For years, the one bright spot on Mississippi’s otherwise bleak health care landscape has been its reputation as a leader in childhood immunizations. Last year, 99.6 percent of kindergartners were fully immunized, by far the highest rate in the country.
“In a state where there are not a lot of health care statistics that we brag about, it’s one of the things that we do really well,” Dr. Mary Currier, the former state health officer, told Mississippi Today last year.
The reason for the state’s success is a 40-year-old law that, unlike those in other states, has remained impenetrable to the loopholes requested by the anti-vaccine movement.
But Mississippi’s reputation as a leader in immunizations masks a more complex reality—when it comes to young children, teenagers and adults, Mississippi lags far behind the national average, in some cases coming in dead-last, according to data from the Centers for Disease Control and Prevention in Atlanta.
“There are huge, huge gaps and we definitely want that to be part of the narrative,” said current State Health Officer Dr. Thomas Dobbs.
Mississippi is currently tied for 34th in early childhood immunizations, with just 72 percent of children under three receiving five vaccines on schedule. While the rate rises to nearly 100 percent in kindergarten, the numbers nearly flip by the time kids are in high school.
In overall vaccinations among teenagers, Mississippi comes in at 47th, ahead of just Kansas, South Carolina and Oklahoma, according to the CDC. And the state ranks dead last for HPV vaccinations among teenagers, with just over half of kids in that recommended age group receiving the vaccine.
Numbers don’t improve much in adulthood. Mississippi currently ranks 36 in vaccine coverage among adults, with just 35 percent of adults having the recommended pneumococcal, tetanus, diphtheria and shingles immunizations.
“It’s pretty dismal,” said Jill Gonzalez, a researcher with the online site Wallethub, which released a study of national vaccination rates last week.
And the vast majority of Mississippians of all ages avoid flu shots, which aren’t required for school age kids. Mississippi currently ranks 46th in influenza vaccinations, according to the CDC, with just 42 percent of Mississippians getting flu vaccines last year.
This, said Dobbs, is a serious problem with flu season around the corner. Mississippi has the second-highest flu-related death rate in the country. Hawaii is the only state where a more people per capita die from flu.
“It’s the thing that we’re really, really bad at,” Dobbs said. “What happens is that if you look at people in Mississippi over 65, we’re actually really good. But there’s a perception that adults and children don’t need the vaccine as much as they do. We have a lot of deaths in that age group because people underestimate the risk.”
The problem with immunization numbers, according to Dobbs, is the same problem for Mississippians when it comes to other aspects of health care: access.
“With early childhood vaccines, part of it are the intrinsic social barriers in Mississippi—poverty, transportation—those play a big role. So if we’re ranked 20 from the bottom in immunizations when there’s no law mandating them, I’d argue that’s pretty good compared with other (areas of health care),” Dobbs said.
“But I think it’s also way deeper than that. I think it’s health culture in Mississippi … We don’t seek health care, we don’t embrace health services. Part of it’s a cultural thing, part’s an awareness thing and part is that people don’t think they’re at risk of dying of something like the flu.”
Ironically, high immunization rates are perhaps more important in a state like Mississippi, which already has a less-healthy population, according to Dobbs and Gonzalez.
“We’re paying the price in well being and lives and also in money,” Dobbs said.
He points to HPV, which causes cervical cancer and certain throat cancers. Increasing the immunization rate, he said, “could completely eliminate cervical cancer.”
But Dobbs and Gonzalez split on best way to address this problem. No states, Gonzales said, mandate vaccines outside of school entry. Instead, she points to states like Massachusetts, which have adopted an incentive program, rewarding families that comply with recommendations with gift cards and vouchers.
“Local authorities are really going to have to help this at a grass roots level and help from the ground up, rather than having states mandate this.”
Dobbs said he agrees that Mississippi is unlikely, in the current anti-vaccine climate, to add more immunization requirements to law, but he thinks increasing coverage depends on increasing awareness.
And he said that recent campaigns, launched by the Department of Health, have made a difference. Though he acknowledges the HPV immunization rate “still lags,” he said it’s gone up dramatically. The rate has most than tripled since 2008, when it was 16 percent among Mississippi teenagers. During that same time, the national rate almost doubled, from 35 percent to 68 percent.
“We’ve really got to double down as much as we can in this era of rapid news cycles and information overload. Sometimes information is hard to stick, but we need people to understand how important this is,” Dobbs said.
This article first appeared on Mississippi Today and is republished here under a Creative Commons license.
by JULIE WHITEHEAD / MISSISSIPPI CENTER FOR INVESTIGATIVE REPORTING – Mississippi Today, October 3, 2019
Mental illness could look like the mother of three suffering from postpartum depression.
Or a single man with an engineering degree who can’t find a job because he has a history of paranoid schizophrenia.
Or the child with autism who reads voraciously but won’t talk to strangers — including a doctor — under any circumstances.
Mental illness manifests itself in signs and symptoms at times readily identified by a doctor, at times only known by the one who is affected. Don’t think it’s easy to look at someone and tell if they’re mentally ill. Mental health is nothing if not fragile. Even the most well-adjusted suffer periods of depression over a job situation or a poor marriage.
Where does one begin to seek help?
Family doctors often prescribe medication for mental health issues based on their own training or in conjunction with a therapist trained to treat mental disorders with therapy, said Angela Ladner, executive director of the Mississippi Psychiatric Association.
Other resources include education and advocacy groups such as the National Alliance for Mental Illness for adults or Families as Allies for children. NAMI has chapters throughout Mississippi to offer support and education on mental illness to families and individuals needing help, said Sitaniel Wimberly, program director in the state.
Another place to seek help for mental health issues could be ministries operated by faith communities. Valerie McClellan, program director for Solomon Counseling Center at Catholic Charities in Jackson, said the nonprofit’s outpatient mental health services served 181 families and individuals in its 2018 fiscal year.
The three counselors at the center offer a range of services, McClellan said, from children’s trauma services to premarital counseling to family conflict.
Jo Hebert, licensed professional counselor at St. Mark’s United Methodist in Flowood, said her eight-year-long ministry has seen many individuals with a variety of issues as well—grief counseling and issues stemming from divorce, depression and anxiety. “I meet with people right where they are and feel comfortable sharing their burdens and helping them find hope, then take steps to finding more hope,” Hebert said.
Not everyone with a mental health issue needs to see a psychiatrist, Ladner said. “Psychiatric providers are for the 20 percent of the population with a chronic mental health issue,” she said.
Counselors, however, are trained to know when a client’s need outstrips what they can offer, Hebert said. That’s where a psychiatrist can step in and offer more support.
Local mental health centers, located throughout the state, funded by county boards of supervisors and the state Department of Mental Health, see many of the individuals with more severe and chronic mental illness, said Adam Moore, communications director for the Department of Mental Health.
The centers must meet state guidelines to be certified mental health providers, Moore said, but are not directly operated by the department. They provide a wide array of services, including crisis management, medication management and outpatient counseling, he said.
The state is divided into 14 regions, each having a system of mental health satellite offices, Moore said. People seeking mental health treatment can locate the office nearest them using the provider locator on the department’s website.
Individuals in crisis can call a toll-free number for their region and reach a crisis intervention team, who can assess the individual’s needs for mental health treatment. Shareka Jefferson, county administrator for the Region 7 office in Choctaw County in north Mississippi, said staff there regularly get calls to the hotline for individuals needing assistance.
With no inpatient facilities available in the area, Region 7 can only offer services at the crisis center in Clay County, a 16-bed facility several miles away. The Choctaw County office also has one psychiatrist available three times a month and a psychiatric nurse practitioner twice a month for medication management, Jefferson said.
Such an arrangement is not unusual in Mississippi, Jefferson said. “There’s a shortage of psychiatrists all over Mississippi,” she said.
Jo Ann Marsh, director at Region 12 Pine Belt Mental Health Center in south Mississippi, echoed that assessment. “We always need more of them so we can help more people,“ Marsh said. With 565 employees covering nine facilities, only two are psychiatrists with a number of nurse practitioners filling in the gaps for medication management, Marsh said.
Often a severe crisis, such as a suicide threat or attempt, leads to a need for inpatient services. The Department of Mental Health provides 401 adult psychiatric beds for intensive inpatient services, with 118 adult acute beds and 75 continued treatment service beds at Mississippi State Hospital at Whitfield, 50 adult acute psychiatric beds each at North Mississippi State Hospital in Tupelo and South Mississippi State Hospital in Purvis, and 108 adult acute psychiatric beds at East Mississippi State Hospital in Meridian, according to figures provided by Moore.
For-profit and nonprofit hospitals fill in the gaps for those in the state needing inpatient treatment.
Family members of children with mental illness can start looking for answers in their schools. “All 14 Community Mental Health Centers are required to offer their services to local school districts within their catchment area,” said Moore.
In fiscal year 2018, there were 22,074 children and youth served through School-Based Outpatient Therapy in 940 schools by 620 school-based therapists, Moore noted. Region 8 Mental Health in Brandon has counselors available at all 28 schools in the Rankin County School District under a pilot program that could be replicated across the state, according to Nina Williams, clinical director. “The goal is to catch children before they reach a crisis point,” Williams said.
Veterans can receive mental health care at the closest VA medical center to their home, said Susan Varcie, public affairs officer with the G.V .( Sonny) Montgomery Veterans Affairs Medical Center in Jackson. Over 9,500 veterans are enrolled in mental health programs at the Jackson VA, she said. Other Mississippi veterans are served by Biloxi and Memphis VA systems. Wait times range from no wait at Natchez’s outpatient clinic to 24 days at Greenville’s clinic, she noted.
Insurance is mandated to provide just as much benefit for mental illnesses as for physical illnesses, said state Insurance Commissioner Mike Chaney. The 2008 Mental Health Parity and Addiction Equality Act was the first law that required mental health care parity, and then under the Affordable Care Act in 2016, Mississippi chose mental health parity as an essential health benefit, Chaney noted.
The main difficulties are limitations to office visits and availability of coverage for prescribed medications, he said.
This story was produced by the Mississippi Center for Investigative Reporting, a nonprofit news organization that seeks to hold public officials accountable and empower citizens in their communities.
Where to seek help:
National Suicide Prevention Helpline: 1-800-273-TALK
Crisis numbers for Regional Health Centers:
Region 1 – 888-404-8002 (Coahoma, Quitman, Tallahatchie, Tunica)
Region 2 – 866-837-7521 (Calhoun, Lafayette, Marshall, Panola, Tate, Yalobusha)
Region 3 – 866-255-9986 (Benton, Chickasaw, Itawamba, Lee, Monroe, Pontotoc, Union) Region 4 – 888-287-4443 (Alcorn, DeSoto, Prentiss, Tippah, Tishomingo)
