A sad succession of newscasts highlights the fact that people with mental disorders fall through the proverbial mental health safety net. In light of mass killings around the nation by disturbed individuals, mental health advocates are flabbergasted that public mental health facilities are being closed haphazardly. The state of Georgia is a shameful and current illustration.
THE GEORGIA Department of Behavioral Health and Developmental Disabilities operates six state hospitals in Atlanta, Milledgeville, Augusta, Columbus, Thomasville and Savannah. In May, without action from the Georgia legislature, DBHDD Commissioner Frank Berry, with the approval of Gov. Nathan Deal, abruptly announced that Southwestern State Hospital, the psychiatric hospital in Thomasville, will close Dec. 31.
Advocates quickly raised an alarm. They cite serious, well-documented problems with the state’s behavioral health and developmental disabilities care transition programs. Concerned citizens urged caution. They advocated keeping SWSH open until replacement services have a proven track record.
SWSH SERVED about 1,800 people annually. Many will be lost to care under the de-hospitalization initiative. Some disabled patients have died already by the state’s placement of developmentally disabled individuals into unsafe settings. The feds halted such releases until safety can be assured. Yet the DBHDD, which is assigned to protect the individuals, rigidly adheres to a flawed five-year plan to close more state hospitals. More will die.
The DBHDD plans to close regional hospitals across Georgia. The unanswered question is in what order will Columbus, Savannah, Milledgeville, Augusta and Atlanta lose state hospitals.
Advocates and mental health professionals say that the need for scrutiny is growing as the DBHDD increasingly moves patients out of established hospital programs to untested, inadequate community services, aiming to control costs. The better approach is to improve quality through close management of patient care. Georgians need both hospitals and community services – not one or the other. The combination provides the best quality of care.
The federal government requires states to establish quality standards for institutions that treat severely and persistently mentally ill people. In 2010, Georgia and the federal government struck a “settlement agreement.” Georgia’s DBHDD, I believe, is attempting to cheat this protective oversight. This has resulted in a patchwork of ill-advised and unproven changes.
ALL COUNTIES served by Southwestern State Hospital are rated as Mental Health Professional Shortage Areas by the U.S. Department of Health and Human Services.
This fact raises concerns about the care Georgia gives its mentally ill. The federal government, in turn, has been criticized for failing to fulfill its duty to ensure that Georgia does what is best for patients and public safety. The U.S. Department of Justice, to date, has ignored the closure of the only state mental hospital for the lower third of Georgia. Communications with the Justice Department calling for further review have gone unanswered.
The settlement agreement says how many doctors and psychologists a specific program must have. DBHDD officials know community programs do not meet the settlement agreement. They do nothing. Before closing hospitals, the Justice Department needs to review the adequacy of the DBHDD’s network of community providers and assess that new services comply with federal requirements.
AT THE CENTRAL office of the DBHDD, I believe unscrupulous underlings scheme to bypass the feds. How? By closing hospitals such as Southwestern even though replacement services do not exist.
Georgia’s track record of care for frail, developmentally disabled people released from state hospitals confirms tremendous deficiencies in health safety. Lacking the means to identify health status and safety needs was the proximate cause of the Justice Department’s investigation of Georgia’s DBHDD. The problems followed developmentally disabled patients into the community.
There is evidence of pervasive medical neglect, systematic abuse and lack of oversight – in some cases life-endangering. According to audits, safety compliance has remained low. Fewer than 27 percent of community providers have the means to identify health status and safety needs.
A systematic comparison on a national level has been done by the Treatment Advocacy Center. This national nonprofit organization dedicated to eliminating barriers to the timely and effective treatment of severe mental illness documented a significant higher rate of arrest-related deaths in states with fewer public mental hospitals. Individuals with mental illness are both victims and perpetrators. (Link to the 2012 research report: http://tacreports.org/storage/documents/no_room_at_the_inn-2012.pdf)
CRIMES AGAINST people will increase without the safety net of public mental health hospitals such as SWSH. More federal investigation and monitoring of community services will expose Georgia’s sabotage of the settlement agreement. The DBHDD is putting public safety on the back burner.
In Georgia’s traditional state hospital system plus strong community services, individuals with mental health disorders would have a safety net. This net protects citizens.
(The writer is a clinical associate professor in the Department of Psychiatry and Health Behavior of the Medical College of Georgia at Georgia Regents University.)