Georgia has been rapidly rolling out community services for the mentally ill and developmentally disabled this year, but advocates say much work is left to do to help children with behavioral challenges and to foster better coordination of care among medical doctors and mental health specialists for all patients.
The state has opened new crisis stabilization units, peer support centers and other services to help mentally ill adults live productive lives -- the result of a five-year agreement between the state and the U.S. Department of Justice. It needs to put that same urgency into helping children -- an issue left unaddressed in the deal -- said Cynthia Wainscott, a mental health advocate in Bartow County.
“If we don’t, we will be overwhelmed by more sick adults in the future,” Wainscott said.
The issue is one focus of a new report from the nonprofit Carter Center examining ways communities can work with the state and identify local resources to establish the unique behavioral health services they need. The center recently hosted the first of three regional community town hall meetings in Cartersville to get input from local leaders, advocates, families, consumers and peer support counselors. Other meetings in metro Atlanta and Savannah still need to be scheduled.
“Nothing works unless you develop that grass-roots support,” said Lei Ellingson, associate director of the center’s mental health program. "They have to invest in it."
Existing gaps
Last fall, Georgia reached an agreement with the Justice Department following an investigation into the abuse and deaths of dozens of patients in state mental institutions. Since then, the state has stopped admitting developmentally disabled people -- who have lifelong physical or mental impairments that prevent them from living on their own -- into state hospitals. It also plans to provide community-based support services to 9,000 mentally ill individuals.
Those efforts are critically important but not enough, Ellingson said. The mental health needs of children are addressed in education, child welfare, juvenile justice and other settings -- creating a need for cross-agency coordination to improve a fragmented system of care, she said.
Statewide in 2009, 11 percent of children ages 9 to 17 -- totaling nearly 140,000 -- had significant behavioral impairments, according to the center's report.
The study is a good analysis of gaps that continue to exist in Georgia mental health care, said Tom Wilson, a spokesman for the state Department of Behavioral Health and Developmental Disabilities. Georgia has made a strong commitment to serve children and adolescents in their communities, including moving all kids with mental health issues out of state institutions in 2009, he said.
The state is considering the report's recommendations, such as adding a Department of Education representative onto the Behavioral Health Coordinating Council, which already includes the heads of the Departments of Juvenile Justice and Community Health and other agencies, Wilson said.
Roughly 50 percent of behavioral disorders appear before a child turns 14, and 75 percent begin to show by age 24, the study shows. They're more at risk of getting in trouble with authorities and dropping out of high school, Wainscott said, adding that catching a problem early can “prevent that downward life spiral."
Integrating care
Abused as a child, 52-year-old Mary Jacobs didn’t get the help she needed until recently.
Less than six months ago, the Carrollton woman was ready to end her life. She suffered from post-traumatic stress and dissociative disorders and wound up in mental hospitals against her will. A falling out with family left her feeling there was no reason to go on. She had a will drawn up and ensured her grown children had access to her bank account.
But when Jacobs walked into Cartersville’s new peer support center -- one of the state's new services -- for advice on writing final letters to her kids, she instead found a network of people who had been through similar traumas and understood her anger at the failures of the state’s mental health system.
“They were living, breathing examples of survival,” she said. “That place saved my life.”
Whether in children or adults, identifying and treating mental issues as early as possible can lead to less severe outcomes and shorter recovery times, Ellingson said.
One key to improving health outcomes and providing more cost-effective care is better coordination among primary care doctors and behavioral health specialists, according to the center’s study.
Individuals with serious mental illness who are served by public mental health systems die on average 25 years earlier than the general population from largely treatable physical ailments, the report states. For instance, people who suffer from depression are less likely to take their medications for high blood pressure or diabetes.
Georgia is partnering with universities to train up-and-coming doctors how to interact with the mentally ill and connect them with other resources, such as employment support, not just prescription drugs, Wilson said.
The majority of depression cases are handled by primary care physicians, in part, because family doctors know their patients well, said Dr. Leonard Reeves, chairman of the Georgia Academy of Family Physicians. In severe cases, they refer patients to psychiatrists, he said, but there is a shortage of psychiatry specialists in the state.
In Cartersville, the Highland Rivers Community Service Board -- which provides mental health, developmental disability and substance abuse services -- is partnering with a local group on a new facility that would include medical and mental health professionals under one roof.
Transportation can be a huge barrier for low-income individuals, so having a one-stop shop where a physician can refer someone to a psychiatrist down the hall is helpful, service board CEO Jason Bearden said. The facility could open in the spring.
Jacobs, who still attends classes at the Bartow County peer support center, said she hopes mental health services will continue to grow and that she can someday become a peer counselor herself.
"I'm on the road back to work, instead of draining the system," she said. "The whole world has changed for me."
A Hidden Shame
In January 2007, The Atlanta Journal-Constitution began a yearlong series of articles that revealed more than 100 patients of Georgia's state psychiatric hospitals had died under suspicious circumstances during the previous five years. In response to the articles, the U.S. Justice Department opened an investigation into whether the state was violating the civil rights of hospital patients and others in the mental health system. State and federal officials reached an agreement last year that calls for wholesale changes, including a new emphasis on community-based care. This article examines gaps not covered by the agreement.
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