Who pays for mental health treatment between civil commitment order and admission to a Mississippi state hospital?

Plain-English summary

Mississippi has a chronic civil-commitment problem: a chancellor enters an order committing a person for mental health treatment, but no bed is available at the state hospital. The person sits somewhere local while the wait runs. The Washington County attorney asked who pays for the local treatment in that gap.

The AG walked through Sections 41-21-61 et seq. and answered:

1. Beyond the court-process costs (capped at $400 by Section 41-21-79) and the initial transportation cost (Section 41-21-77(1)), the county of residence is responsible for the treatment costs incurred before admission to a state-operated facility. Section 41-21-73(4) is explicit: "Treatment before admission to a state-operated facility shall be located as closely as possible to the patient's county of residence and the county of residence shall be responsible for that cost."

2. County-owned hospitals are encouraged but not required to provide temporary care. Section 41-21-77(1) frames it as legislative "intent" that county-owned hospitals work with regional community mental health/intellectual disability centers, not as a hard duty.

3. Counties may but need not enter contracts with hospitals or third-party providers for the local services; if they do, no Department of Mental Health director's approval is required.

What this means for you

For boards of supervisors and county finance offices

The opinion places the cost of pre-admission civil commitment treatment on the county of residence. Section 41-21-73(4) provides that "[t]reatment before admission to a state-operated facility shall be located as closely as possible to the patient's county of residence and the county of residence shall be responsible for that cost." The $400 cap in Section 41-21-79 is for the court-process expenses (court costs, prehearing hospitalization, transportation, physician/psychologist/nurse-practitioner/PA fees, and attorney fees); the AG concluded the county's responsibility for the treatment itself runs "beyond" that cap. A lack of in-county capacity does not shift the cost away from the county.

For county attorneys advising the board

The AG confirmed that the county of residence is responsible for these treatment costs and that Section 41-21-77(1) does not impose a duty on county-owned hospitals to provide care; it expresses a legislative "intent" that they "work with regional community mental health/intellectual disability centers in providing care to local patients." The opinion also concluded there is "no statutory requirement for counties to contract with community hospitals or third parties," though Section 41-21-143 authorizes collaborative agreements, and the opinion identified no Department of Mental Health director approval requirement for such contracts.

For county-owned hospital administrators

The opinion concludes county-owned hospitals are not statutorily required to take pre-admission civil commitment patients. In the AG's reading, the "intent" language in Section 41-21-77(1) is a legislative intent that county hospitals work with regional centers, not a duty. Where care is provided before admission, Section 41-21-73(4) puts the cost on the patient's county of residence.

For families and patients in the civil commitment process

Under this opinion, the cost of local treatment during the wait for a state hospital bed falls on the county of residence, not on the patient. Section 41-21-79 caps the court-process expenses at $400; for an indigent respondent the county pays those, and for a non-indigent respondent they are "taxed against the respondent or his or her estate."

For judges entering civil commitment orders

Section 41-21-73(4) directs that pre-admission treatment "shall be located as closely as possible to the patient's county of residence." Where capacity exists locally, that is the preferred location, and the county of residence is the responsible payor. Where capacity does not exist locally and the patient is held farther away pending admission, the county of residence still bears the cost.

Common questions

Who pays for mental health treatment after a civil commitment order but before admission to the state hospital?

The patient's county of residence. Section 41-21-73(4): "Treatment before admission to a state-operated facility shall be located as closely as possible to the patient's county of residence and the county of residence shall be responsible for that cost."

What about court costs and hearing-related expenses?

Capped at $400 total under Section 41-21-79. Court costs, prehearing hospitalization, transportation, physician/psychologist/nurse practitioner/PA fees set by the court, and reasonable attorney fees set by the court all fit within that $400 cap. If the respondent is indigent, the county pays. If not, the costs are taxed against the respondent or the respondent's estate.

Does Section 41-21-77(1) require county hospitals to provide temporary care?

No. The statute expresses a legislative intent that county-owned hospitals "work with regional community mental health/intellectual disability centers in providing care to local patients." That is encouragement, not a duty.

Does the county have to contract with a hospital or third-party provider?

No. There is no statutory requirement to enter such a contract. Section 41-21-143 authorizes collaborative agreements as an option. The county can also cover pre-admission care through other arrangements.

Does the Department of Mental Health director have to approve a county's contract?

The AG opinion notes that there is no statutory requirement for such approval. Section 41-21-77 contemplates cooperation, not director-level approval of county contracts.

What if the county can't find anyone willing to provide the local care?

The county still has the statutory financial responsibility. The bed-shortage problem is a real one, but Section 41-21-73(4) does not contemplate the cost shifting elsewhere. Counties typically work through regional community mental health centers, with which Section 41-21-77 contemplates collaboration.

Background and statutory framework

Sections 41-21-61 et seq., civil commitment. Mississippi's civil commitment statutes for persons with mental illness or intellectual disability set the procedure for commitment, the cost-allocation rules, and the relationship among state-operated facilities, regional community mental health centers, and county hospitals.

Section 41-21-73(4). After clear and convincing evidence and consideration of alternatives, the court commits the patient "in the least restrictive treatment facility that can meet the patient's treatment needs." Pre-admission treatment is to be located near the county of residence, and the county of residence pays.

Section 41-21-77(1). "It is the intent of this Legislature that county-owned hospitals work with regional community mental health/intellectual disability centers in providing care to local patients." Permissive, not mandatory.

Section 41-21-79. Caps the court-process incidental costs at $400. The funds come from the county of residence for indigent respondents and are taxed against non-indigent respondents or their estates.

Section 41-21-143. Authorizes collaborative agreements among the relevant entities for civil commitment care.

Citations

• Miss. Code Ann. § 41-21-73(4)
• Miss. Code Ann. § 41-21-77(1)
• Miss. Code Ann. § 41-21-79
• Miss. Code Ann. § 41-21-65(6)
• Miss. Code Ann. § 41-21-143

Source

• Landing page: https://attorneygenerallynnfitch.com/divisions/opinions-and-policy/recent-opinions/
• Original PDF: https://attorneygenerallynnfitch.com/wp-content/uploads/2024/10/W.Griffin-October-10-2024-Mental-Health-Related-Costs-1.pdf

Original opinion text

October 10, 2024
Willie Griffin, Esq.
Attorney, Washington County Board of Supervisors
Post Office Box 189
Greenville, Mississippi 38702-0189
Re:

Mental Health Related Costs Following Commitment Order When No Bed
is Available at State Hospital

Dear Mr. Griffin:
The Office of the Attorney General has received your request for an official opinion.
Questions Presented

1. Other than the costs required by Mississippi Code Annotated Section 41-21-79, "Liability
   for costs; maximum amount," and the initial cost for transportation to a state center for
   treatment (Section 41-21-77(1)), are counties responsible for costs related to the treatment
   of persons ordered committed for mental and/or intellectual disability?
2. If Section 41-21-77(1) imposes a duty on a county-owned community hospital to work
   with regional health centers to provide care for local patients, does that require the
   community hospital to provide temporary care?
3. Which governmental entity is responsible for the costs of court-ordered local mental health
   services pending acceptance and transportation to a state facility?
4. Are counties required to enter contracts with community hospitals or third parties licensed
   and/or certified by the Mississippi Department of Mental Health to provide the local
   services, and must such contracts be approved by the director for Department of Mental
   Health?
   Brief Response

5. Yes. Pursuant to Section 41-21-73(4), "[t]reatment before admission to a state-operated
   facility shall be located as closely as possible to the patient's county of residence and the
   county of residence shall be responsible for that cost."

6. Section 41-21-77(1) states that "i[t] is the intent of this Legislature that county-owned
   hospitals work with regional community mental health/intellectual disability centers in
   providing care to local patients."

7. Please see response to question one.
8. Please see response to question two. There is no statutory requirement for counties to
   contract with community hospitals or third parties to provide local mental health services
   for persons ordered committed but awaiting a placement at the state hospital for treatment.
   Applicable Law and Discussion
   Sections 41-21-61 et seq., regard persons in need of mental health treatment and civil
   commitments.
   You first ask if counties are responsible for costs related to the treatment of persons ordered
   committed for mental and/or intellectual disability beyond the cost set forth in Section 41-21-79
   and the initial cost for transportation to a state treatment center. Section 41-21-73 regards hearing
   requirements for civil commitments and allocation of costs for the same. Subsection (4)
   specifically provides:
   If the court finds by clear and convincing evidence that the proposed patient is a
   person with mental illness or a person with an intellectual disability and, if after
   careful consideration of reasonable alternative dispositions, including, but not
   limited to, dismissal of the proceedings, the court finds that there is no suitable
   alternative to judicial commitment, the court shall commit the patient for treatment
   in the least restrictive treatment facility that can meet the patient's treatment needs.
   Treatment before admission to a state-operated facility shall be located as closely
   as possible to the patient's county of residence and the county of residence shall be
   responsible for that cost. Admissions to state-operated facilities shall be in
   compliance with the catchment areas established by the State Department of Mental
   Health. A nonresident of the state may be committed for treatment or confinement
   in the county where the person was found.
   Miss. Code Ann. § 41-21-73(4) (emphasis added). Accordingly, beyond Section 41-21-79,

Section 41-21-79 provides:
The costs incidental to the court proceedings including, but not limited to, court costs, prehearing
hospitalization costs, cost of transportation, reasonable physician's, psychologist's, nurse
practitioner's or physician assistant's fees set by the court, and reasonable attorney's fees set by the
court, shall be paid out of the funds of the county of residence of the respondent in those instances
where the patient is indigent unless funds for those purposes are made available by the state.
However, if the respondent is not indigent, those costs shall be taxed against the respondent or his
or her estate. The total amount that may be charged for all of the costs incidental to the court
proceedings shall not exceed Four Hundred Dollars ($400.00). Costs incidental to the court
proceedings permitted under this section may not be charged to the affiant nor included in the fees
and assessments permitted under Section 41-21-65(6).

a civilly committed patient's county of residence is also responsible for the costs of a patient's
treatment before admission to a state-operated facility.
You next ask if Section 41-21-77(1) requires county-owned community hospitals to provide
temporary care to persons ordered committed for mental and/or intellectual disability treatment.
Pursuant to Section 41-21-77(1), "[i]t is the intent of this Legislature that county-owned hospitals
work with regional community mental health/intellectual disability centers in providing care to
local patients." (emphasis added).
Finally, while there is no statutory requirement for counties to contract with community hospitals
or third parties to provide local mental health services for persons ordered committed but awaiting
a placement at the state hospital for treatment, counties may do so. See Miss. Code Ann. § 41-21-143 (regarding collaborative agreements).
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