippi House of Representatives. Prompted by a request from the Mississippi Sheriffs’ Association, Bain asked Creekmore to chair a special Judiciary B subcommittee to explore mental health delivery in Mississippi. Creekmore’s subcommittee will focus particularly on the fact that law enforcement agencies have increasingly become the first point of contact for people undergoing an acute mental health crisis.

Because of the serious shortage of available community-based mental health professionals in the state, law enforcement officers frequently get the call when a mentally ill person’s behavior alarms their family or neighbors. Most of these police officers have little or no training in dealing with mental health crises. 

People who may have committed no crime end up in jail, because there is nowhere else for them to go.

Creekmore launched his investigation with a meeting of his subcommittee at the state capitol in Jackson on November 15. Law enforcement officers, mental health professionals and others spoke to the subcommittee during the meeting.

Among the speakers was Sheriff Greg Pollan of Calhoun County. Pollan is also the president of the Mississippi Sheriffs’ Association. Like all of Mississippi’s 82 sheriffs, a major part of Sheriff Pollan’s responsibility is running the county jail.

“It seems like we, as a general rule, are the mental health facilities in our counties,” said Sheriff Pollan. He pointed out that he and his staff have no training or qualifications to run a mental health treatment center.

Pollan said that, as of the date of the hearing, four of the 45 inmates in the Calhoun County jail were mental patients waiting to be transferred to mental health facilities. They wait in jail until a scarce bed opens up at a facility equipped to treat mental patients. Sheriff Pollan said the typical mental patient in the Calhoun County jail is housed with criminal inmates for an average of seven days before they can be placed in an appropriate facility.

New Albany Police Chief Chris Robertson spoke at the November 15 hearing. He told of specific instances in which his department was dealing with individuals who had come to the attention of his department, not because they had committed crimes, but because they were mentally ill and had no place else to go.

The problems described by Chief Robertson and Sheriff Pollan are typical of those faced by sheriffs in all 82 counties and in several hundred local and institutional police departments.

The mess that Sam Creekmore and his subcommittee have been asked to tackle did not develop overnight.

Eleven years ago, in 2011, the U.S. Department of Justice (DOJ) reprimanded the State of Mississippi for its failure to fund enough community-based mental health services.

Federal District Judge Carlton Reeves

DOJ filed a lawsuit in 2016 in the U.S. District Court for the Southern District of Mississippi to force Mississippi to adequately fund community-based mental health facilities.

On July 21, 2021, Federal District Judge Carlton Reeves ruled in favor of DOJ’s lawsuit and ordered the State of Mississippi to improve the funding of its community-based mental health assets. Judge Reeves appointed Dr. Michael Hogan, formerly Commissioner of Mental Health for the State of New York, as a special monitor to oversee Mississippi’s compliance with his order.

Mississippi Attorney-General Lynn Fitch responded by hiring the Phelps Dunbar law firm to try to minimize the financial impact on the state of Mississippi from the federal judge’s order and from Dr. Hogan’s work as the court-appointed monitor.

Judge Reeves responded by reaffirming his order.

Only 330 years ago “demonic possession” was considered a major cause of insanity and about 20 women were convicted and executed as witches in Salem, Massachusetts.

A hundred and eighty years ago in the 1840s, nurse and educator Dorothea Dix, while visiting a prison in East Cambridge, Massachusetts, observed four mentally ill women who had been designated as “looney paupers.” The women were locked up in filthy conditions. Dix wrote of mentally ill people “…confined within this Commonwealth, in cages, stalls, pens! Chained, naked, beaten with rods, and lashed into obedience.”

Mississippi State Lunatic Asylum (est. 1855) in Jackson, MS

Dix became an effective advocate for what was known as the “mental hygiene movement.” She is credited with instigating nationwide political interest that resulted in the establishment, between 1840 and 1880, of more than 30 state psychiatric hospitals, sometimes called “insane asylums.”

The Mississippi State Hospital at Whitfield is one example of such state mental institutions established a century or more ago.

Mississippi’s mental hospital  was relocated in 1935 and renamed “Whitfield” in honor of Gov. Henry L Whitfield.

For about a hundred years, the large state-run mental hospitals or “lunatic asylums” such as Whitfield were the norm in mental health treatment in America. Some of these state institutions housed more than 10,000 patients or “inmates.” Even Whitfield, in a relatively small state, had 3,000 patients in 1935.

In the 1950s, thinking among mental health professions shifted to the belief that smaller “community-based” treatment centers were a more efficient and humane way to treat mental illness.

It was argued that patients did better living in the general population, not in large institutions. They were to live with their families or in small state-operated community-based homes and receive treatment in smaller community treatment centers. This trend was sometimes called “deinstitutionalization.”

Deinstitutionalization became the official policy of the federal government with the passage of the Community Mental Health Act of 1963.

Many argue that deinstitutionalization has been a failure because, among other reasons, families are simply not capable of dealing at home with their members who suffer acute mental health episodes. The growing number of homeless people on the streets of American cities is often blamed on “mental patients being dumped out of institutions and onto the streets.”

In fact, much of the population formerly housed in the large state mental asylums is now housed in jails and prisons. As if another overly-long and unpronounceable word was needed, critics of deinstitutionalization call this process “transinstitutionalization.” Transinstitutionalization simply means that mental patients, instead of being housed in large state mental hospitals, are lodged in a variety of institutions including county jails, state prisons, half-way houses, acute care hospitals — a hodge-podge of institutions that are in no way prepared to deliver useful treatment for the mentally ill.

The largest single population of mentally ill persons in any American institution today is housed at the Cook County Jail in Chicago. The largest population of these unfortunate persons in the state of New York is housed at the New York City Jail on Riker’s Island in the East River.

Representative Creekmore and his subcommittee face a daunting task.

Nearly everyone agrees that more community-based mental health services are needed. Most would agree that local law enforcement agencies should not bear responsibility for dealing with patients in a mental health crisis.

The heavy lifting will come in finding the money to do what needs to be done. As always, the devil is in the details.

–JWS