A federal judge in Mississippi ruled Wednesday that the state had violated federal civil rights law by not providing mental health patients enough care in their communities, forcing them to essentially be segregated in state-run hospitals.

In a 61-page opinion, Judge Carlton W. Reeves of United States District Court in Jackson, Miss., said that the state had run afoul of the Americans With Disabilities Act. He said he would appoint a special master to oversee changes to Mississippi’s mental health system.

“Despite the state’s episodic improvement, it operates a system that unlawfully discriminates against persons with serious mental illness,” Judge Reeves said in the opinion.

He said that the discrimination would end only when every person with a serious mental illness “has access to a minimum bundle of community‐based services that can stop the cycle of hospitalization.”

While the state appears to offer a broad range of community services, Judge Reeves said, the “descriptions do not match the reality.”

He noted that one critical service — in which psychiatrists, nurses and other specialists treat patients with the most severe mental illnesses in their homes or communities, possibly diverting them from hospitals — covers only 14 of the state’s 82 counties. And in those 14 counties, teams are sometimes understaffed, Judge Reeves said.

A 24-hour crisis line that is supposed to respond to people in need by dispatching teams of mental health professionals does not always do so, Judge Reeves said. In some parts of the state, teams were based too far away to be effective, Judge Reeves added.

In contrast, he said Mississippi spends disproportionately more money on mental health hospitals, lagging behind other states that have transitioned better to community care. Judge Reeves said that in 2015, the state’s spending on community-based mental health services was less than the 2006 national average.

“If it remains uninterested in fixing this problem, the state will be doomed to repeat it — and repeatedly have to defend it in federal court,” Judge Reeves wrote in his opinion.

Judge Reeves said that both the United States Department of Justice, which brought the lawsuit in 2016, and the state must submit names of potential special masters within 30 days.

The Department of Justice said in an emailed statement that it was “pleased with the decision.”

“The court’s decision noted the harmful impact institutionalization has on individuals with serious mental illness including the lack of freedom, independence, and privacy,” the department said.

It is not clear whether the state intends to appeal the judge’s ruling. At a news conference Wednesday, Jim Hood, the attorney general of Mississippi, said it was too early to file an appeal. He expected that even after Judge Reeves decides on a special master, it will probably take several months before a final plan on the mental health system is put into place, and a final order from the court is issued.

Mr. Hood, who is running for governor, said he had repeatedly warned the Mississippi Legislature since 2013 about underinvesting in community mental health services.

“Many of us don’t like a federal court telling us what to do,” Mr. Hood said. “I don’t like it. We ought to fix our own problem before a federal court has to step in.”

He said in a statement that the state would “continue to work with the court to increase the mental health services available to Mississippians.”

The state’s mental health system had been scrutinized by the Justice Department for nearly a decade. The department sent the state a letter in 2011, saying it was violating the Americans with Disabilities Act by “unnecessarily institutionalizing persons with mental illness,” according to Judge Reeves’s opinion.

Years of failed negotiations followed. The federal government sued in 2016. During a four-week trial in June and July, patients, experts and state officials testified about the challenges facing the state’s mental health system.

One patient testified that she was “terrified” of state hospitals, Judge Reeves wrote. In his opinion, he quoted her testimony, in which she told the court: “They take all your rights away and there is no dignity. They pump people full of drugs. They make you use a community bathroom even though you have your own room. Women who are menstruating have to walk around the halls with a handful of tampons.”

Judge Reeves said that 2,784 residents of Mississippi were institutionalized in 2018.

The state’s department of mental health did not immediately respond to a request for comment on Wednesday evening. During the trial, the executive director of the department, Diana Mikula, defended the agency and said that the state had a plan for placing people in more community-based care.

Jennifer Mathis, director of policy and legal advocacy for the Bazelon Center for Mental Health Law in Washington, called Wednesday’s ruling significant. She said it showed that the Trump administration, like President Barack Obama’s administration, was serious about holding states accountable for not trying to better integrate people with disabilities into their communities.

“You needlessly institutionalize people and everybody starts to think that’s where they belong,” she said. “It’s really hard to undo.”

Mihir Zaveri covers breaking news from New York. Before joining The Times in 2018 he was a reporter for The Houston Chronicle.

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