JACKSON, Miss. -- A federal judge should intervene in Mississippi's mental health care system, a U.S. Justice Department lawyer argued Monday, saying the state has moved far too slowly to provide community alternatives to mental hospitals.
"They could be living in more integrated settings, but they never get the chance, because the state does not make the necessary services available, lawyer Patrick Holkins said in closing arguments following a monthlong trial. "That is not just a policy failure, but a civil rights violation."
Lawyers for the state, though, told U.S. District Judge Carlton Reeves that the Justice Department had failed to prove the alleged violations of the Americans with Disabilities Act.
"There was no evidence that anyone was unnecessarily institutionalized in Mississippi," Jim Shelson argued for the state.
Both sides will get one more chance to argue their position in post-trial briefs due in three weeks. Then Reeves, who heard the evidence without a jury, will have to decide.
The federal government catalogued a litany of alleged transgressions during the trial, including mentally ill people held in jails because crisis teams don't respond; people forced to live far from their family because services aren't available in their hometowns; and people who make repeat trips to state mental hospitals because there's no effective planning for them to transition to community services and the most intensive kinds of services aren't made available.
The Justice Department argues that all these offenses are violations of the U.S. Supreme Court's 1999 Olmstead decision, which found that unjustified confinement in a mental institution is illegal.
The state, though, said the Justice Department concedes that Mississippi has community-based services, but argues that they're just not good enough. The state says that's not an Olmstead violation and presents no clear standard for Reeves to rule on.
"Is there any jurisprudence anywhere that describes enough?" asked lawyer Reuben Anderson. "I would say to your honor, there is no standard in law or anywhere else about enough."
Shelson said Mississippi wasn't being given enough credit for what it has accomplished. He also argued that the federal government wants to impose such an expensive set of programs that it would qualify as a "fundamental alteration" of Mississippi's system, which the Olmstead decision says the federal government can't impose.
The state lawyer argued that the more that the federal government demanded "the stronger the state's fundamental alteration defense," Shelson said.
The Justice Department counters that Mississippi could afford more services if it filed more claims with the state-federal Medicaid insurance program, and argued that appeals courts have ruled since Olmstead that a state needs a working plan to assert a fundamental alteration defense.
"No plan exists in Mississippi, much less one that's comprehensive and effectively working," Holkins said.
Shelson closed by saying Mississippi just needs more time to make progress on its own.
"What this case really about, your honor, is the pace of change," he said.
But the federal lawyers rejected that argument, saying the state was barely moving until the trial grew near and that people are suffering unnecessarily.
"Time is certainly one thing the state has already had plenty of, yet the state asks for a little more," Justice Department lawyer Regan Rush said. "Yet time is running out for the people in this case."
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