State Mental Hospitals: Move faster to fix mental health care

Atlanta Forward / The Editorial Board's View: Come Jan. 15, Georgia is supposed to be in significant compliance with federally mandated improvements. Reports indicate we’re not even close.

Sarah Crider’s darkest hours had no dawn. As evening passed into midnight in her room at a Georgia mental hospital in 2006, the 14-year-old lay dying, hours after complaining of stomach pain. She vomited at midnight, and again two hours later. By the time overtaxed hospital workers entered her room about 6:15 a.m., she was dead. An autopsy revealed she suffered from an obstructed colon and a severe bacterial infection.

Sarah’s death was no anomaly. A 2007 investigation by The Atlanta Journal-Constitution found neglect, chronic staff shortages and other profound problems were plaguing Georgia’s seven state mental hospitals and contributing to a lengthy list of patient injuries, assaults and deaths. As state officials offered up excuses and promises to do better, the U.S. Justice Department stepped in.

One result of Justice’s investigation was a ticking clock for Georgia. Come Jan. 15, our state is supposed to be in “significant” compliance with an agreement to improve mental care.

If the first step toward a solution is acknowledging the problem, we may finally be pulling onto the road toward recovery. Now we need to drive faster.

Notably, some real progress toward bettering the state’s mental health system seems to have been made since last summer. Even so, there’s a very real chance that a federal judge could decide early next year that our efforts have fallen way short. Georgia promised in a settlement agreement to be in “substantial compliance” by January with 345 specific provisions. In a report filed in September, the state acknowledged meeting just 21 of them, although individual hospitals may have bettered that record.

Georgia can, and must, do better. We must step up the pace of progress seen since a reorganization last summer created the state’s new Department of Behavioral Health and Developmental Disabilities (DBHDD).

Aiding citizens who are unable to help themselves is a basic tenet of even the most minimalist vision of governance. A real accuracy check of a society’s moral compass is how well it treats the weakest who walk among us. Georgia can surely find a way to do the right thing for our mentally ill.

The right thing won’t be cheap. It’s equally true that Georgia cannot afford a gold standard of treatment during a time of plunging state revenues.

A reasonable, consistently applied model of care is what’s called for in the state’s psychiatric hospitals. Bundle that with a decent, expanded network of community mental health resources and Georgia will likely have a mental health safety net that can pass federal muster. Boosting community services may well prove cheaper than relying as heavily as we do on an antiquated hospitalization model.

There are at least 115 flesh-and-blood reasons for forging ahead even more rapidly. That is the number of hospitalized Georgia mental patients who died between 2002 and 2007 under questionable circumstances. It’s not an exaggeration to say that Justice’s assessment of the situation in Georgia’s state psychiatric hospitals has been scathing.

While state and Justice Department lawyers file paperwork, the potential for tragic — and preventable — harm likely remains present in the hallways and patient rooms of the state’s overburdened mental health system. That must change.

In fairness to the state and Gov. Sonny Perdue, Georgia has begun getting its administrative arms around this long-running crisis.

After mulling privatization of mental health services, the state chose another option. Effective last July, the new department of behavioral disabilities was created as part of a reorganization of the former Department of Human Resources.

Under a new commissioner, psychiatrist Dr. Frank Shelp, DBHDD has reached out to mental health advocates and enacted some innovative reforms.

A new partnership with Medical College of Georgia is bringing additional expertise and staffing to the state hospital in Augusta. The arrangement should ease chronic staff shortages and improve training for both hospital workers and medical students. Care should improve as a result, and this model would seem to be cost-effective, a major concern for all state agencies during this recession.

Shelp is also bringing in expert psychiatrists, psychologists and social workers to work at the hospitals, including a team aimed at high-profile problems. This, too, could help better care by bringing in fresh perspectives and best practices. It’s hoped the lessons and methods imparted will remain long after the consultants have departed.

The new agency also seems intent on developing consistent procedures for both treating mental illness and managing the programs and institutions needed to do so. A solid playbook consistently applied should lead to better care and fewer mistakes that can prolong patient misery or, at worst, cost lives.

Mental health in Georgia finally seems headed away from a shameful legacy. Speeding up the rate of progress, though, will require, at a minimum, continuing to safeguard the state’s budget devoted to this vital work. Gov. Perdue made the right move in exempting mental health from the budget ax this year. That wasn’t an easy call in the face of a billion-dollar budget shortfall.

His stance should continue into 2010 and beyond. The General Assembly should also look hard at ways to siphon over at least a bit more money to the new agency.

That requires making hard choices during a time of shrinking resources. Doing the right thing doesn’t always come cheap, though, especially when human lives are at stake.

Andre Jackson, for the Editorial Board

In coming weeks and months, we will look at major issues Atlanta must address in order to move forward as the economy recovers. Look for "Atlanta Forward," which will identify these discussions. Send comments to