Georgia officials committed Tuesday to spend millions of dollars to help mentally ill and developmentally disabled people move out of state mental hospitals and receive services in their communities -- but where that money will come from remains to be seen.
In reaching the landmark settlement with the U.S. Justice Department, the state will need to come up with $15 million in the amended annual budget and an additional $62 million in the 2012 budget for mental health services, said Tom Wilson, spokesman for the state Department of Behavioral Health and Developmental Disabilities. Other state officials acknowledged that finding the additional money will present significant challenges.
"Obviously, this agreement comes with a price tag that will pose a challenge at a time of declining revenues," said Nathan Deal, Republican gubernatorial candidate.
Justice Department officials said the settlement, which still needs approval from a federal judge, will transform the state's mental health system, reducing reliance on mental hospitals while it adds community services.
"It addresses the needs of people who are currently institutionalized who don't need to be there, and it also addresses the needs of people who are in danger of institutionalization," said Thomas E. Perez, assistant attorney general for civil rights.
Perez said the settlement not only fulfills Georgia’s moral and legal obligations, but also helps the state financially. Georgia pays an average of $174,000 a year to house someone in a state hospital, compared with the $47,000 average cost to provide in-home services to the developmentally disabled, he said.
Democratic gubernatorial candidate Roy Barnes, through a spokeswoman, concurred, "Today's settlement will help Georgia in the long run since it generally costs less to house someone in in-home, community based services than it does in a state facility."
The agreement was 11 years in the making, following a 1999 U.S. Supreme Court decision in a Georgia case that ruled it was unconstitutional to institutionalize people with developmental disabilities when there are community alternatives. Two institutionalized women seeking community-based care sued Tommy Olmstead, then the commissioner of the Georgia Department of Human Resources.
The agreement differentiates between the developmentally disabled -- those who have a lifelong physical or mental impairment that impedes their ability to function -- and people who have mental illnesses such as schizophrenia or bipolar disorder.
By July 2015, the state will attempt to move all people in state hospitals with that diagnosis into community settings. Provisions also will be made for expanded community-based services for about 9,000 people with mental illness.
Under the agreement, Georgia must establish several 24-hour crisis service centers and mobile teams to respond to needy individuals experiencing a crisis anywhere in the state.
Georgia also agreed to create more than three dozen community teams to help the state’s mentally ill residents transition into community settings, and pay for 35 community-based psychiatric hospital beds in hospitals that aren’t run by the state.
Georgia advocates for people with mental illness and developmental disabilities such as cerebral palsy, autism and other disorders hailed the agreement.
"What a day!" said Cynthia Wainscott, a Mental Health America of Georgia board member. "It has been a long hard process but we now have a set of agreements that will improve community services as well as the hospitals."
The agreement focuses on moving people with developmental disabilities out of institutions into community settings, where they can be closer to their community and family. There are 1,800 people in state mental hospitals, 711 of whom have developmental disabilities, which are genetic disorders that cause cerebral palsy, autism, Down syndrome. Under the agreement, the state will stop admitting people whose primary diagnosis is developmental disability into state hospitals by July 2011, and instead place them directly into community services.
Gov. Sonny Perdue said in a statement, "I am confident that we finally have an agreement that moves us towards our common goals of recovery and independence for people with mental illness and developmental disabilities."
The changes will require about a $60 million addition in the agency's annual budget of $1 billion that serves people with mental illness, developmental disabilities and addictive diseases.
The state will continue to improve conditions at its mental hospitals, which will still serve some mentally ill people and those referred by the criminal justice system.
The agreement foresees an expansion in community services and service providers for the mentally ill and developmentally disabled, including some housing, crisis units and employment support. More than 100,000 people with developmental disabilities and mental illness received community-based services last year in Georgia, Wilson said. The state provides oversight over these private service providers, with regular inspections, audits and satisfaction surveys of clients.
The Associated Press contributed to this article.
Continuing coverage
In "A Hidden Shame," a series of articles that began in 2007, The Atlanta Journal-Constitution revealed that dozens of patients at Georgia's psychiatric hospitals had died from abuse, and that the state lagged in providing community-based mental health treatment. Georgia created a mental health agency, and the U.S. Justice Department opened an investigation. The AJC continues its coverage as developments unfold.
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