Georgia’s mentally ill need options

By Paul Bolster

The 2010 Georgia General Assembly must support a new strategic direction for the state mental health programs.

Last year, legislators created a new Department of Behavioral Health and Developmental Disabilities. In 2008, the state agreed with the U.S. Justice Department to address the dangerous conditions in its psychiatric hospitals and agreed with the Civil Rights Division of the Centers for Medical Services to enable persons with disabilities to leave institutions and live in the community (the Olmstead plan).

To fulfill its commitments, the state needs a new mental health strategy — one that combines an expansion of community-based treatment and affordable supportive housing.

There is little money, but still we must fix a broken and quality-starved system. Since Georgia ranks 46th among states in per capita spending on mental health, it is inevitable new money will be needed.

But more importantly, the mental health service system must leverage its current dollars by combining them with federal dollars authorized under the Medicaid program and the $200 million in affordable housing dollars currently available to the state from the U.S. Department of Housing and Urban Development.

Hospitals have a role in public safety and protecting individuals with mental illness. They must be safe and therapeutic places. However, most people with mental illness can now live positive and creative lives in the community. They don’t need to be isolated in institutions — jails, prisons and hospitals. Most can live in housing in our community if we give them appropriate support. Think of housing as health care.

We know that supportive housing yields a more creative life for the individual and it costs less. There is plenty of hard Georgia evidence that it works.

One study by the Georgia Department of Community Affairs predicts we would save $13,000 for every mentally ill person we help to succeed in housing of his or her own. It will take both new money and a reprogramming of existing money to create a new result.

Legislators must help their new Department of Behavioral Health implement a new strategy. Its hospitals must focus their expensive treatment on persons who need long-term care. Put the acute care in the community. Crisis stabilization capacity can be covered by Medicaid.

Expand Assertive Community Treatment teams to provide intensive housing-based services. Expand “primary” community mental health clinics so timely appointments replace hospital emergency rooms, currently the only sure path to help.

Our current nonsystem operates like a revolving door. Our frailest citizens go around and around, from emergency room to shelter to police car to jail to hospital. The endless system of emergency care wastes the few dollars that we have. Legislators have a real opportunity to support a marriage between housing and treatment.

Put more of the state’s $200 million HUD dollars into supportive housing. Develop supportive housing for persons who frequent our hospitals. Construct new programs that bridge the gap between the wasteful emergency systems and the housing that gives people hope, stability and independence.

Yes, the Department of Behavioral Health will need financial help from the General Assembly, but most importantly, it will need support for a new strategy. This new strategy can keep our mental health system out of the control of the federal courts and it can do a better job keeping our citizens safe and living independent, fulfilling lives.

Paul Bolster is executive director of the Georgia Supportive Housing Association.