MS 2023-05-W-Bailey-May-1-2023-Psychiatric-Treatment-for-an-Individual-Committed-for-Substa May 1, 2023

If someone is court-committed for drug or alcohol treatment in Mississippi, can the state hospital just transfer them to the psychiatric ward?

Short answer: No. A state hospital cannot reroute a person court-committed for substance use disorder treatment into an inpatient psychiatric ward under Section 41-31-11. The hospital's medical director can, however, bring fresh civil commitment proceedings under Section 41-31-19 if the patient is found to need mental health treatment, and there's no requirement to first discharge them from the substance use commitment.

Disclaimer: This is an official Mississippi Attorney General opinion. AG opinions are persuasive authority but not binding precedent. This summary is for informational purposes only and is not legal advice. Consult a licensed Mississippi attorney for advice on your specific situation.

Subject

Psychiatric Treatment for an Individual Committed for Substance Use Disorder Treatment

Recipient

Wendy D. Bailey, Executive Director, Mississippi Department of Mental Health

Plain-English summary

Mississippi State Hospital and East Mississippi State Hospital both treat psychiatric patients and substance use disorder patients on the same campus, but the two patient populations get there through completely different commitment statutes. The Department of Mental Health asked: when someone is committed for substance use treatment but turns out to need psychiatric care, can the hospital simply transfer them under Section 41-31-11 (which lets a hospital move a substance-use patient between facilities or programs)?

The AG said no. Section 41-31-11 is about moving substance-use patients within or between substance-use settings, not about moving them into the mental-health system. The two commitment statutes have different procedural protections, including different physician-examination requirements and different definitions, and the legislature did not blur them. The Mississippi Supreme Court has been firm that hospitals are "not at liberty to second guess" the chancery court's commitment ruling.

The path forward, when a substance-use patient also needs psychiatric care, is Section 41-31-19. The hospital's medical director may initiate civil commitment proceedings under the proper mental-health statutes (Sections 41-21-61 et seq.) in the county where the person is. Importantly, the AG said there is no requirement to discharge the substance use commitment first; the medical director can run the new commitment in parallel.

What this means for you

State hospital medical directors and attorneys

Build the workflow around Section 41-31-19, not Section 41-31-11. When clinical staff identify a substance-use commitment patient who also needs psychiatric care, the legal step is initiating a new civil commitment in the proper county. Have a written protocol that triggers a 41-21-61 et seq. proceeding once the medical evaluation supports it. Do not move the patient to a psychiatric ward first and seek the order later; the chancery court order has to come first.

Hospital admissions and discharge planners

Two parallel chancery court orders is a paperwork-heavy but legally clean state. The patient stays admitted under the substance-use order while the new mental-health proceeding is pending. Track both orders separately, with separate review and renewal calendars. Document the dual-order status in the medical chart.

Chancery court judges

This opinion confirms that your commitment orders mean what they say, and a hospital cannot reclassify the basis of confinement administratively. If you receive a Section 41-31-19 medical-director petition for a patient who is already committed under Section 41-31-1 et seq., the AG's view is that the new petition stands on its own; there is no statutory requirement that the substance-use order be terminated first.

Patients, families, and advocates

A loved one committed for drug or alcohol treatment cannot be moved into a psychiatric ward without going back to court. If a hospital does that, request the chancery court order that authorized the move. If there isn't one, that is a legal problem the hospital has to fix, often by filing a fresh commitment petition under the mental-health statutes with notice to the patient and counsel.

Mental health attorneys

The pre-commitment hearing rights under Section 41-21-63 and 41-21-73 are the procedural backbone here. Bethany v. Stubbs (Miss. 1981) makes clear those rights cannot be skipped by relabeling a substance-use commitment.

Common questions

What does Section 41-31-11 actually allow?
It allows transfer of a substance-use patient between institutions used for substance-use commitment, or between departments within such an institution, with written notice to the committing court. It does not authorize moving the patient into a mental-health-commitment program.

Why are the two commitment paths separate?
The legislature wrote different statutes with different definitions, hearing requirements, and physician examinations. Section 41-21-67(2) requires two licensed physicians (or one physician plus a psychologist, nurse practitioner, or physician assistant) for mental-health commitments. Section 41-31-5(3) only allows the chancellor to order a single physician examination for substance-use commitments, and only at the chancellor's discretion. The legislature did not intend the two regimes to be interchangeable.

Can the same patient be under both orders at once?
Yes, the AG explicitly said so. There is no statutory requirement to discharge the substance-use commitment before bringing a mental-health commitment, so a hospital can run both orders in parallel.

Who initiates the new mental-health commitment if the patient is already at the hospital?
The medical director of the hospital, under Section 41-31-19. The proceeding goes in the county "wherein the person involved is restrained for commitment to such institution as shall be proper."

Does this rule apply only to MS State Hospital and East Mississippi State Hospital?
Those are the hospitals named in the request, but the statutory framework applies to any state-run inpatient commitment program subject to Sections 41-21-61 et seq. and 41-31-1 et seq.

What if the patient appears acutely psychiatric and needs urgent stabilization?
The opinion does not address emergency holds. Mississippi has separate emergency-hold provisions, and clinicians should consult them. The opinion is about the long-term legal authority to provide psychiatric inpatient treatment, not about momentary safety interventions.

Background and statutory framework

Mississippi has two separate civil commitment regimes for adults. Sections 41-21-61 et seq. govern mental-health commitments. Sections 41-31-1 et seq. govern substance-use disorder commitments. Each comes with its own procedural protections.

Mental-health commitments require pre-commitment hearings under Sections 41-21-63 and 41-21-73, with appointed counsel and physician examinations under Section 41-21-67(2). Section 41-21-61(f) excludes from the definition of "person with mental illness" anyone whose only diagnosis is dependence on or addiction to alcohol or drugs. That definitional split is part of why the two regimes do not interchange.

Substance-use commitments under Section 41-31-1 et seq. have a more streamlined process under Section 41-31-5(3) (chancellor may order a single-physician examination) and a transfer authority under Section 41-31-11 (transfers between substance-use facilities). Section 41-31-19 is the bridge: when a substance-use patient is found to be suffering from a mental condition, the medical director can bring fresh commitment proceedings under the mental-health statutes.

The Mississippi Supreme Court reinforced these boundaries in C.W. v. Lamar County, 250 So. 3d 1248, 1253 (Miss. 2018), where the Court held that hospitals are "not at liberty to second guess [a] chancery court" and that chancellor commitment rulings are "entitled to the full force of law." Bethany v. Stubbs, 393 So. 2d 1351, 1353 (Miss. 1981), described the due process protections built into the mental-health commitment process.

Citations

Miss. Code Ann. § 41-21-61 et seq. (mental-health commitments)
Miss. Code Ann. § 41-21-61(f) (definition of "person with mental illness," excluding addiction-only)
Miss. Code Ann. § 41-21-63(1) (limits on commitment to public treatment facility)
Miss. Code Ann. § 41-21-67(2) (physician examination requirements)
Miss. Code Ann. § 41-21-73 (pre-commitment hearing requirements)
Miss. Code Ann. § 41-31-1 et seq. (substance use disorder commitments)
Miss. Code Ann. § 41-31-5(3) (chancellor's discretion to order examination)
Miss. Code Ann. § 41-31-11 (transfers between substance-use facilities)
Miss. Code Ann. § 41-31-19 (medical director authority to initiate mental-health commitment)
Miss. Code Ann. §§ 43-21-315, 43-21-611 (additional commitment authorities cross-referenced)
C.W. v. Lamar County, 250 So. 3d 1248, 1253 (Miss. 2018)
Bethany v. Stubbs, 393 So. 2d 1351, 1353 (Miss. 1981)
MS AG Op., Presley (Mar. 3, 1994) (commitment proceedings not interchangeable)

Source

Original opinion text

May 1, 2023
Wendy D. Bailey, Executive Director
Mississippi Department of Mental Health
1101 Robert E. Lee Building
239 North Lamar Street
Jackson, Mississippi 39201
Re:

Psychiatric Treatment for an Individual Committed for Substance Use
Disorder Treatment

Dear Director Bailey:
The Office of the Attorney General has received your request for an official opinion.
Background
According to your request, Mississippi State Hospital in Whitfield and East Mississippi State
Hospital in Meridian provide both psychiatric and substance use (alcohol and drug) disorder
treatment to individuals who have been court-committed. Individuals are typically committed for
either psychiatric treatment or substance use disorder treatment. Mississippi Code Annotated
Sections 41-21-61 et seq. govern mental health commitments, and Sections 41-31-1 et seq. govern
substance use disorder commitments.
Questions Presented
1. Does Section 41-31-11 authorize Mississippi State Hospital and East Mississippi State
Hospital to transfer an individual court-committed for substance use disorder treatment to
an inpatient acute psychiatric ward for treatment when the initial commitment order is for
substance use disorder treatment?
2. Does the hospital need to discharge and seek a civil commitment order for mental health
treatment in order to legally provide psychiatric treatment to an individual committed to
Mississippi State Hospital or East Mississippi State Hospital for substance use disorder
treatment?

Brief Response
1. No. Section 41-31-11 does not provide Mississippi State Hospital or East Mississippi State
Hospital the authority to transfer an individual court-committed for substance use disorder
treatment to an inpatient acute psychiatric ward for mental health treatment.
2. When an individual committed to Mississippi State Hospital or East Mississippi State
Hospital for substance use disorder treatment is found to be suffering from a mental
condition requiring commitment for psychiatric treatment, the hospital's medical director
may bring commitment proceedings, in accordance with Sections 41-21-61 et seq., for
psychiatric treatment. Miss. Code Ann. § 41-31-19. In this scenario, there is no statutory
requirement that an individual be discharged from his or her commitment for substance use
disorder treatment prior to a medical director bringing mental health commitment
proceedings.
Applicable Law and Discussion
This office has previously opined that there is no indication that the commitment proceedings for
mental health under Sections 41-21-61 et seq. and for substance use disorder under Sections 41-30-1 et seq. are in any way interchangeable. MS AG Op., Presley, at *1, (Mar. 3, 1994). The
Mississippi Supreme Court has also been clear in this regard, emphasizing that state hospitals are
"not at liberty to second guess [a] chancery court" and that a chancellor's commitment rulings are
"entitled to the full force of law." C.W. v. Lamar County, 250 So. 3d 1248, 1253 (Miss. 2018).
Section 41-31-11 allows for the transfer of an individual being treated for drug and alcohol abuse
"from one institution used for the commitment of alcoholics and drug addicts to another institution,
or from one department in any institution to another as is deemed necessary for their care and
treatment." The committing court must be provided with written notification and the details of the
transfer, including the name of the new program or facility. Id.
The commitment processes under Sections 41-21-61 et seq. (mental health commitments) and
Sections 41-31-1 et seq. (substance use disorder commitments) are different. For example, Section
41-21-67(2) requires that individuals being considered for mental health commitment undergo a
physical and mental examination by "two (2) reputable, licensed physicians or one (1) reputable,
licensed physician and either one (1) psychologist, nurse practitioner or physician assistant . . . ."
But individuals being considered for substance use disorder commitment have no such
requirement. See Miss. Code Ann. § 41-31-5(3) ("The said chancellor, in his discretion, may
require that the alleged alcoholic or drug addict be examined by the county health officer or by
such other competent physician or physicians as the chancellor may select . . . ."); see also Bethany
v. Stubbs, 393 So. 2d 1351, 1353 (Miss. 1981) (discussing pre-commitment hearings for mental
health treatment: "Due process is guaranteed under . . . Section 41-21-63 and Section 41-21-73
which require and provide for pre-commitment hearings before the chancery judge and for an
attorney to represent the person during the hearing.").
Moreover, Section 41-21-63(1), pertaining to mental health treatment, specifies that "[n]o person,
other than persons charged with crime, shall be committed to a public treatment facility except
under the provisions of Sections 41-21-61 through 41-21-107 or 43-21-611 or 43-21-315." Along
these same lines, Section 41-21-61(f) provides that "a person having only . . . brief periods of
intoxication caused by alcohol or drugs [or] dependence upon or addiction to any alcohol or drugs"
does not fit within the statutory definition of a "[p]erson with mental illness." Accordingly, Section
41-31-11's transfer language does not provide authority to transfer an individual court-committed
for substance use disorder treatment to an inpatient acute psychiatric ward for mental health
treatment.
Although the language in Section 41-31-11 does not authorize the transfer of an individual court-committed for substance use disorder treatment to an inpatient acute psychiatric ward for mental
health treatment, we direct you to Section 41-31-19 pertaining to individuals committed for
substance abuse disorder:
The medical director of the hospital may bring commitment proceedings under the
provisions of the proper statute in the county wherein the person involved is
restrained for commitment to such institution as shall be proper, if said person is
found to be suffering from a mental or nervous condition or affliction requiring his
adjudication and commitment under said statute.
This statute allows the medical director of Mississippi State Hospital or East Mississippi State
Hospital to bring commitment proceedings in accordance with Sections 41-21-61 et seq. when an
individual committed to the hospital for substance use disorder treatment is found to be suffering
from a mental condition requiring commitment for psychiatric treatment. In this scenario, there is
no statutory requirement that an individual be discharged from his or her commitment for
substance use disorder treatment prior to a medical director bringing mental health commitment
proceedings.
If this office may be of any further assistance to you, please do not hesitate to contact us.
Sincerely,
LYNN FITCH, ATTORNEY GENERAL
By:

/s/ Maggie Kate Bobo
Maggie Kate Bobo
Special Assistant Attorney General