Mental health services must get more money

Gov. Sonny Perdue’s proposal to pry mental health services out of the bloated and ineffective bureaucracy of the Georgia Department for Human Resources clearly ought to be approved by the state Legislature when it convenes in January.

However, the change will make little or no difference in protecting the state’s most vulnerable residents unless Perdue and the Legislature back up the move by appropriating more money for needed services.

Advocates for the mentally ill and a handful of state legislators have been pointing out for years that mental health services have been shortchanged within DHR. Time after time, the needs of mentally ill Georgians have taken a back seat to the needs of other expensive programs administered by the huge agency.

Over the summer, for example, DHR officials diverted $6.6 million in spending originally planned for mental health services for children to other agency programs that were running short of money. And the only reason that move was noticed was because Georgia had already been under investigation by the U.S. Justice Department for possible civil rights violations of mentally ill patients. The federal investigation was launched in the wake of reports by this newspaper documenting more than 135 suspicious deaths among patients since 2002.

As those articles pointed out, Georgia is far behind other states in per-capita spending on mental health services and ranks 42nd in spending for community mental health services. That is critical, because ineffective and underfunded outpatient services at the community level invariably drive chronically ill patients into state hospitals, where the care is even more expensive.

Because mental health services have been folded into the giant DHR and its $1.6 billion budget, it can be difficult to track relatively minor spending adjustments such as the one that occurred this summer. Yet those changes mount up over the years, producing a pattern of neglect that invariably gets the state in trouble and does a disservice to Georgians who have no other way to get care.

Creating an independent agency to provide services to the mentally ill should improve accountability in how and where the money is spent. If carried out properly, the decision to split DHR into three separate agencies —- each with a distinctive mission —- could help state leaders prioritize social and health services and better connect spending to the performance of doctors, hospitals, clinics and others providing those services.

It makes little sense, for instance, that Medicaid —- the government-funded insurance program for the state’s poorest residents —- is administered out of the Department of Community Health, while DHR administers the Division of Public Health, which provides money for county health departments that often serve the same population. Under the new structure, a new Department of Health would coordinate both programs, as well as regulate medical providers.

Some current programs under DHR —- child welfare, the Division of Family and Children’s Services, as well as programs for people with development disabilities —- might also benefit from the restructuring. For example, the state continues to endure one crisis after another in child protection. B.J. Walker, who now serves as commissioner of the entire DHR, would take over as head of a more tightly focused Department of Human Services, and would perhaps be a more effective manager in dealing with those issues.

However, a mental health professional, not a career bureaucrat, should be appointed to oversee a new Department of Behavioral Health, the agency proposed to administer mental health services. Even after separating from DHR, the new department will be responsible for dozens of programs that ought to be examined carefully for effectiveness, and each of those programs will be championed by advocacy groups demanding more money for their cause.

While substance abuse and mental retardation may be considered “behavioral” fields, spending on those programs must be balanced carefully against the state’s years of neglect in spending for state hospitals and community mental health services. For the time being, the state must place its highest priority there.

—- Mike King, for the editorial board (mking@ajc.com).

 SKIMPING ON MENTAL HEALTH IN GEORGIA
By moving mental health programs out from under the Department of Human Resources, state officials hope to improve the quality of care provided to Georgia's most vulnerable residents. But that hope won't be realized unless the new mental health agency gets enough money to operate effectively. Georgia falls in the lower half among all states in per-person spending on both community mental health services and those provided at state psychiatric hospitals. Here's where the state ranks:

Community mental health services
1. Alaska,................$232.10
2. District of Columbia,..$228.82
3. Pennsylvania,..........$163.90
4. Vermont, ..............$145.59
5. New York,..............$141.72
National average: ........$70
42. Georgia,..............$26.67
43. South Dakota, ........$26.19
44. Louisiana,............$23.68
45. Kentucky, ............$22.97
46. Arkansas, ............$22.92
47. Nebraska, ............$22.84
48. Texas,................$22.07
49. Idaho,................$21.70
50. Florida,..............$19.66
51. New Mexico, ..........$12.90
     
State psychiatric hospitals
1. District of Columbia,..$138.82
2. Mississippi, ..........$57.82
3. New York,..............$55.62
4. New Jersey,............$49.63
5. Connecticut, ..........$47.98
Average:..................$30.32
35. Georgia,..............$22.31
46. Texas,................$13.81
47. Oklahoma, ............$12.86
48. New Mexico, ..........$11.33
49. Arizona,..............$10.55
50. Arkansas, ............$10.19
51. Iowa, ................$9.22
     
Source: National Association of State Mental Health Program Directors Research Institute Inc., 2005 spending