It is time someone spoke the truth about care of seriously mentally ill and addiction-prone people and services for the developmentally disabled in Georgia. While articles in the AJC over the past few years illustrate the debacle consumers and families now face, they serve primarily as warning flags, which those in leadership positions know will soon be forgotten with tomorrow’s news.
During a period from 1982 to 1989, under the leadership of Dr. James Ledbetter and Dr. John Gates, Georgia experienced an interval of enlightened leadership at the Department of Human Resources. While Ledbetter fought for legislative approval and funding, Gates and his staff entertained novel ideas, approaches and improved management strategies to enhance both the hospital and community services for consumers.
This age of enlightenment proved short-lived. In the mid-1990s, Georgia House Bill 100 was promulgated as a radical method to restructure mental health and substance abuse services and to promote enhanced community-based services for both these clients and, indirectly, consumers with developmental disabilities.
At about this time, two political trends occurred: an attitude by the executive branch that could best be described as “ignorance” (meaning, ignoring the realities, challenges and needs of these consumers and families), and legislative neglect (meaning that funding for these services and programs would continually diminish over the subsequent two decades).
In fact, there is an almost linear correlation between the deterioration in services and Georgia’s rank in per capita funding compared to other states.
HB 100, which was envisioned as a giant evolutionary leap, became instead a stimulus for further fragmentation of services, especially for the mentally ill. The state was divided into far too many regions, each with its idiosyncratic views of both the needs of consumers and the methods for funding critical services. Funding and staffing of hospitals were progressively curtailed, leading to today’s problems and imperiled care in these hospitals. The mantra for the hospitals did evolve, however, from “doing more with less,” to “doing less with nothing.”
In the communities, the mantra became: “Provide minimal services while enhancing billing for group services.” While fraud, bankruptcy, mismanagement and closings destroyed a number of community programs, success seemed to be defined by the salaries and perquisites of top managers. Medical and psychiatric care was marginalized, part-time physicians were the norm and client-centered care plans were inadequate.
One of the most devastating effects of the politicization of mental health, addiction and developmental disabilities care occurred at the offices of the Division of Mental Health, Substance Abuse and Developmental Disabilities. Its employees had no or minimal knowledge of mental health services, hospital programs or of facilitating the community-based independence of individuals with developmental disabilities. The mantra at this top level of management became: “Keep me out of the governor’s doghouse and off the AJC front page.”
Throughout this period, the voice of advocacy, while at times justifiably strident, was viewed as unfortunate noise. Advocacy was to be ignored, tolerated or contained. The presence of a few positions on community boards, at the state division office or in hospitals was condescendingly considered a necessary evil. The fact that many suffering from mental illness would reside eventually in local jails or become inmates with the Department of Corrections was tolerated as an out-of-sight, out-of-mind phenomenon.
This trend of shifting responsibilities will continue as the state likely will opt for privatization of services to escape the guillotine of federal inquiry and oversight.
Over the past two decades, there have been only two respites from this deterioration; the administration of Gov. Roy Barnes (whose wife, Marie Barnes, was a vocal and often present supporter of services for these consumers), and during the interval of state medical leadership by Dr. Thomas Hester.
Georgia was rated 14th among states in a survey in “Hospital and Community Practice” in the early 1990s while our state is now ranked near the bottom, and as among the worst in the nation in funding, for example.
A similar phenomenon has befallen medical practitioners in this system. Only one or two positions for medical or psychiatric involvement (much less, leadership) exist at the higher state levels and these positions are perennially vacant. The notion of best-practice standards, medication management and novel consumer-centered treatment are not encouraged at hospitals and essentially have never existed in most community clinics.
The past several decades of this errant leadership and fiscal denial has created a maelstrom of compromised and fragmented care for those who suffer from mental illness and addiction, as well as for those consumers who are developmentally challenged.
The politicization of the delivery and provision of these services has completely distorted the notion of what the “product” should be. The “product” should revolve around how the care of each individual is constructed and provided, and be measured by that individual’s progression in her or his autonomy and health.
The “product” should not be political expediency, distorted funneling of funds, unenlightened administration and flawed management systems forced upon a service delivery network which, by its nature, is already extremely challenging.
Dr. James W. Mimbs of St. Simons Island served as a psychiatrist and administrator with the Department of Human Resources before his retirement five years ago.
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