Georgia has made significant strides in moving the developmentally disabled and mentally ill out of state mental hospitals and into community settings -- despite notable gaps in care, a new report shows.
No longer admitting the developmentally disabled into state institutions marks a “landmark accomplishment” for Georgia, according to the report by Elizabeth Jones, an independent reviewer appointed to track the progress of a five-year agreement between the state and U.S. Department of Justice.
Over the past eight months, the state's efforts include placing 192 developmentally disabled people -- who have lifelong mental or physical impairments that often prevent them from living on their own -- into homes with no more than four people. Under the agreement, the state also aims to provide community-based support to 9,000 mentally ill individuals. Overall, it plans to spend $72 million in the first two years alone.
“We’re putting in place the foundation,” said Tom Wilson, a spokesman for the Georgia Department of Behavioral Health and Developmental Disabilities. “We’re moving very quickly.”
The state has put in hard work, but the next year is about measuring quality and assessing whether the system is really working, said Talley Wells, an attorney with the Atlanta Legal Aid Society.
“Are people really recovering and staying out of the hospitals?” Wells said.
Failures documented in the report show challenges ahead as the state works to set up networks of community providers and ensure people get the individualized attention and services they need.
In some cases, caregivers didn’t track individuals’ weight fluctuations. Unsafe medication practices included untrained staff helping people who couldn’t medicate themselves. One woman lost 14 pounds over nearly seven months because she didn’t receive a dietary supplement as ordered. And an allegation of neglect by a host home provider was substantiated following the death of one individual.
The department has already investigated and corrected some problems, Wilson said. The state agency will also offer training and technical assistance where needed, as well as remove providers who aren’t delivering a high level of care, he said.
The state is also setting up a management team to assess the quality of provider care. While regional offices currently monitor quality, adding a dedicated team will allow more case follow-up, find issues more quickly and track changes over time, Wilson said.
One concern pointed out in the report is that some people don’t have enough productive, enjoyable activities during the day, said Pat Nobbie, deputy director of the Georgia Council on Developmental Disabilities. Some also want to be employed, Nobbie said.
“That’s a challenge and requires some pretty sensitive knowledge of folks -- what they’re capable of, what they’re interested in doing,” she said.
The goal is for people not just to receive care but be able to participate in activities they’re interested in and engage in the community, Wilson said.
Despite challenges, the state has met the majority of nearly three dozen goals it had to meet by July 1 under the agreement. Georgia reached the agreement last fall with the Justice Department following an investigation into the abuse and deaths of dozens of patients in state mental hospitals.
Efforts so far include treatment teams to provide crisis and support services, a crisis respite home and mobile services for the developmentally disabled, crisis stabilization units for the mentally ill, and contracts with community hospitals for beds when needed. The state shut down Northwest Georgia Regional Hospital in Rome earlier this year. And it enrolled 100-plus people in supported employment programs and helped individuals find affordable housing.
But transforming Georgia’s system of more than 100 years of placing people in state institutions -- sometimes for decades -- won’t happen overnight, advocates say.
Services and housing options are still lacking, but the ship is turning, said Cynthia Wainscott, a mental health advocate in Bartow County. Wainscott is excited by a new peer support center in Cartersville not required under the agreement.
“We are not where we need to be," she said, "but we are so much better than we were."
It’s a massive challenge requiring oversight and coordination -- from training staff to working with other agencies, said Tom Bornemann, director of the Carter Center’s mental health program. Services can deteriorate fast if efforts are let up even a little, Bornemann said.
“Our biggest concern is that the momentum continue to move fast and hard forward,” he said. “We’ve got a real opportunity to turn things around.”
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 the state's progress over the past eight months.
About the Author
