When the National Alliance on Mental Illness graded each state on its mental health system last year, no state received an A. Only five earned a B. The "national grade" was a D.

By that standard, Georgia, with its D, is average.

The advocacy organization did cite some positives for Georgia, including a program to train consumers to counsel others with mental illness.

Among Georgia's urgent needs, the group said: more money.

Below are experts' ideas for improving a state's psychiatric hospitals. Georgia lacks many of these options, advocates say, while others need strengthening.

PATIENT CARE

> Allow random hospital visits by trained groups of people with mental illness and their families, as New Jersey does. Family members and hospital staff say Georgia does not allow visitors in patient rooms and most care areas.

> Assign nurse practitioners to hospital units to oversee patients' general medical needs. "It doesn't cost a boatload of money," says Jennifer Bright of Mental Health America, a patient advocacy group.

> Staff hospitals at adequate levels, as required by federal regulations.

> Emphasize quality care. "It's executive leadership, legislative leadership, leadership in the agency," says Mike Hogan, Ohio's mental health director. Ideally, he says, hospital administrators "don't keep their job unless they provide quality."

> Create an independent board to review each death in a state institution. Illinois and New York have such panels.

> Establish a meaningful voice on hospital boards for people with mental illness and their families.

WORKERS

> Pay hospital workers competitive salaries. "We've upgraded our pay overall," says Ohio's Hogan. "We are competitive with the private market."

> Provide programs to forgive school loans of physicians and nurses to encourage them to work in state hospitals, as Ohio does.

> Automatically fire employees who abuse patients. In cases of serious assaults, turn employees over to local authorities.

INFRASTRUCTURE

> Replace or renovate outdated buildings. "A lot of hospitals are crumbling facilities, kept together with chewing gum," says Ron Honberg of the National Alliance on Mental Illness. North Carolina has launched a $400 million initiative to build new mental hospitals.

> Use video cameras in hallways and common rooms extensively, as New Jersey does, to document patient care.

COMMUNITY

> Provide more housing, employment opportunities, transportation, medication assistance and other services to help people with mental illness live outside institutions. In Tennessee, a $120 million effort is creating more than 4,800 housing units for people with mental illness, reducing hospitalizations. "One reason that people back up in hospitals, in states like Georgia, is there's nowhere to go," says Honberg of the National Alliance on Mental Illness.

> Expand the availability of community teams to help mentally ill people in crisis. Georgia's intervention teams need more support and training, says NAMI's Georgia chapter. "These [teams] could prevent hospitalization in the first place," says Bright of Mental Health America.

Sources: Bazelon Center for Mental Health Law; Mental Health America; National Alliance on Mental Illness; departments of mental health in New Jersey, North Carolina, Ohio and Tennessee; Georgia Advocacy Office; Georgia Mental Health Consumer Network