Cayla holds a Bachelor of Arts degree in psychology with a minor in child and family studies from the University of Southern Mississippi, graduating in the class of 2010. Following graduation, she secured a position at Pine Belt Mental Healthcare, obtaining licensure through the state department of health as a certified case management professional. Initially serving in that capacity, Cayla’s role transitioned to that of a community support specialist, during which she worked during the early stages of the implementation of the Wraparound program, a collaboration between governmental entities and organizations that provide behavioral healthcare and management services.
Today, that program is widely implemented across the regions served by PBMHR. During Cayla’s tenure at the center, spanning from 2011 to 2012, the author managed a caseload of 88 clients in the Forrest County region.
Recently, Jerry Mayo, who served as executive director at Pine Belt Mental Health Care, engaged in a collaborative effort by attending a joint committee on public health and welfare held at the Mississippi state capitol in Jackson as part of the current session of the Mississippi Legislature. His purpose was to provide insights into his extensive experience in the realm of community mental health throughout Mississippi, a state grappling with significant disparities in this regard. Mayo specifically fielded inquiries pertaining to budget allocations, service provisions, employment dynamics, and the myriad challenges encountered across the mental healthcare center’s 13 regions.
Mayo concluded his tenure at Pine Belt Mental Healthcare in Mississippi in 2018, marking the end of a career spanning more than two decades. Mayo’s expertise and contributions to the organization have left an indelible mark.
Initially recruited for his strong business acumen, he commenced his journey in 1991 as the finance officer for the community mental health organization. By 1998, he had ascended to the position of director, overseeing operations across the entire state.
During his time at the helm, Mayo’s responsibilities were manifold, with governance structured around a commission comprising 12 to 18 members, guiding the mental health care center’s endeavors. According to its website, Pine Belt Mental Healthcare Resources is a tax-exempt 501(c)(3) community mental health center established in 1973.
Headquartered in Hattiesburg, Pine Belt Mental Healthcare Resources offers a wide array of mental health services.
In Mississippi, the Department of Mental Health addresses three overarching categories: drug/alcohol, mental health, and individuals with intellectual/developmental disabilities – better known as IEP – all within a unified framework. Despite the center’s efforts to cater to the diverse needs of these groups, challenges persist within the broader structure of the community mental health system, warranting attention.
Several of these pertinent issues were deliberated upon during the recent joint committee meeting.
At Pine Belt Mental Healthcare Resources, individuals may seek services or enter into the program through various pathways, depending on their age and specific needs. For children, access to services often begins with a referral from a teacher or support staff.
Sometimes, it can be a referral from a general practitioner; one key component of children enrolled in community mental health services is their involvement in an Individualized Education Program within their educational system. Oftentimes, the two go hand in hand, and mental health professionals work closely alongside school staff to ensure that milestones are achieved and to address behavior concerns and even medication modifications if necessary.
As individuals transition into adulthood, they may move from children’s services to adult services once they reach the legal age to represent themselves. Adults and children who are seeking treatment at PBMHR typically undergo a psychological evaluation, or “intake,” to determine their needs and diagnosis.
From there, a treatment plan is initiated, and a team of professionals are assigned the case to follow during the time that the client is enrolled in community mental health services. Some individuals may be mandated by the court to seek services at a community mental health center following legal proceedings or involuntary commitment.
There are also circumstances in which a person receives inpatient care for a mental illness or dependency problem, at which point they may choose to follow up that inpatient care with community services to ensure they have a support group and treatment plan to follow post-rehab. These criteria are often incorporated into their treatment plans as they work toward
reintegration into the community.
Each client at PBMHR is assigned a multidisciplinary team tailored to their specific needs. This team typically includes a doctor, a case manager or community support specialist, and a therapist or clinician, ensuring comprehensive care and support. According to their most recent bylaws, Community Mental Health Centers operated under the authority of regional commissions established under Mississippi Code Section 41-19-31.
Per that mandate, DMH/P must provide all the following core services and have the capacity to offer these services in all counties designated in the DMH/C region, or all counties identified by DMH/P providers:
- Adult mental health services;
- Children/youth mental health services;
- Substance use services; and
- Intellectual/developmental disability services.
Services for Substance Use Providers designated as or DMH/O or DMH/P must include the following:
- Outpatient services (general and intensive);
- Substance use treatment services; and
- Opioid services.
Within each of those categories are subcategories of care that include specific services and requirements to be met for each client enrolled in the care. Those things include peer support services, outpatient therapy, DUI assessment services, residential services, HIV intervention services, crisis response and withdrawal management services.
Overall, Pine Belt Mental Healthcare Resources strives to provide comprehensive, evidence-based mental health services to individuals of all ages and backgrounds in Mississippi. Mayo explained that there is a significant shortage in trained staff qualified to fill these vacancies in our community mental health centers.
Of the vacancies that are currently listed, several hundred are calling for a master’s level, professional or higher degree. Many of the jobs aside from that require a bachelor’s degree, while there are some careers that only require a high school diploma or GED.
Those positions that require a college degree offer a starting salary that is oftentimes as little or less than what a person could earn at a fast food restaurant or grocery store. The turnover rate in community mental health settings is notoriously high, at approximately 20-25 percent, and there are always a large number of job openings available at any given time – in some regions more than in others.
The reasons for this can vary, but are almost all likely related to salary restrictions, hostile work environments, stressful work environments and a lack of proper support in terms of job training and advancement.
Case manager caseloads are often too high, which creates strain on the system and professionals as they try to equally meet the needs of all clients. In many cases, a caseload may be tailored to specific schools within a region to optimize support and coordination.
Limiting the geographic area covered by a professional streamlines their workload, allowing them to concentrate on a specific locality within their region. This enables them to forge deeper connections with the staff within that area or school district, enhancing professional rapport and collaboration.
In the field of community mental health, where high turnover rates are already a concern, fostering continuity of care is paramount. Clients, whether children or adults grappling with mental health or substance abuse issues, are more likely to engage in treatment when they perceive their providers as committed and reliable.
This turnover phenomenon, prevalent in areas with high turnover rates, notably impacts both short-term and long-term outcomes in the field. Directors and board members overseeing daily operations play a pivotal role in minimizing barriers for clients and communities.
By implementing strategies to enhance continuity of care and reduce turnover, they can improve overall outcomes and promote the well-being of those served. It is crucial that the counties in which the centers operate play a role in ensuring the organization’s success.
This involves an effort to facilitate structure within the agency and leadership roles that are constantly evolving and improving to meet the new challenges and needs of the communities served.
Author’s note: In Mississippi, there exists a legal limit on the number of clients a professional can manage on their caseload, similar to the student-to-teacher ratio requirements in public school systems. A decade ago, that legal limit for a caseload was approximately 55 clients, although enforcement of this limit varies and is often overlooked altogether. During my time in the field, my caseload extended beyond this limit, reaching 88 clients across Forrest County. Spanning the entire county, my clients were dispersed across 22 different schools, encompassing all districts within the county boundaries: Forrest County School District, Petal School District, and the Hattiesburg Public School District.
Despite spending the majority of their time in the field, community mental health professionals are often not provided with company-issued cell phones. Instead, they are expected to handle calls through personal devices or check messages on office landlines after they’ve completed their fieldwork.
Similarly, they lack company vehicles, despite extensive fieldwork, and are required to maintain full-coverage auto insurance at their own expense with a reimbursement per mile for travel time. There is a legal threshold for the cost of travel, based on a “cents on the mile” formula.
That limit is usually fluctuating, and most of the time employees receive approximately half of the total reimbursable rate for their fuel consumption. Despite their advanced education – typically a bachelor’s degree or higher – these professionals often receive salaries below industry standards.
Operating in a jurisdictional grey area between county and state, they lack the benefits afforded to state employees. However, they undergo rigorous training in crisis intervention, including restraint techniques for mentally ill individuals, as well as first aid and CPR.
Licensed by the Department of Health and Department of Mental Health at the state level, these professionals play a vital role in the mental health landscape, despite facing challenges in terms of resources and compensation.
Author’s note: During my time, there were stringent requirements, such as meeting production standards for six consecutive weeks before being granted approval to use company benefits. This means that professionals were obligated to bill Medicaid for 30 out of the 40 hours worked per week, with certain limitations, for six consecutive weeks without falling below that threshold before they could be taken off probation and granted certain job benefits.
Those primary professionals tasked with fieldwork spend the majority of their time engaged in various activities such as staff meetings, training sessions, traveling to and from clients’ homes or schools, and completing paperwork for client charts – and these activities are not billed. Services provided in the community mental health setting are typically billed in terms of “billable hours.”
For instance, if a case manager or Community Support Specialist needs to observe a client in a classroom setting, they allocate time on their schedule accordingly. Face-to-face interactions with clients constitute billable services, which are then invoiced to the insurance provider, often Medicaid, for community services.
Mental health staff are not only required to meet a designated production quota of billed hours each week, but they are also obligated to document a progress note for each billable service rendered to clients. These progress notes entail completing paperwork with checklists regarding the client’s physical and mental state, supplemented by details from field observations or visits.
These notes are subsequently integrated into the client’s medical records to track their care and progress over time. Typically, case managers are responsible for maintaining records of client care, with caseload sizes varying depending on the county of employment.
Many children receiving services at Pine Belt Mental Healthcare Resources undergo cognitive behavioral therapy, an evidence-based treatment combining medication with therapeutic techniques.
Additionally, the organization offers wraparound services, which serve as a comprehensive support network within the individual’s community. This approach involves a team of professionals and support staff, including counselors, case managers, teachers, parents, and others involved in the client’s daily life, working collaboratively for the individual’s benefit. Pine Belt Mental Healthcare Resources operates statewide, organized into regions based on counties.
The organization’s inception traces back to the mid-1960s, when federal legislation was created with a goal of establishing community mental health services nationwide. Subsequently, in the early 1970s, state legislation enabled counties with shared interests to form regional commissions, facilitating the provision of mental health services at a local level.
Initially, there were 15 community mental health centers established. Federal grants stipulated that these centers serve populations ranging from at least 75,000 people to no more than 250,000. However, there is no longer a population limit imposed on these centers today.
Counties serve as crucial units for geographic management, ensuring efficient allocation of resources. Region 12, for instance, encompasses a catchment area with a population of 700,000 people, representing the population to which they aim to provide services.
In terms of population served, Medicaid constitutes approximately 52 percent of the funding for community mental health centers, yet about 38 percent of the individuals served are not covered by Medicaid. Those individuals are either underinsured or uninsured. This means they likely lack a payer to cover the costs of the services provided, posing significant challenges for community mental health centers.
While most services reimbursed by Medicaid come close to covering the costs, some may not, exacerbating the financial strain on these centers.
Community mental health centers also receive funding from grants, with certain portions of these grants earmarked for specific criteria and services, in addition to Medicaid and support from the Department of Mental Health. Counties that are served contribute funds as well, with the amount determined annually through the Department of Mental Health appropriations bill.
These county contributions are often tied to historical amounts from the 1980s, and although many counties now contribute more than what was required decades ago, others do not. These funds, amounting to approximately 3.5 percent of the total budget across the entire service system (approximately $9 million), are crucial but may not fully cover the costs associated with providing care for the uninsured.
In Forrest County, for example, approximately 1 percent of the budget was earmarked for public health and welfare at the last budget meeting for Fiscal Year 2023. One of the prominent challenges facing community mental health centers is the presence of competitors.
While these competitors are certified by the Department of Mental Health to provide services, they differ in their approach. They selectively target populations and services, maximizing reimbursement and profit margins. This selective approach often leaves community mental health centers to bear the burden of providing care to underinsured and uninsured individuals, as Medicaid reimbursement alone may not cover the costs.
Furthermore, these competitors can aggressively recruit staff trained by community mental health centers, offering them higher salaries.
This creates a talent drain for the centers, exacerbating staffing challenges and further straining resources. In closing, I will circle back to the words that Jerry Mayo repeated multiple times: “community mental health centers are businesses embedded in government; businesses that sell time.”
Mayo went on to explain, “we’re on a ‘kill what you eat’ model… We have the ability to generate revenue, but that revenue has to be sufficient and the way you generate revenue is against the fixed reimbursement rate per hour… you have the ability to generate some money against the cost you have to pay employees and when those get out of balance, it makes it difficult for a mental health center to be sustainable.”
Operating a community mental health center is akin to managing a community hospital in many ways. Both institutions aim to address the healthcare needs of a specific geographic area.
In Forrest County, with the likes of Forrest Health – which is the umbrella over many county-run hospitals and affiliates statewide – we lead the way in many matters in the field of healthcare. However, securing adequate funding to provide comprehensive services poses a significant challenge in some areas.
Additionally, there is a risk of individuals seeking services elsewhere if reimbursement rates are insufficient. Those who cannot afford private healthcare often rely on community mental health centers, creating a situation where the center bears the burden of serving a financially disadvantaged population.
This overlap between financial constraints and the center’s mission to provide accessible mental healthcare underscores the complexities of operating such facilities. Finding sustainable funding sources while maintaining the commitment to serving the community remains a constant challenge.
The outcome of these centers can vary greatly based on who they hire to be the person in charge. Currently, the person in charge of the department of mental health in Mississippi is Wendy Bailey, and she comes fully prepared to do the job.
With data in hand, she has addressed the senate committees in Jackson more than once. Most recently, she followed up the joint session on public health and welfare a few days after Mayo spoke.
The differences in approach between those two is both notable and hopeful. According to the Mississippi Trauma Conference website, Bailey currently serves as the executive director of the Mississippi Department of Mental Health a role she assumed in January 2021.
During Bailey’s years at the agency, she focused on strategic planning, performance development, and budget management. She received her bachelor’s degree from Belhaven University and her master’s degree from Webster University.
She is a graduate of the John C. Stennis Institute of Government and is a Licensed Mental Health Administrator and Certified Public Manager. Bailey serves on numerous boards and task forces, including the Governor’s School Safety Task Force, Southeast Mental Health Technology Transfer Center Advisory Board, Board for the Mississippi Department of Rehabilitation Services, State Early Childhood Advisory Council, Certified Public Manager Program Board, and the Mississippi’s Suicide Prevention Task Force.
Bailey serves as a liaison with national organizations such as Mental Health America, Substance Abuse and Mental Health Services Administration and National Association of State Mental Health Program Directors Research Institute. She lives in Rankin County with her husband, Charles, and their son, Brandon.
