The near collapse of community mental health services in South Mississippi was not a shock to anyone in the know.
Public records, and Sun Herald interviews with current and former employees, reveal an agency that had been unraveling for several years.
The four-member board of commissioners that oversees Gulf Coast Mental Health knew the agency was in trouble long before it nearly collapsed in August under the weight of financial problems, public records and interviews show.
Harrison County supervisors also had been warned more than a year earlier that the agency was not delivering adequate services to its most severely mentally ill clients, according to a clinical psychologist and law enforcement heads.
Nine months before community mental health was in full-blown crisis, Gulfport Councilman Rusty Walker sounded the alarm in a public meeting and posted the video online.
“I have no confidence in the agency any longer,” Walker said. “I believe that they are squandering money. That’s a strong statement. I intend it to be strong.”
Further, the state Department of Mental Health had uncovered serious deficiencies with GCMH services by December 2017, according to minutes of GCMH commission meetings.
Yet nobody stepped in to correct the problems until June, when GCMH commissioners asked member counties for advance funding to remain afloat. The public — and even GCMH employees — did not learn until July 17, when the Sun Herald broke the news, that the agency planned to close its doors when money ran out in less than a month.
Supervisors and the Mississippi Department of Mental Health expressed alarm and are now working to keep the agency’s doors open, but its survival remains in doubt.
Thousands of mentally ill and developmentally disabled residents and their families rely on GCMH inpatient and outpatient services in Harrison, Hancock, Stone and Pearl River counties. Further, the agency provides therapists to schools in all four counties and stabilizes mentally ill patients who might otherwise be jailed.
GCMH is one of 13 regional agencies in the state’s network of community mental health services in Mississippi.
“To me, it’s paramount that our community has those resources in place — and I’m not talking about substandard resources —because what are your alternatives if you don’t have resources in place?” asked Gulfport Police Chief Leonard Papania.
“We wouldn’t have our hospitals saying we’re all shutting down. That’s just not an option. We have got to demonstrate that we have a viable solution in the works and I’m not sure if we’ve got one.”
HOW IT STARTED
The board’s longest-serving commissioner, Candy Murphy of Hancock County, said the agency has long dealt with high turnover and trouble recruiting staff because of low pay in public mental health.
Murphy and many others said GCMH’s longterm employees stayed because they believed in the agency and loved their work.
She remembers few if any problems with critical certifications for professional staff, required for grants and insurance billing, under the leadership of Jeff Bennett. Bennett stepped down as executive director around 2016, after 30 years on the job.
“We never had any issues,” said Murphy, who has served as Hancock County’s commissioner for more than 20 years. “There were times when we talked about budget issues, especially after (Hurricane) Katrina and BP (oil spill). Even back then, there were concerns about Medicare and Medicaid billing.”
The new executive director, Shelley Foreman, started work in January 2016 after more than 25 years with the agency, previously as regional director of children’s services. Foreman, who has moved on to another mental health job, said she is trying “to remain positive.”
Foreman took over an agency with an annual operating budget of around $11 million, a little more than half from patient fees covered by Medicaid or private insurance.
Agency services include crisis stabilization, substance abuse treatment, group homes and day treatment centers for the severely mentally ill, a work activity center for developmentally disabled adults, counseling and medication clinics. The agency has thousands of clients, many of them unable to pay for private services.
Foreman said problems with certification for professional staff preceded her. She went to her directors at sites spread throughout the four-county region, she said, explained certification requirements and insisted they be met.
“That became my number one priority: Let’s get in line with what we have to do legally to bill, so a lot of people weren’t happy with me,” Foreman said.
Dissatisfaction, she said, led to employee departures or changes in duties. By October 2017, the agency board minutes say, GCHM had an entirely new executive team, including a new chief financial officer hired after the previous CFO retired.
Foreman also said poor financial decisions were made during her administration, but not by her.
“I am passionate about mental health needs for all people,” Foreman said. “I hope they are able to recover and offer services to the individuals that desperately need them.
“I’ve spent my entire career with the mission of helping individuals with mental illness that are vulnerable and I will continue to do that.”
MANAGEMENT WOES MOUNT
The board of supervisors in each county appoints one of the four commissioners on the GCMH board. Candy Murphy is the only commissioner who worked with the previous management team.
The board for decades met over lunch, paid for by GMHC, once a month at the Great Southern Club, an arrangement set up by previous board member and Gulfport attorney Harry Allen, who passed away in January 2016.
Their lunches cost anywhere from around $180 to more than $220 a month, according to minutes the Sun Herald reviewed from 2016 to date. The only other compensation they received was mileage to and from meetings, Murphy said.
The Mississippi Department of Mental Health and GCMH commissioners were aware of certification problems at the agency by December 2017, board minutes say.
MDMH had by this time performed its annual audit of many GCMH services. The audit pointed to problems at Crossroads Recovery Center in Gulfport, where GCMH offers drug- and alcohol-dependent clients inpatient and outpatient treatment.
MDMH gave the agency a good report overall, Foreman told the board.
Foreman told commissioners that MDMH issued 41 citations at Crossroads. An auditor for MDMH found patient charts without required treatment plans, objectives for treatment or patient assessments.
“Ms. Foreman was informed that if CRC (Crossroads) was a private facility, services would be suspended that day,” the December 2017 minutes say.
Monthly financial reports grew vague and sporadic after CFO Tom Pritchard retired in March 2017.
The CFO who replaced him, Mary Jones, started reporting budget shortfalls. By July 2017, the minutes note that Foreman and Jones were looking for ways to cut expenses.
At some meetings, the month’s financial statements had not been closed and could not be reported. By February 2018, the budget “was out of whack,” client fees were down and the agency was behind on billing. Jones blamed the previous administration, the minutes say.
She said that she had a plan to increase agency reserves from $2.5 million to $5 million.
Recovery of grant funds and other financial problems started to mount.
By the end of 2018, the situation had grown serious enough that commissioners decided to forego any per diem and the lunches GCMH paid for each month. Commissioners moved their monthly meetings to morning hours.
Minutes say: “The commissioners added that we cannot continue at this rate; pay cuts and/or terminations may need to be made as well as increasing client fees.”
Commissioners Murphy and Laura Hasty, Harrison County’s member, said the board asked a lot of questions and worked to get to the bottom of agency problems. Hasty said commissioners were getting excuses from the agency’s administration and were unable to see the scope of the financial problems.
The annual financial audit, usually ready by February, was not completed on time. Foreman canceled the March director’s meeting. The auditing firm was still waiting on information in April when Foreman and the board had a showdown. The board peppered her with questions and said they would be meeting with agency directors without Foreman.
“It was stated that clients are at risk because the agency is not being managed correctly,” the minutes say.
Foreman said she decided to resign.
Vickie Taylor, a therapist who served as Hancock County clinical director, agreed to step in as interim director. She is trying to help straighten out the agency but said she has no desire to remain permanently in the job.
“Vickie told us, ‘This is like an onion, every layer I peel, it gets a little worse,’ ” Murphy said. “We didn’t know the extent of the problem until Vickie Taylor got there.”
The reserves that were supposed to be built up had shrunk to $341,512 by the time GCMH gave Harrison County supervisors are report in June. Payroll costs alone are up to $300,000 a month.
LIVES AT STAKE
GMCH clients were, and still are, at risk, the heads of two law enforcement agencies told the Sun Herald.
Law enforcement agencies in the region tried for several years to work with GCMH on crisis intervention. When officers pick up mentally unstable people who might hurt themselves or others, there are two choices: jail or a crisis stabilization unit.
Harrison County Sheriff Troy Peterson runs the jail for the county and its five cities. Jail, he said, is no place for the mentally ill.
He and city police chiefs in Harrison County sent officers for 40 hours each of crisis intervention training, anticipating that GCMH would work with them to house patients in its crisis stabilization unit until they were stabilized and sent home or to the state mental hospital.
Peterson said GCMH was able to dedicate only 16 beds in its 42-bed crisis stabilization unit to the crisis intervention program and rarely had a bed available. In many cases, officers were forced to arrest mentally unstable people on misdemeanor charges — disturbing the peace, for example.
“We can’t medicate, whereas a mental facility can.” Peterson said. “It’s causing them more mental issues because now they’re not in the world, they’re not close to their family where someone can talk them down.
“They’re in a cell where they’re locked down 12 hours a day and they’re just looking at the walls.”
APPEALING FOR HELP
In mid-2018, Gulfport Police Chief Leonard Papania and clinical psychologist Julie Teater went to the Harrison County Board of Supervisors about problems at GCMH.
Teater evaluates patients to determine whether they should be involuntarily committed. Many of these patients wind up at GCMH’s crisis stabilization unit in Gulfport.
She said patients were being released from the unit without followup care and wound up being committed again.
“I said, ‘I have grave concerns about the level of care,’ ” she said. “I said that there’s a problem and y’all need to do something. They told me I should go to the commission meetings.”
In June of 2018, Teater found the commissioners meeting in a back room at the Great Southern Club and asked them how they considered that a public meeting. The next month, commissioners moved their meetings to GCMH’s Broad Avenue offices in Gulfport.
She attended several of the meetings, but made little headway and got no indication that GCMH had serious financial problems.
Both she and Peterson worry that someone will die unless community mental health services are revived.
“That’s the sad part,’ the sheriff said. “This is going to happen because someone is not getting the help they need.”
Commissioners are interviewing candidates for executive director. A former mental health executive for Memorial Hospital at Gulfport is working with GCMH staff on billing and certifications.
Marlin Ladner, president of the Board of Supervisors, wants the agency stabilized and the causes of the crisis examined, which would include a forensic audit.
Law enforcement agencies, Teater and others who deal directly with GCMH clients worry about the sustainability of mental health services, especially because funding intended for next fiscal year has already been advanced to the agency.
“Is it going to get fixed?” Peterson asked. “We all hope so. We’re optimistic about it, but nobody can answer that question.”