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:
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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."
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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.
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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
You need to budget for pre-admission civil commitment treatment costs. Section 41-21-73(4) puts that cost on the county of residence, full stop. The $400 cap in Section 41-21-79 is for the court-process expenses (court costs, prehearing hospitalization, transportation, fees for physicians/psychologists/nurse practitioners/PAs, and attorney fees), and that cap does not extend to the treatment that happens between the commitment order and the bed availability. If your county lacks dedicated capacity, the cost still lands on the county.
For county attorneys advising the board
The opinion confirms what is already implicit in Section 41-21-73(4) and answers a practical follow-up: the county is responsible for these costs even when there is no in-county facility to provide them. Section 41-21-77(1) does not impose a duty on county-owned hospitals to provide care; it expresses a legislative intent that they collaborate with the regional mental health system. So the county cannot rely on its own hospital being statutorily required to take the patient. If the hospital agrees to take the patient, document the cost-sharing or rate arrangement with the regional center.
Section 41-21-143 authorizes collaborative agreements; Section 41-21-77 envisions cooperation between county hospitals and regional centers. None of these provisions impose a contracting requirement, and none condition county action on Department of Mental Health director approval.
For county-owned hospital administrators
You are not statutorily required to take pre-admission civil commitment patients. The "intent" language in Section 41-21-77(1) is a policy statement, not a duty. If you do agree to provide care, the cost lands on the county of residence. Negotiate the rate up front. If the patient's county of residence is different from the hospital's county, the patient's county pays.
For families and patients in the civil commitment process
If a family member has been ordered committed and is waiting for a state hospital bed, the cost of any local treatment during the wait is on the county of residence, not on you or the patient. Section 41-21-79 caps the court-process expenses at $400, with the county paying for indigent respondents and the costs taxed against non-indigent respondents or their estates. If the local provider is sending bills to the family, raise that with the county attorney.
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
1. 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."
- 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." - Please see response to question one.
- 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