After three decades of working with patients and policymakers to improve Mississippians’ mental health, Joy Hogge is retiring this spring from her role as the executive director of the Mississippi Families As Allies, a nonprofit aimed at supporting children with behavioral challenges. 

Since earning her clinical psychology degree in the early 1990s, Hogge has treated kids in state hospitals; helped the federal and state governments better understand where health systems fall short; and advocated for laws that better protect vulnerable Mississippians.

In anticipation of her upcoming retirement, Mississippi Today interviewed Hogge about her mental health work in the South and what she’s excited about in the future. 

Mississippi Today lightly edited this interview for clarity and length. 

Mississippi Today: You weren’t always on the policy side of things. You started on the clinic side. Can you talk about that a bit?

Joy Hogge: Yes. I got my PhD at Texas A&M in counseling psychology back in 1992. I started working at a state hospital, and I ended up working with kids. I worked there, and then I worked at Dallas Child Guidance (Dallas Child & Family Guidance Center). Ended up in Mississippi when my husband and I moved here. 

I loved that work, but I would get really frustrated because we would bring families together with the different groups that were working with them, the different systems. I’d see every system when the family wasn’t in the room, blaming them. I just thought, “I didn’t go to school all those years to do this.” Once I came to Mississippi, I was introduced to Families As Allies — what it meant to really partner with families and let them take the lead in the care for their children. 

So I did that work at first, clinically working with families. I was the director of children’s mental health services at Catholic Charities, and we had a whole bunch of community based programs. We had a crisis intervention program, a crisis center, therapeutic foster care in home — all kinds of things where we used that model. In partnering with families, I came to see what a difference that made in my practice and in the programs we were running. It was very, very hard, and we learned a lot. I learned a lot about myself. But then, with families and with Families As Allies, we started working on designing programs together from the very beginning, so they were responsive to families. And then that led into policy.

Then, I ended up having a child. I stayed at home with him, and he experienced some challenges. I came back to work about 10 years later on (the policy) side. 

MT: You said something I found really interesting when you were describing your work as a clinic psychologist. That, if I heard you correctly, when children left the room, you often heard families blame their children.

JH: Oh, what I was saying is that when families, the whole family, wasn’t in the room, I heard the different systems blame the family. What would happen — I worked at a state hospital. We would have these treatment teams. First, it would be, say, us and the school system there. And everyone in those two groups would be blaming child welfare. And then child welfare would get there, and they would blame another system. But then everyone would blame the family once all the systems got there and say “It’s all the family’s fault that this child is having all these problems.” Then, we would get in the room and the family would come in. But nobody would be honest and say “This is what I think was going on.”

I just thought if I spent all this money and time to get a PhD just to blame all these systems and blame families, that doesn’t make any sense. And then, when there really are those honest conversations — where everybody is saying what they really think and families can say what they really want — you see they really know their children. They’re an expert on their child. Children are experts on themselves. It just starts shifting the whole picture. 

MT: When you became a parent of a child who had some challenges, were you ever worried that some of these same systems that you heard gossiping behind families’ backs were doing the same with you and your family?

JH: Absolutely. I remember when I started looking for preschools for him, I’d hear these “nicey-nice” things like “Oh, have you ever thought about homeschooling him? Maybe that would be the best thing for him.” And I was like, “Well, have you ever heard that he has the right to a free and appropriate public education?” Then, they would stop. 

But yes. I knew, because he had a lot of special health care needs, that I now have that child that sometimes the teacher might be hoping, “Oh, I hope he doesn’t come in today. Because it’ll be especially hard if he’s here.” That’s very hard. I think the reason I got this (Families) job is because when I had my interview, I described the first time I went to a school meeting with my child. I’ve been to a bunch with other families. And I sat in the car and cried, because I was too scared to go in. It was just a totally different experience as a parent. 

MT: Can you say a little bit about what you were scared of?

JH: I was scared they would judge me. I was scared that they wouldn’t do what was needed to keep my son safe at school. I was scared I wouldn’t know what to do — that I’d just fall apart if that happened. Interestingly, I thought back to some of those families that I first got to know at Families As Allies. And I remembered how they were just fearless. I thought, “Okay, I’m putting my big girl britches on and going in there. I don’t even remember what happened in the meeting. I think things went okay. But that feeling of “I’m going to be okay,” because I thought about what those families did for their kids.

MT: Eventually, you join Families As Allies. Do you join as executive director initially?

JH: Basically, anyone who wants to be a part of Families As Allies can be. Anyone who’s listening to this, I hope they know that. But the (former) executive director, who was Tessie Schweitzer, she was the one who I first met who mentored me. She was ready to retire — she had actually retired and come back. So the job was advertised. Some of the families who I had worked with way back when encouraged me to apply. They were saying “You know. You know what it’s like.” I thought about that sitting in the car. It’s that shared, lived experience among families or parents, or whoever’s raising a child, who’ve been through this. 

MT: So what year did you start as executive director?

JH: December 15, 2011. I’ve told this story so many times. December 22, 2011 was when the Department of Justice filed their big letter. 

MT: The letter is from the Department of Justice, saying they have not found the Mississippi Department of Mental Health services have adequately followed the law with regards to the Olmstead ruling (the Supreme Court ruling that says Americans with disabilities have the right to receive services in their community and cannot be institutionalized if less restrictive options are available). When you read that letter in your second week at Families As Allies, what goes through your head?

JH: Keep in mind, I’ve been doing all this stuff just on my own — working with Families As Allies just as a mom while I stayed home with my son. I had heard people from the mental health system and the Department of Mental Health, including the executive director at that time, talk about how they wanted to move to community-based services. I’m reading this (letter) and thinking, “Oh, all this is true. Only they left a whole bunch of stuff out. It’s worse than this.” I thought we would all start working on things together. I was getting calls, because I was one of the few people at work that didn’t have any vacation time. So that’s how it all began. 

MT: After the DOJ files that letter, what do you see as the response from the people named in the letter (former Gov. Haley Barbour and other state legal and health officials)?

JH: I remember going to a board meeting of the Department of Mental Health right after that, and they were very angry. They were saying “He does not have the right to do this to us. If it ain’t broke, don’t fix it.”

MT: He as in (Former President Barack) Obama?

JH: Yeah. It took me the whole board meeting, but I finally figured out it was Obama. I think the Department of Mental Health staff was probably a little more circumspect. And then there were different advocacy organizations that started getting together in the community to see what we wanted our response to be. There was actually a pretty wide range. Some people were saying, “We think the Department of Mental Health is doing a pretty good job.” Our organization was more concerned because we saw what was happening to kids. They were ending up institutions, because they couldn’t get the care they wanted. So there was a wide range of reactions. 

MT: What were some of those things you saw left out of the DOJ letter?

JH: One thing I didn’t understand at the time — that division is probably not going to do anything with school services. But the fact that for children, yes, they were ending up in institutions. They still are, and there’s still not the range of community-based services that are needed. But there’s this whole other issue of children not being able to be educated at school if they have mental health challenges that result in a disability that adversely affects their ability to learn. They’re not being accommodated, and they’re still being kicked out of school. So it was mostly things in the education system.

The Department of Justice, I thought, was always very willing to work with the state — really, I felt like, trying to lead them along and say, “Just do these very basic, menial things” they saw as an egregious violation. The state seemed to see it as an egregious violation of their right to rule themselves. 

MT: What was the state of community mental health services and community mental health centers in Mississippi in 2011?

JH: Keep in mind, I had been away, and I wasn’t working a lot with the community mental health centers. There weren’t as many types of services as there needed to be, and as there are now. There’s more now that actually helps people live in the community. It was more just focused on treatment. Things like giving people the support so they can have an apartment in the community and a job. There weren’t things like that. There weren’t as many crisis services. There wasn’t, and there’s still not as much as there needs to be from what I can see, much coordination between the state hospital system and the community mental health system. So the community mental health system might not even know someone was returning to the community from the hospital. Then, you have people cycling in and out, and that’s (what) the lawsuit ended up being about.

Editor’s Note: When asked about Hogge’s comments about the coordination between community mental health centers and state hospitals, Phaedre Cole, president of the Mississippi Association of Community Mental Health Centers, said communication has improved significantly between the two groups since the Department of Justice sent its 2011 letter. She also said there are always ways to further improve on it. 

MT: So 2016, five years later, the DOJ does end up filing a lawsuit. What is Families As Allies’ reaction?

JH: We supported it. There was a whole lot that happened up until that point. There was a temporary agreement that the DOJ wouldn’t sue if the state did certain things, and one of those was to complete an assessment on the children’s system. We helped gather information — we brought families together so they could meet with the experts. We did it on the condition that we could have a copy of the assessment. Because it was running on for so long, we wanted to be able to actually do something. And the state wouldn’t release those. The Clarion-Ledger sued, and they finally released those. One thing we said all along is that the information that was most needed was from people directly receiving services and their families. Because from what we could see, they weren’t being asked until that assessment. 

MT: So the lawsuit proceeds. But it’s dismissed in 2023. What was your reaction and Families As Allies’ reaction to the lawsuit being dropped?

JH: I was really devastated. I thought it was a travesty, because the Department of Mental Health was making progress — having to report what it was doing and be much more transparent with real data, not data that is just internally gathered and reported. That had been really helpful. I went — it was in October of 2022 — I went to the 5th Circuit hearing when the state was trying to get the lawsuit dropped. I am not a lawyer, but one thing that was just gravely concerning to me — and it still is — is that the state’s main defense seemed to be that the federal government did not have as much of a right as it thought it did to enforce the Americans with Disabilities Act. I mean, I have a child with a disability. And here is the Solicitor General for Mississippi — now, he’s being paid to find the best defense. What he appeared to be arguing (for) would gut the Americans with Disabilities Act. Not just for people in Mississippi, if this went on to the Supreme Court. Not just for people with mental illness. 

And that terrified me. What really just broke my heart, I don’t even know the words for it, is the leadership of the Department of Mental Health, Wendy Bailey, was sitting there with him. I’m thinking, “You may not have a choice about how all this is defended.” But I had real questions about, “Do you understand what they’re saying?” What he appears to be saying is that (for) the people your agency is supposed to serve, we’re going to gut the law that protects them. Even if they’re going to do that, how can you sit there and appear to be complicit?

Editor’s Note: Mississippi Today reached out to Mississippi Department of Mental Health Executive Director Wendy Bailey about Hogge’s comments related to Bailey’s role in the Department of Justice lawsuit. In response, Bailey wrote in an emailed statement, “Mississippi has made meaningful progress, and I am proud of that progress and the partners delivering care across the state. While there are still gaps and areas to strengthen, DMH is committed to addressing unmet needs and improving outcomes through strong, effective partnerships that provide real services to Mississippians.”

Mississippi Today also reached out to Solicitor General Scott Stewart and the Attorney General’s Office about his argument in court. Neither responded.

MT: Former Mississippi Today Reporter Isabelle Taft reported stories about that time. In those stories, DMH’s response was that we’re already serving people in their communities. We (the federal government and DMH) share the same priorities. What did you think of that argument? 

JH: I’ve never understood that, because it was like they were saying two things at once. The only thing DMH was being asked to do was go by its own standards and to do it across the state with the programs they already have. So I don’t know why that was such a big deal if that’s what they were already doing. That’s always puzzled me. On the other hand, the arguments were consistently that the federal government does not have the right to tell us what to do. And there is a clause in Olmstead from Ruth Bader Ginsburg that the state can’t be asked to fundamentally alter its mental health system in order to comply. They (DMH) would bring that up, and I’m thinking, “It probably is an alteration for y’all, and maybe it’s an alteration beyond what you can do to actually go by your standards and provide the services to everyone.” Shouldn’t be, but maybe it is. So I don’t know. But how can both those things be true at once? 

MT: So two and a half years after the lawsuit is dropped, how close do you think DMH is to following all the provisions related to Olmstead with regards to mental disabilities among adults and children?

JH: If you’re asking me are they doing what that lawsuit required them to do, they are probably closer. Whether or not we have a mental health system that helps all people with mental illness in the state have the opportunity to be in the community and live and work in the community (and for children, go to school), that’s a much different question. I’m not sure how much closer we are to that. 

MT: When you look back on your career impacting mental health systems from the clinical all the way to the policy advocacy side in Mississippi, what are you most proud of? 

JH: I think maybe my own increasing recognition that unless whatever is done — whether it’s with one family, or one person, or building a program, or working on a policy — unless it is done from the very beginning with the people that policy, or that therapy, or that program are about. Unless it’s done truly in partnership, and preferably with them leading, it’s not going to be meaningful. And I have been so struck by that over and over again, and so humbled by that in my own work. I didn’t like learning that lesson, and I have to relearn it every day. And it’s hard. I say the one thing you have to give up is control. I don’t like that at all, but it’s transformative. I am proud that looking back, I think I made that happen more and more with individual families, with programs and with policy. That trajectory got stronger over the course of my career. 

MT: You think Families As Allies now compared to when you first got involved is better at involving the people most impacted by the health issue with some of your advocacy work?

JH: I think so. The lawsuit and COVID really opened up a lot of opportunities. The lawsuit allowed us to really encourage families to just start coming to things like (Department of) Mental Health board meetings and these meetings with the Department of Justice. And people hadn’t done that before. Other groups seemed really nervous if the Department of Justice asked, “Can you help bring families together?” We just did it. I remember I called the Department of Mental Health and said, “This is what we’re doing. And if y’all want to get families together and talk to them about what they want to see from the mental health system, we’ll do it for you, too.” That just seemed like the thing to do. 

When COVID happened, we started emphasizing our newsletter a lot more, and it started coming out once a week. Haven’t been as good about that the last few months. But that allowed us to do a lot more updates, like on the lawsuit, and really get a lot of information out there to families. I think that made a difference. And then policymakers seemed to get interested. 

MT: What is your hope, not only for advocacy groups like Families As Allies, after you retire, but also for the state of mental health services in Mississippi?

JH: There’s this dilemma, because we get money from the Department of Mental Health, and several groups that do work related to mental health advocacy do. That’s not uncommon, but it creates a tension. So I hope there will be a continued commitment to dealing with that tension by always being led by the people the issue is about. 

I am just struck when I’m talking to people who are newer to this work and a lot younger than me. (I hope) there will be a continued commitment to look at how we can fund and do this work creatively so it’s not so dependent on the funding, it’s not so dependent on the systems. 

MT: Is there anything you’re excited to talk about now that you won’t be part of an organization getting funding from DMH? 

JH: Well, probably everything I’ve said in this interview. I was in this weird position because during the time I was staying home with my son, I just went up to the Legislature and said whatever I wanted. I worked with Families As Allies, but I wasn’t getting any money. When I got my job as the executive director of this organization that does advocacy work, I had to tone it back. Because we were getting money. From not just mental health, we also have gotten it from different state systems. But that’s the one that would be most concerning as far as saying something. 

MT: To clarify, they (Department of Mental Health) weren’t explicitly saying “you need to tone it back?” 

JH: Right. I think just being able to talk as freely as I have today, and to continue to explore the idea of, could the mental health system be structured differently and work better for more Mississippians. Or am I the only one that thinks that? Or if people explored that more, that whole model of having it be based on overall outcomes for the state. I would love to explore that more. 

I’m the president of the board of the National Federation of Families, which is our parent organization. I’m excited about being able to do more with that because I have more time. I’m just, I’m excited about the opportunities. And I’m getting to do a couple things in the next few weeks that are more learning about things at the national level. I’m going to a national peer support summit planning that I got invited to go to. I’m learning some more about child welfare. I’m excited about those things, and just having a chance to learn without having to be responsible for a whole lot of other things, too.