BY THE NUMBERS
Department of Justice Settlement Agreement
For individuals with mental illness:*
2,864 Number receiving regular and intensive case management services
2,421 Number receiving funding for housing
1,673 Number participating in services led by their peers
1,779 Number getting individualized care from Assertive Community Treatment, or ACT, teams
1,238 Number receiving employment help
For individuals with developmental disabilities:**
4,800 Families provided with family supports
500 Individuals moved from state hospitals into community settings
600 People who received waivers to help prevent hospitalization
270 Approximate number still living in state-run hospitals
12 Crisis respite homes created
12 Mobile crisis teams created
* Numbers current as of July 1.
** Numbers current as of July 2.
Source: Georgia Department of Behavioral Health and Developmental Disabilities
The state’s behavioral health agency will remain under the oversight of the U.S. Department of Justice — at least for now — after failing to move enough Georgians with developmental disabilities out of state-run hospitals and into the community.
About 500 people with developmental disabilities have moved from state institutions into homes in the community over the past five years, according to the state Department of Behavioral Health and Developmental Disabilities. But that number still falls short of the 750 individuals the state was supposed to have moved out by the end of June.
In 2010, the DOJ and state signed a five-year settlement agreement to shift severely mentally ill and developmentally disabled individuals out of state mental hospitals and into community settings after an investigation into the abuse and deaths of dozens of patients. Federal officials launched the investigation following a 2007 series of stories in The Atlanta Journal-Constitution, titled "A Hidden Shame," that brought the abuses to light.
As of Thursday, roughly 270 individuals with developmental disabilities, such as cerebral palsy or Down syndrome, remained in state hospitals. That's in part because Frank Berry, commissioner of the behavioral health department, suspended transfers for nearly a year in the wake of reports of individuals being abused in their new homes and having inadequate access to medical care.
“It was an important pause for us and a difficult one for us,” department Chief of Staff Judy Fitzgerald said in a recent interview with the AJC. “We had to acknowledge we had to do more preparation.”
‘We’ll keep getting better’
In response, the agency set about developing a 41-step process to transition people with developmental disabilities from hospitals into communities.
Staff members begin working with individuals two or three months in advance and talking about what they like to eat, what they like to do, said Dan Howell, developmental disabilities division director, during the Carter Center’s annual Mental Health Forum in May. The staff also looks closely at individuals’ medical and behavioral needs, Howell said.
The behavioral health department is also working with local nurses, doctors, hospitals and other health care providers to ensure they’re ready to meet individuals’ needs, Fitzgerald said.
Eight individuals have successfully moved into community settings since that suspension lifted at the end of December. And, advocates say, that’s simply not fast enough.
“We haven’t addressed the isolation. We haven’t addressed their hopes and dreams,” Josh Norris of the Georgia Advocacy Office said at the mental health forum. “We’ve got to do better.”
People with developmental disabilities deserve the opportunity to have homes, friends, jobs and the power to decide what they want to do every day just like everybody else, he said.
But the job of moving these individuals into new homes is an often complicated and emotionally fraught process. Some people have serious physical ailments that require intense medical care. Others have called places like the state's Gracewood facility in Augusta home for decades. Elderly parents in their 80s worry about future care for their adult children after they're gone.
Fitzgerald acknowledged the frustrations.
The department is working to move people in the most integrated and responsible way possible, she said. “This is system reform that takes time.”
“We want to move forward too,” she said. “We’ll keep getting better.”
‘A fragile but growing community’
Still, in many ways, the state has succeeded in transforming a broken system — dependent on aging, decrepit mental hospitals — into one focused on helping patients build independent, productive lives for themselves.
Hundreds of people with mental illness are now living in their own houses and apartments; they’re receiving job training and settling into lives with friends and community. The settlement agreement focused on 9,000 people with severe mental illness, such as schizophrenia and bipolar disorder, who were frequently in and out of state hospitals, chronically homeless or in and out of jail.
“The state has continued to sustain progress strengthening its system of community-based supports for individuals with serious and persistent mental illness,” independent reviewer Elizabeth Jones wrote in a March report.
Nearly two dozen teams of professionals, called Assertive Community Treatment or ACT teams, provide individualized care to nearly 1,800 Georgians with mental illness, visiting many at home every day. It’s currently providing employment services to about 1,240 people and has surpassed the DOJ’s requirements in that area every year.
The state is also providing housing support and “bridge funding” — which helps pay for apartment rental deposits, furniture and other necessities to help people get settled in a new home — to roughly 2,400 people with mental illness. Overall, the state is pumping more than $170 million into the DOJ agreement efforts in fiscal 2016 alone.
Advocates have especially applauded the strides the state has made in providing housing to thousands of individuals with mental illness. Having a stable place to live is fundamental to a person’s recovery, they say.
“The state has now created, particularly for people with mental illness, a fragile but growing community system based on dignity, independence and value,” said Talley Wells with the Atlanta Legal Aid Society.
‘We want to see it done right’
For now, it’s unclear how long the Georgia behavioral health agency will remain under the federal Department of Justice’s purview.
The state is waiting to hear from the DOJ on a plan it submitted in mid-April to address how it intends to reach the settlement’s remaining goals.
There are two big hurdles: Moving individuals with developmental disabilities still living in state hospitals out into the community, and providing housing help to all of the 9,000 mentally ill Georgians the settlement targets “who need such support.”
“We’re going to be successful regardless of what the Department of Justice does,” Berry, the behavioral health agency’s commissioner, said at the Carter Center forum. “I believe we can do this work.”
The settlement agreement already calls for the DOJ to continue its oversight for another year, Fitzgerald said. “We have not anticipated that June 30 (of 2015) is magical in any way.”
The state has created a foundation on which to build more community services to serve Georgians with mental illness beyond just the 9,000 targeted in the settlement, said Thomas Bornemann, director of the Carter Center’s Mental Health Program.
“The progress has been enormous,” but there is still a long way to go, Bornemann said.
“Yes, we would like to see things sped up a bit,” he said. “But we want to see it done right.”
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