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Thursday, veterans across Missouri will attend an event at the State Capitol marking the 70th anniversary since the end of the Korean War.

Attorney General Kwame Raoul will join state lawmakers Thursday to explain legislation that clarifies what consequences 'crisis pregnancy center' will face for deceiving users.

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Mined land may have contributed to the disaster. It may also be the best place to rebuild.

A potentially fatal pathogen called Candida auris has adapted to cross the “temperature barrier” into humans, causing cases to jump by 1,200 percent since 2017.

"Our way of life has been totally destroyed.”

by Isabelle Taft, Mississippi Today, and Mollie Simon, ProPublica

This article contains descriptions of threats of violence and mental illness.

This article was produced for ProPublica’s Local Reporting Network in partnership with Mississippi Today. It was also co-published with Sun Herald and Northeast Mississippi Daily Journal. Sign up for Dispatches to get stories like this one as soon as they are published.

If you or someone you know needs help:

• Call the National Suicide Prevention Lifeline: 988
• Text the Crisis Text Line from anywhere in the U.S. to reach a crisis counselor: 741741

Nearly 40 years ago, a federal appeals court ruled that Alabama officials could not jail people in mental health crisis who were sent to the state for help. Jailing people going through the state’s civil commitment process, the court decided, amounted to punishment. And about 30 years ago, after Kentucky was labeled the worst state in the nation for jailing mentally ill people without charges, legislators there banned it.

But a new survey of counties and an analysis of jail dockets in Mississippi, which has no such law, has found that people going through the civil commitment process for mental illness are regularly jailed as they await evaluation and treatment, even when they haven’t been charged with a crime. Some counties routinely hold such people in jail — people awaiting treatment for mental illness or substance abuse were held in jail without charges at least 2,000 times from 2019 to 2022 in 19 counties alone, sometimes for days or weeks.

Nationally, Mississippi is a stark outlier. Mississippi Today and ProPublica conducted a nationwide survey of disability advocacy organizations and state agencies that oversee behavioral health. None described anything close to the scale of what’s happening in Mississippi.

Civil commitment laws are meant to ensure people get treatment even when they don’t recognize that they need it, said James Tucker, an attorney and the director of the Alabama Disabilities Advocacy Program. Locking them up as they wait for a treatment bed doesn’t fulfill that goal.

“The bargain for your lack of freedom is that the state has decided you need treatment,” he said. “The minute that order is entered, the state has a constitutional duty to deliver treatment.”

At least 12 states plus the District of Columbia prohibit jailing people undergoing commitment proceedings for mental illness unless they have been charged with a crime.

Mississippi law, however, allows people going through the civil commitment process to be sent to jail if there is “no reasonable alternative.” If there are no publicly funded beds in appropriate facilities, local officials sometimes decide they have no other option.

“We Forbid the Use of Jails”

In the 1970s, a federal class-action lawsuit against Alabama officials alleged that it was unconstitutional to jail people going through the commitment process for mental illness while they awaited hearings. It was common at the time: Probate judges in three-quarters of the state’s counties had jailed people, according to discovery findings cited in a court ruling.

Lawyers for the plaintiffs — everyone in the state who had been committed or would be in the future — cited previous lawsuits that had uncovered fire hazards, overcrowding and a dearth of mental health and routine medical care in Alabama’s county jails.

The district court ruled against the plaintiffs’ constitutional claims, reasoning that if the local jail was the only option in a county, it was the least restrictive facility that would also protect society.

"The bargain for your lack of freedom is that the state has decided you need treatment. The minute that order is entered, the state has a constitutional duty to deliver treatment." – James Tucker, director of the Alabama Disabilities Advocacy Program

But in 1984, a panel of judges on the 11th U.S. Circuit Court of Appeals rejected that reasoning. Circuit Judge Thomas Alonzo Clark wrote in his opinion that nothing prevented counties from placing people in a public facility in another county or in a local private facility that was equipped to handle mentally ill patients.

Clark cited a doctor’s testimony that jail often worsened psychosis, made it harder to treat people and increased suicidal tendencies.

“We forbid the use of jails for the purpose of detaining persons awaiting involuntary civil commitment proceedings, finding that to do so violates those persons’ substantive and procedural due process rights,” the judge wrote.

The reasons that Alabama officials provided for placing people in jail were similar to Mississippi officials’ arguments today. But Mississippi is in a different federal circuit, and the practice there has not been tested with a class-action lawsuit.

A sister of one woman who had died in a Mississippi jail in 1987 tried and failed to convince a federal judge that the woman’s rights had been violated when she was incarcerated without treatment.

Colett Boston, left, and Everlean Boston hold a photograph of their mother, Mae Evelyn Boston, in Oxford, Mississippi. When the sisters were young, their mother died in jail as she went through the civil commitment process. (Eric J. Shelton/Mississippi Today)

Mae Evelyn Boston, an Oxford woman who had dealt with paranoid schizophrenia for most of her adult life, had a psychotic episode shortly after giving birth. Her older daughter, Everlean, was 12 years old; she remembers her mother saying she was going to kill the baby because the girl “had a demon in her.”

One of Boston’s sisters initiated commitment proceedings — making Boston one of more than 100 people jailed for that reason from 1984 to 1988 in Lafayette County, according to a deposition cited in a 1990 ruling by U.S. District Judge Neal Biggers. When deputies arrived to take her mother into custody for evaluation, Everlean recalled, it took six of them to get her onto the ground before handcuffing her and placing her in the back of a cop car.

Once Boston was in jail, guards did not complete a medical screening required by department policy and didn’t know Boston had given birth via cesarean section 12 days before, Biggers wrote. She died two days later from heart failure caused by blood clots.

Everlean Boston remembers her mother smoking cigarettes and listening to the blues on quiet Sundays at home. The day deputies took her mother away was the last time she saw her. “I never got to say goodbye,” she recalled. “I never got to say I loved her. It hurts.”

“I never got to say goodbye. I never got to say I loved her. It hurts.” – Everlean Boston, whose mother, Mae Evelyn Boston, died in jail as she went through the civil commitment process

Biggers concluded that the “medical care customarily provided by the county for mentally ill detainees does not fall below constitutional standards” and that what happened with Boston represented a “scheduling error” and an “isolated instance.” The county, which argued it had provided adequate care for Boston, had the right to detain people like her “in the interest of societal safety,” he found, and those people were not entitled to placement in the “least restrictive alternative” such as a hospital. Biggers considered the Alabama appeals court ruling from a few years earlier, but concluded it didn’t apply because it was based on specific facts about that state’s jails.

“The court declines to hold that use of jails for temporary detention of persons awaiting civil commitment proceedings is unconstitutional per se,” Biggers ruled.

Since then, at least nine lawsuits have been filed over the deaths of Mississippians incarcerated during civil commitment proceedings. None of those lawsuits directly challenged the constitutionality of being jailed during the commitment process. The U.S. Supreme Court has not ruled on the matter, academics and attorneys with expertise in civil commitment said.

In the years after Boston’s death, Mississippi continued to stand out.

The chancery courthouse in Lafayette County, at the site that previously housed the county jail where Mae Evelyn Boston died (Eric J. Shelton/Mississippi Today)

In 1992, the National Alliance for the Mentally Ill and Public Citizen’s Health Research Group conducted a national survey about the practice of jailing mentally ill people.

Almost a third of city and county jails in Mississippi responded. About 76% of respondents said they detained people who had not been charged with a crime and were awaiting an evaluation, treatment or hospitalization for mental illness. That was the second-highest percentage of any state in the country and far higher than the national average of 29%.

An unnamed Mississippi jail official said in the organizations’ report that jails were a “dumping ground for what nobody else wants.”

The report gave its “Worst State Award” to Kentucky, where 81% of responding jails reported holding people without criminal charges for mental evaluations.

Two years later, Kentucky’s legislature voted unanimously to ban the practice. The state health agency and its federally designated disability rights organization told Mississippi Today and ProPublica that Kentucky jails today are not used to hold people without charges awaiting mental health evaluations.

Few States Compare to Mississippi

Officials with the Mississippi Department of Mental Health emphasize that they do not support the practice of jailing people during the commitment process. But a spokesperson said they “have heard anecdotally from other states regarding challenges of individuals waiting in jail.”

Nationally, even basic data like the number of people committed each year is elusive. After reviewing some of Mississippi Today and ProPublica’s findings, the Treatment Advocacy Center, a national nonprofit that advocates making it easier for people with mental illness to get treatment, started planning a project to understand how often people are jailed without charges during the commitment process across the U.S.

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Mississippi Today and ProPublica contacted agencies overseeing mental health and disability advocacy organizations in every state to find out whether Mississippi is an outlier. It is.

Respondents in 42 states and the District of Columbia said they were not aware of people being regularly held in jail without charges during the psychiatric civil commitment process. In a handful of those states, respondents said they had seen it once or twice over the years.

In two states, people can be sent from state psychiatric hospitals to mental health units inside prisons. In a few others, respondents said they had seen people jailed for noncompliance with court-ordered treatment for mental illness or substance abuse.

Respondents in three other states — Alaska, South Dakota and Wyoming — reported that people sometimes are sent to jail to await psychiatric evaluations, but the information they provided suggested that it happens to fewer people, and for a shorter period, than in Mississippi.

In 2018, staffing shortages at the Alaska Psychiatric Institute caused people to be held at the Anchorage Correctional Complex until they could be evaluated. The next year, an Anchorage judge ordered an end to the practice except in the “rarest circumstances,” finding that it had caused “irreparable harm.”

A subsequent settlement declared that jails shouldn’t be used unless no other option was available and that such detentions should be as short as possible.

But detentions do still occasionally happen in the state when people in rural areas await transportation to an evaluation center, said Mark Regan, legal director at the Disability Law Center of Alaska. According to the Alaska Department of Family and Community Services, people awaiting evaluation were held in jail 555 times from mid-2018 through late February 2023.

Across South Dakota, people without charges sometimes have been held in jail during the commitment process, according to law enforcement agencies and Disability Rights South Dakota, but such holds are limited by law to 24 hours; in Mississippi, the vast majority of cases analyzed were for more than 24 hours. The South Dakota Department of Social Services said it doesn’t track how often it happens and declined to answer questions.

And in Wyoming, a person can be held in jail for up to 72 hours on an emergency basis before a hearing, but they must have a mental examination within 24 hours. Such holds in jail have occurred “in very rare circumstances,” according to the state.

Attempts to constrain the use of jails date back at least to 1950, when the federal government sent governors model legislation that limited the incarceration of people for mental illness to “extreme emergency” situations. The National Institute of Mental Health called incarcerating such people “among the worst of current practices.”

Some states adopted the legislation. Mississippi did not.

Agnel Philip contributed reporting.

by Isabelle Taft, Mississippi Today, with data analysis by Agnel Philip, ProPublica, reporting by Mollie Simon, ProPublica

This article contains detailed descriptions of mental illness and suicide.

This article was produced for ProPublica’s Local Reporting Network in partnership with Mississippi Today. It was also co-published with Sun Herald, Northeast Mississippi Daily Journal and The Guardian. Sign up for Dispatches to get stories like this one as soon as they are published.

*** If you or someone you know needs help:

• Call the National Suicide Prevention Lifeline: 988
• Text the Crisis Text Line from anywhere in the U.S. to reach a crisis counselor: 741741

When sheriff’s department staff in Mississippi’s Benton County took Jimmy Sons into custody several years ago, they followed their standard protocol for people charged with a crime: They took his mug shot, fingerprinted him, had him change into an orange jumpsuit and locked him up.

But Sons, who was then 20 years old, had not been charged with a crime. Earlier that day, his father, James Sons, had gone to a county office to ask that his youngest son be taken in for a mental evaluation and treatment. Jimmy Sons had threatened to hurt family members and himself, and his father had come across him sitting on his bed with a loaded shotgun.

On Sons’ booking form, in the spot where jailers usually record criminal charges, was a single word: “LUNACY.”

The booking form for Jimmy Sons, identifying his “offense” as “lunacy” (Obtained by Mississippi Today)

In every state, people who present a threat to themselves or others can be ordered to receive mental health treatment. Most states allow people with substance abuse problems to be ordered into treatment, too. The process is called civil commitment.

But Mississippi Today and ProPublica could not find any state other than Mississippi where people are routinely jailed without charges for days or weeks during that process.

What happened to Sons has occurred hundreds of times a year in the state.

The news organizations examined jail dockets from 19 Mississippi counties — about a quarter of the state’s 82 — that clearly marked bookings related to civil commitments. All told, people in those counties were jailed at least 2,000 times for civil commitments alone from 2019 to 2022. None had been charged with a crime.

Most were deemed to need psychiatric treatment; others were sent to substance abuse programs, according to county officials.

Since 2006, at least 13 people have died in Mississippi county jails as they awaited treatment for mental illness or substance abuse, Mississippi Today and ProPublica found. Nine of the 13 killed themselves. At least 10 hadn’t been charged with a crime.

A woman going through the civil commitment process, wearing a shirt labeling her a “convict,” is transported from her commitment hearing back to a county jail to await transportation to a state hospital in north Mississippi this spring. (Eric J. Shelton/Mississippi Today)

We shared our findings with disability rights advocates, mental health officials in other states and 10 national experts on civil commitment or mental health care in jails. They used words such as “horrifying,” “breaks my heart” and “speechless” when they learned how many people are jailed in Mississippi as they go through the civil commitment process.

Some said they didn’t see how it could be constitutional.

“If an ER is full, you don’t send people to jail,” said Megan Schuller, legal director of the Bazelon Center for Mental Health Law, a Washington, D.C.-based organization. “This is just outright discriminatory treatment in my view.”

Mississippi Today and ProPublica also interviewed 10 individuals who had been committed and jailed, as well as 20 family members.

Many of those people said they or their family members had been housed alongside criminal defendants. Nobody knew how long they would be there. They were often shackled when they left their cells. Some of them said they couldn’t access prescribed psychiatric medications or had minimal medical care as they experienced withdrawal from illegal drugs.

“It felt more criminal than, like, they were trying to help me,” said Richard Millwood, who was booked into the DeSoto County jail in 2020 following an attempted suicide. “I got the exact same treatment in there as I did when I was in jail facing charges. In fact worse, in my opinion, because at least when I was facing charges I could bond out.”

"I got the exact same treatment in there as I did when I was in jail facing charges. In fact worse, in my opinion, because at least when I was facing charges I could bond out." — Richard Millwood, who was booked into jail following an attempted suicide

DeSoto County leadership, informed of Millwood’s statement, did not respond.

Millwood spent 35 days in jail before being admitted to a publicly funded rehab program 90 miles away.

Jimmy Sons didn’t receive a mental evaluation when he was booked into the Benton County jail in September 2015, according to documents in a lawsuit his father later filed. Less than 24 hours later, he was dead. Left alone in a cell without regular visits by jail staff, he had hanged himself.

He had been back in Mississippi for just a few days, planning to join his dad in electrical work, said his mother, Juli Murray. He had set out from her home in Bradenton, Florida, so early in the morning that he didn’t say goodbye.

Murray remembers the phone call from Jimmy’s half-brother in which she learned her son was in jail. She didn’t understand why.

“If you do something wrong, that’s why you’re in jail,” she said. “Not if you’re not mentally well. Why would they put them in there?”

The Lesser Sin

When James Sons went to the clerk’s office in the tiny town of Ashland to file commitment paperwork for his son, he took the first step in Mississippi’s peculiar, antiquated system for mandating treatment for people with serious mental health problems.

Jimmy Sons at age 18 at his father’s home in Mississippi (Courtesy of John Sons)

It starts when someone — usually a family member, but it could be almost anyone — signs a form alleging that the person in question is “in need of treatment because the person is mentally ill under law and poses a likelihood of physical harm to themselves or others.”

James Sons filled out that form, listing why he was concerned: Jimmy’s guns, his threats, his talk of suicide.

Then a special master — an attorney appointed by a chancery judge to make commitment decisions — issued a “Writ to Take Custody.” It instructed sheriff’s deputies in Benton County, just south of the Tennessee border, to hold Jimmy Sons at the jail until he could be evaluated.

The sheriff’s office asked Sons to come in on an unrelated matter. When he showed up, Chief Deputy Joe Batts told him he needed a mental health evaluation. Batts tried to reassure Sons that the process would be as quick as possible and would end with him back home, according to Batts’ testimony in the lawsuit Sons’ father filed over his death.

Then Batts told Sons, “What we’re going to have to do now is take you back and book you.”

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What he never told Sons, he later acknowledged in a deposition, was that the young man would have to wait in jail for days before he would see a mental health provider. The first screening required by law was four days away. If it concluded he needed further examination, he would be evaluated by two more medical professionals. Then the special master would decide whether to order him into treatment at a state psychiatric hospital.

The whole process should take seven to 10 days, according to the state Department of Mental Health. But sometimes it takes longer, the news organizations found. And if someone is ordered into treatment at their hearing, they generally have to wait for a bed, though the department says average wait times for state hospital beds after hearings have dropped dramatically in the last year.

While waiting for their hearing, people like Sons are supposed to receive treatment at a hospital or a short-term public mental health facility called a crisis stabilization unit. But state law does allow people to be jailed before their commitment hearing if there is “no reasonable alternative.” (The law is less clear about what’s allowed following a hearing.)

The Benton County Sheriff’s Department formerly housed the county jail where Jimmy Sons died, in Ashland, Mississippi. (Eric J. Shelton/Mississippi Today)

Mississippi Today and ProPublica spoke to dozens of officials across Mississippi involved in the commitment process: clerks who handle the paperwork, chancery judges and special masters who sign commitment orders, sheriffs who run the jails, deputies who drive people from jails to state hospitals, and the head of the state Department of Mental Health.

None of them thinks jail is the right place for people awaiting treatment for mental illness.

“We’re not a mental health hospital,” said Greg Pollan, president of the Mississippi Sheriffs’ Association and the sheriff of rural Calhoun County in the north of the state. “We’re not even a mental health Band-Aid station. That’s not what we do. So they should never, ever see the inside of my jail.”

Batts himself, who took Sons into custody in Benton County, said law enforcement officers across Mississippi “hate to detain people like that. But we’re told we have to do it.” He acknowledged that the facility “was substandard to begin with, not having the space and the adequate facilities to hold and monitor someone in that mental state — it just puts everybody in a bad situation.” And he said he thought the state could provide alternatives to jail.

Some counties jail most people going through the commitment process for mental illness, Mississippi Today and ProPublica found. Other counties reserve jail for people who are deemed violent or likely to hurt themselves. And at least a handful sometimes jail people committed for substance abuse — even though a 2021 opinion by the state’s attorney general says that isn’t allowed under state law.

This happens because until people are admitted to a state hospital, counties are responsible for covering the costs of the commitment process unless the state provides funding. If a crisis stabilization unit is full or turns someone away, the county must find an alternative, and it must foot the bill.

Counties can place patients in an ER or contract with a psychiatric hospital — and some do — but many officials balk at the cost. Many officials, particularly those in poor, rural counties, see jail as the only option.

“You have to put them somewhere to monitor them,” said Cindy Austin, chancery clerk in rural Smith County, located in central Mississippi. Chancery clerks are responsible for finding beds for people going through the commitment process. “It’s not that anybody wants to hold them in jail, it’s just we have no hospital here to hold them in.”

Timothy Gowan, an attorney who adjudicated commitments in Noxubee County from 1999 to late 2020, said people going through the commitment process there generally were jailed if they were determined to be violent and their family didn’t want them at home.

According to the Noxubee County jail docket, people going through the civil commitment process with no criminal charges were booked into the jail about 50 times from 2019 to 2022. Ten stays lasted at least 30 days. The longest was 82 days.

“Putting a sick person in a jail is a sin,” Gowan said. “But it’s the lesser of somebody getting killed.”

Some counties rarely hold people in jail — sometimes because a sheriff, chancery judge or other official has taken a stand against it. Rural Neshoba County in central Mississippi pays Alliance, a psychiatric hospital in Meridian, to house patients.

"We’re not a mental health hospital. We’re not even a mental health Band-Aid station. That’s not what we do. So they should never, ever see the inside of my jail." — Greg Pollan, president of the Mississippi Sheriffs’ Association and sheriff of Calhoun County

The practice isn’t confined to poor, rural counties. DeSoto County, a populous, relatively wealthy county near Memphis, jailed people without charges about 500 times over four years, the most of any of the counties analyzed by Mississippi Today and ProPublica. The median jail stay there was about nine days; the longest was 106.

The state and county recently set aside money to build a crisis stabilization unit — currently, the nearest one is about 40 miles away — but the county and the local community mental health center haven’t decided on a location, said County Supervisor Mark Gardner.

Some county officials say that keeping people out of jail during the process requires the state to step up. State Rep. Jansen Owen, a Republican from Pearl River County in southern Mississippi who represents people during the commitment process, said he believes counties that spend “millions of dollars on fairgrounds and ballparks” could find alternatives to jail. But he also sees a need for more state-funded facilities.

“You can’t just throw it on the counties,” he said. “It’s a state prerogative. And them being held in the jail, I think, is a result of the state kicking the can down the road to the counties.”

Wendy Bailey, head of the state Department of Mental Health, said it’s “unacceptable” to jail people simply because they may need behavioral health treatment. Department staff have met with chancery clerks around the state to urge them to steer families away from commitment proceedings and toward outpatient services offered by community mental health centers whenever possible.

The Department of Mental Health says it prioritizes people waiting in jail when making admissions to state hospitals. The state has expanded the number of crisis unit beds from 128 in 2018 to 180 today, with plans to add more. And it has increased funding for local services in recent years in an effort to reduce commitments.

But Bailey said the department has no authority to force counties to change course, nor legal responsibility for people going through the commitment process until a judge orders them into treatment at a state psychiatric hospital.

Locked in the “Lunacy Zone”

Willie McNeese’s problems started after he came home to Shuqualak, Mississippi, a town of about 400 people and a lumber mill, in 2007. He had spent a decade in prison starting at age 17.

He found the changes that had taken place — bigger highways, cellphones — overwhelming, said his sister, Cassandra McNeese. He was eventually diagnosed with bipolar disorder.

“It’s like a switch — highs and lows,” said Willie McNeese, now 43. “I might have a whole lot of laughter going on, trying to make the next person laugh. Then my day going down, I be depressed and worried about situations that nobody can change but God.”

McNeese has been involuntarily committed in Noxubee County 10 times since 2008 and has been jailed during at least eight of them, one for more than a month in 2019 according to court records and the jail docket. During his most recent commitment starting in March 2022, McNeese was held in jail for a total of 58 days in two stints before eventually going to a state psychiatric hospital.

Cassandra McNeese, left, and her mother, Yvonne A. McNeese, in Shuqualak, Mississippi. Cassandra’s brother, Willie McNeese, has been held in jail during civil commitment proceedings at least eight times since 2008. Cassandra McNeese said Noxubee County officials told her jail was the only place they had for him to wait. ”This is who you trust to take care of things,” she said. ”That’s all you have to rely on.” (Eric J. Shelton/Mississippi Today)

From 2019 to 2022, about 1,200 civil commitment jail stays in the 19 counties analyzed by Mississippi Today and ProPublica lasted longer than three days. That’s about how long it can take for people to start to experience withdrawal from a lack of psychiatric medications, which jails don’t always provide. About 130 stays lasted more than 30 days.

McNeese said he spent much of his time in jail last year standing near the door of his cell, what jail staff called the “Lunacy Zone,” screaming to be allowed to take a shower. A jailer tased him to quiet him down, and his clothes were taken from him. For a period, his mattress was taken, too.

“It’s a way of punishment,” he said. “They don’t handle it like the hospital. If you have a problem in the hospital they’ll come with a shot or something, but they don’t take your clothes or take your mattress or lock your door on you or nothing like that.”

McNeese said he had inconsistent access to medication and received none during his first stay in 2022, which lasted 25 days.

The Noxubee County Sheriff’s Department did not respond to questions about McNeese’s allegations.

Staff from Community Counseling, the community mental health center where McNeese had regular appointments, could have provided him with medication, but McNeese said no one from the center came to visit him in jail. A therapist at Community Counseling said staff go to the jail only when they’re called, usually when there’s a problem jail staff can’t handle. Rayfield Evins Jr., the organization’s executive director, said when he recently worked in Noxubee, deputies brought people from the jail to his facility for medication and treatment.

"If you have a problem in the hospital they’ll come with a shot or something, but they don’t take your clothes or take your mattress or lock your door on you or nothing like that." — Willie B. McNeese, jailed multiple times following a diagnosis for bipolar disorder

Mental health advocates in Mississippi and other people who have been jailed during the commitment process said the limited mental health treatment McNeese received is common.

Mental health care varies widely from jail to jail, and no state agency sets requirements for what care must be provided. Jails can refuse to distribute medications that are controlled substances, which includes anti-anxiety medications like Xanax. The state Department of Mental Health says counties should work with community mental health centers to provide treatment to people waiting in jail as they go through the commitment process.

But those facilities generally don't have the resources to provide services in jails, said Greta Martin, litigation director for Disability Rights Mississippi.

Martin’s organization, one of those charged by Congress with advocating for people with disabilities in each state, investigates county jails when it receives complaints. “We are not seeing any indication that these individuals are getting any mental health treatment while they are being held in these county facilities,” she said.

Willie McNeese was incarcerated at the old jail in Noxubee County multiple times during civil commitment processes, including his first commitment in 2008. (Eric J. Shelton/Mississippi Today)

McNeese said those jail stays added physical discomfort and pain to the delusions that got him committed in the first place. “Then you get to the mental hospital — they have to straighten you all the way back over again,” he said.

Since being released from the state hospital last year, McNeese said, he has been doing well. He is now living in Cincinnati with his wife.

Scott Willoughby, the program director at South Mississippi State Hospital in Purvis, said it can be hard to earn patients’ trust when they arrive at the psychiatric hospital from jail.

At his facility, patients sleep two to a room in a hall decorated with photographs of nature scenes. Group counseling sessions are often held outside under a gazebo. In between, patients draw and paint during recreational therapy.

Willoughby has spoken with patients who had attempted suicide and were shocked to find themselves in jail as a result.

“People tend to associate jail with punishment, which is exactly the opposite of what a person needs when they’re in a mental health crisis,” he said. “Jail can be traumatic and stigmatizing.”

“I’m More Scared of Myself”

When Sons learned that he was going to be booked, he became anxious about being locked in a cell, Batts testified. So he was assigned to an area of the jail reserved for trusties — inmates who are allowed to work, sometimes outside the jail, while they serve their sentences.

On the afternoon of his first day in jail, Sons was sitting on his bed when a trusty named Donnie Richmond returned from work. Richmond said in a deposition that he asked a deputy who the new guy was.

“You better watch him,” Richmond recalled the deputy telling him. “He kind of off a little bit.”

Richmond offered Sons a cigarette and cookies and asked him why he was there. Sons took a cigarette and told Richmond the deputies had said he would hurt someone.

“He was like, ‘Man, I’m going to be honest with you,’” Richmond testified. “‘I ain’t going to hurt no one. I’m more scared of myself, of hurting myself.’”

Sons was not placed on suicide watch. The jail’s suicide prevention policy applied only to those who had attempted suicide in the jail, although attorneys for the jail officials in the lawsuit over his death said there was an unwritten policy to closely monitor people going through the commitment process.

An excerpt of the Benton County Sheriff’s Department’s suicide prevention policy at the time of Sons’ death (Obtained by Mississippi Today)

That evening, Sons told a jailer he was feeling anxious around the other men. He asked to be moved to a cell by himself.

A guard took him to a cinder block cell with no windows. There was no television and nothing to read. He was given a blanket.

A security camera in Sons’ cell was supposed to allow jail staff to watch him at all times. But jail officials said in depositions that no one noticed anything unusual the next morning.

At 11:28 a.m., Sons rose from his bunk bed, walked to the door and placed his ear near it. He went back to his bunk, fashioned a noose and tied it around his neck. He sat there for three minutes before hanging himself, according to a narrative of the video in court records.

He stopped moving just before 11:38 a.m. A trusty serving lunch peeked through a tray opening in the door 48 minutes later and saw his body.

The door of the Benton County Jail cell where Sons was held (Obtained by Mississippi Today)

Sons’ father sued Benton County, the sheriff and several of his employees over his death. The defendants denied in court filings that they were responsible, but the county’s insurance company eventually settled the case for an undisclosed sum. (All that’s publicly known is that the county paid a $25,000 policy deductible toward defense costs.)

Sheriff’s department staff said in depositions they had kept an eye on Sons, but they couldn’t watch the video feed constantly. Lawyers for the defendants said there was no evidence sheriff’s department employees knew someone could kill himself in the way Sons did.

Sheriff A. A. McMullen, who is no longer in office, acknowledged in a deposition that “any mental commitment is a suicide risk,” but he said he wasn’t sure it would have made a difference if Sons had been placed on suicide watch.

“You could write up the biggest policy in the world and you couldn’t prevent it. There’s no way. God knows, you know, it hurts us,” he said. “If they’re going to do it, they’re going to do it.”

McMullen couldn’t be reached for comment for this story.

In an interview, jail administrator Kristy O’Dell, who joined the department after Sons died, said the jail still holds two or three people going through the commitment process each month.

John S. Farese, an attorney for Benton County, told Mississippi Today and ProPublica that the county, like others, “does the best they can do with the resources they have to abide by the laws” regarding commitments. He said the sheriff and the county will try to adapt to any changes in the law “while still being mindful of our limited personnel and financial resources.” He declined to comment on the specifics of the Sons case, which he didn’t work on.

Murray, Sons’ mother, was at a grocery store around noon the day her son died. As she picked out a watermelon, she thought about him, a fitness buff who loved fruits and vegetables. A strange thought crossed her mind: “Jimmy’s never going to eat watermelon again.”

When she got home, she got the call that he was gone.

John Sons, Jimmy’s half-brother, wrote in a text to Mississippi Today and ProPublica that the family is left with “complete and total guilt for putting him in the prison and always the wonder if we would not have done that move, if he would be with us today.”

But Richmond, the trusty who briefly shared a cell with Sons, testified that it was jail staff who “messed up.”

“He hung himself,” Richmond said. “I say this. God forgive me if I’m wrong. We couldn’t have saved that man from killing himself, but we could have saved that man from hanging himself in that jail.”

How We Reported This Story

No one in Mississippi has ever comprehensively tracked the number of people jailed at any point during the civil commitment process, according to interviews with dozens of state and county officials.

Last year, the state Department of Mental Health released, for the first time, a tally of people who were admitted to a state hospital directly from jail following civil commitment proceedings. The department tracked 734 placements in fiscal year 2022. (Under a law that takes effect this year, every county must regularly report to the department data regarding how often people are held in jail both before and after their commitment hearings.)

But that figure understates the scope of commitments. It doesn’t include people who were sent places other than a state hospital for treatment or who were released without being treated, and it counts only the time people spent in jail after their hearings. People can be jailed for 12 days before a commitment hearing, or longer if a county doesn’t follow the law.

County jail dockets can provide a more comprehensive picture, so Mississippi Today and ProPublica requested them from 80 of Mississippi’s 82 counties. Seventeen counties provided dockets that clearly marked bookings related to civil commitments — with notes including “writ to take custody,” “mental writ” and “lunacy.” In two more counties, we reviewed dockets in person.

Many counties didn’t respond, said their records were available only on paper or declined to provide records. Some cited a 2007 opinion by the state attorney general that sheriffs may choose not to enter the names of people detained during civil commitment proceedings onto their jail dockets.

After cleaning and standardizing the data from the dockets, we counted the number of jail stays involving civil commitments in which the person was not booked for a criminal charge on the same day. (We ended up excluding about 750 civil commitments for that reason.) If the dockets provided booking and release dates, we calculated the duration of jail stays.

Our count of commitments includes those for both mental illness and substance abuse. None of the jail dockets specified which commitment process people were going through, although some county officials said they don’t jail people committed for substance abuse and haven’t for years.

State laws regarding commitment for mental illness and substance abuse are different, but in many counties they were handled similarly until late 2021. That’s when the Mississippi attorney general’s office said state law didn’t allow people going through the drug and alcohol commitment process to be jailed.

To identify deaths of individuals held in jail during the civil commitment process, we reviewed news articles and federal court records. We also reviewed nearly 90 investigations of jail deaths from the Mississippi Bureau of Investigation. Most of the deaths had not previously been publicly reported.

For our survey of practices in other states, we contacted agencies overseeing mental health and disability advocacy organizations in every state and Washington, D.C. We received responses from one or the other in every location, and we received responses from both in 33. We also searched for news reports of similar cases in other states.

Do you have a story to share about someone who went through the civil commitment process in Mississippi? Contact Isabelle Taft at itaft@mississippitoday.org or call her at 601-691-4756.

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Since the Supreme Court overturned Roe v. Wade last year, doctors have warned that limiting abortion care will make pregnancy more dangerous in a country that already has the highest maternal mortality rate among industrialized nations.

The case of Mylissa Farmer, a Missouri woman, is one example. Last August, her water broke less than 18 weeks into her pregnancy, when her fetus was not viable. She was at risk for developing a life-threatening infection if she continued the pregnancy. Yet during three separate visits to emergency rooms, she was denied abortion care because her fetus still had a heartbeat. Doctors specifically cited the state’s new abortion law in her medical records and said they could not intervene until her condition worsened. She eventually traveled to Illinois for care.

Even for people who don’t develop sudden life-threatening complications, doctors note that carrying a pregnancy to term is inherently risky because rapid physical and hormonal changes can exacerbate chronic health conditions and trigger new complications. If more people are forced to continue unwanted pregnancies, there are bound to be more pregnancy-related deaths: A study by the University of Colorado estimates a 24% increase in maternal deaths if the United States bans abortion federally. They predicted the increase would be even higher for Black patients, at 39%. Currently, 14 states have total abortion bans.

Additionally, when abortion is illegal, it makes the procedure more dangerous for those who still try to terminate their pregnancies. The World Health Organization found that unsafe or illegal abortions account for up to 10% of maternal deaths worldwide.

As the United States enters its second post-Roe year, advocates say it’s important to gather data on the impact abortion bans are having on the health of pregnant people to help both policy makers and voters understand the life-or-death consequences of the restrictions. Without such accounting, they say, the public may remain ignorant of the toll. Maternal mortality rates would be a crucial gauge of impact.

Despite the stakes, experts say, at least in the short term, it may be difficult or impossible to track the number of lives lost due to limits on abortion access.

ProPublica spoke to four members of state maternal mortality review committees. Here are some of the challenges they see to drawing any clear conclusions from maternal mortality data in the near future.

The Data Can Be Inconsistent

Each state has its own system for compiling the data maternal mortality researchers work with. The quality of the data varies vastly by state. It can involve comparing birth and fetal death records, scanning through obituaries, and sometimes begging coroner’s offices to send death records. Many states are still working toward a complete system.

“It really depends on the rigor of the contributing entities,” said Dr. Michelle Owens, a maternal-fetal medicine specialist and the clinical chair for Mississippi’s maternal mortality review committee. “We rely so heavily upon the information we glean from these sources, and if that information is not as reliable … it will definitely have a negative impact on our work and understanding of what the contributing things may have been and what the gaps are.”

All the maternal mortality experts that ProPublica spoke with noted issues with the “pregnancy check box” used in death certificates to denote whether a patient was pregnant at the time of death or within the previous year. In Florida, Dr. Karen Harris, an OB-GYN and a member of Florida’s maternal mortality review committee, has observed the check box “overselect some patients who were never pregnant, or not pregnant in the last year, and it underselects patients who were pregnant.”

Sometimes the check box is wrong because of clerical errors, the researchers said. Other times, it’s simply not filled out because no autopsy was performed to verify whether the person was pregnant. That information could be important in measuring deaths that happen early in pregnancy — including murders. Homicide is a leading cause of death for pregnant or recently pregnant Americans, and researchers also would like to measure how abortion bans, which could force people in abusive relationships to carry unwanted pregnancies, affect those numbers.

Studying pregnancy-associated deaths within a year of pregnancy helps researchers account for any additional factors like substance abuse, unstable housing, suicide or mental health problems. These could be important in identifying deaths connected to continuing an undesired pregnancy.

The data can also be slow — some states, like Florida, provide data to the committee for the past year right away. But others are years behind. Currently, many states have only released data through 2019.

Records May Not Address Abortion Access

One of the thorniest questions facing maternal mortality experts: How can they determine if abortion access was a factor?

Dr. Lynlee Wolfe, an assistant professor at the University of Tennessee Medical Center and a member of the state’s maternal mortality review committee, wishes maternal mortality review reports could include a check box for the question, “Did inability to get an abortion play a role?”

“But you often can’t dig that out of notes,” she said. “I think what we’re asking is kind of an untrackable number.”

The experts said they could look into causes of death that may be linked to a patient’s inability to get an abortion when they’re having an emergency pregnancy complication: Sepsis, hemorrhage and heart issues, for example, are all worth studying to see if medical records might indicate if doctors delayed ending the pregnancy because the fetus still had a heartbeat.

But beyond that, when the pregnancy was unwanted or exacerbated broader health concerns, it could prove very difficult to determine if abortion access was a factor in the patient’s decision-making.

For example, if a patient had a heart condition that carried a 50% chance of death in pregnancy, researchers would like to see whether the patient was counseled about the risk and offered a termination.

But in a state that had criminalized abortion, “no one’s going to write that down,” said Harris, the Florida doctor. “So we won’t be able to know in the in-depth review if this was a patient choice — or if it was something that was forced upon her.”

Researchers might be able to learn more about the patient’s state of mind and whether the pregnancy was desired or not from interviews with family members and social service records, Owens, the Mississippi doctor, said. But there’s no guarantee they would have discussed their feelings about the pregnancy with family members either.

“With stigma and controversy surrounding conversations and considerations around abortions, people are hesitant to share those thoughts and feelings outside a very small circle of trust,” she said.

Risk of Political Interference

Maternal mortality review committees are funded by their states, and some are overseen by state legislatures.

The maternal mortality review members ProPublica spoke with said they did not anticipate interference with their report findings, even if they found examples where abortion access was a factor in a maternal death.

But some maternal care advocates worry such committees are vulnerable to political interference and manipulation. Last year, the Texas Department of State Health Services announced it was delaying its 2019 maternal mortality review report, originally scheduled for September 2022, until mid 2023.

Some saw the delay as a way to keep negative numbers out of the public eye during election season and postpone their release until after the 2023 legislative session had ended. A member of the review committee said she believed there was no legitimate need for the delay and that it was “dishonorably burying these women.” ProPublica reached out to the committee and the Texas health agency to ask about these concerns, but did not receive any response.

After pushback, the report was partially released in December 2022. It found persistent disparities affecting Black mothers and showed that the childbirth complication rate had risen 28% since 2018.

In July, Idaho disbanded its maternal mortality review committee, making it the only state without one. Lawmakers cited the costs of operating the committee — though members said operating costs were about $15,000 a year and covered by a federal grant. The decision came after a lobbying group argued that the committee was a “vehicle to promote more government intervention in health care” and opposed its recommendation to extend Medicaid coverage to mothers for 12 months postpartum.

The Sample Size Is Small

Maternal mortality rates in the U.S. are higher than in other wealthy countries and have been rising in recent years, so many resources are devoted to studying root causes of the trend and possible strategies for reversing it. But the actual number of deaths is statistically small: In 2021, the U.S. saw an estimated 32.9 deaths per 100,000 births, or 1,205 total pregnancy-related deaths, according to the Centers for Disease Control and Prevention.

This makes it difficult to draw conclusions that are rigorous by epidemiological standards, said Dr. Elliot Main, a Stanford professor and the former medical director for the California Maternal Quality Care Collaborative.

While researchers may learn of individual cases where it’s clear that abortion access was an issue in the patient’s outcome, it could take years to have a data set large enough to reveal a clear picture.

Main also pointed out that many other factors influence maternal mortality rates, which muddles the picture. “Maternal deaths are so rare and often complicated in their underlying causes,” he said. “If you see a trend over time, we have to break it down to see what’s really causing that.”

Before the Supreme Court’s decision in Dobbs v. Jackson Women's Health Organization struck down federal protections for abortion rights, U.S. maternal mortality rates were already rising. Influences include COVID-19, the opioid crisis and people having children at older ages, when they are at higher risk for complications. The U.S. also has long-standing racial and socioeconomic health care disparities affecting quality prenatal care — more than half of Georgia’s counties have no OB-GYN, for example. That can mean more patients go into pregnancy with undiagnosed health conditions and may be at higher risk for life-threatening complications.

Main and other researchers suggested that studying data on childbirth complications may provide more avenues for understanding the effects of abortion bans, because those are more common and would provide a larger data set to study.

Bans Don’t Prevent All Abortions

One reason the impact of Dobbs on maternal mortality rates could remain limited even in states that have banned abortion is that some people who want to terminate their pregnancy are still able to do so, either by traveling or by ordering abortion medication in the mail.

It’s impossible to know the full picture of how many are able to jump through the hoops and obtain abortions even when there are no legal options nearby. But WeCount, a research project led by the Society of Family Planning that has been collecting data from abortion providers, estimates that in the six months following Dobbs, about 35,000 people in abortion-ban states were able to get abortions in other states — just over half of the people estimated to have sought abortions in those states, based on numbers from the same time period the previous year. It’s unclear what happened to the other half. Some may have continued their pregnancies, others may have ordered abortion pills in the mail, which could be sent by organizations based in Europe and Mexico and not be recorded in any database.

Still, having to travel out of state to a limited number of abortion providers meant more patients were forced to wait until their second trimester, researchers said, when an abortion can be more complicated.

And while abortion pills are considered an exceedingly safe method of terminating a pregnancy through the first 10 weeks, according to the Food and Drug Administration and leading medical organizations, patients should still have the option to take them with the instruction and care of a medical provider, advocates say.