Georgia agrees to additional federal oversight of mental health system

State officials acknowledge efforts to transform dangerous system fell short, pledge new initiatives


2007: The Atlanta Journal-Constitution published a series of articles called "A Hidden Shame," which documented more than 100 suspicious, preventable deaths in state psychiatric hospitals. The U.S. Department of Justice opened an investigation into whether patients' civil rights were violated by hospital conditions.

2010: Federal and state officials reached an agreement to settle the case. Its provisions included the transfers of hundreds of developmentally disabled patients out of state hospitals.

2015: The state missed its deadline to comply with the 2010 agreement.

Wednesday: Officials complete a new agreement calling for at least two more years of federal oversight of Georgia's mental health system.

Six years ago, Georgia promised sweeping changes to its psychiatric-care system, a dark, dangerous place where dozens of patients died under suspicious circumstances.

On Wednesday, state officials acknowledged their efforts have fallen short. They agreed to at least two more years of federal oversight, pledging new spending if necessary to find appropriate, safe homes for patients institutionalized in state mental hospitals, some of them for decades.

Gov. Nathan Deal signed documents committing to remove developmentally disabled adults from the state hospitals by June 30, 2018, three years later than a deadline set in 2010.

As of January, 266 people with developmental disabilities remained in the hospitals.

In addition, the state said it would increase its monitoring of people it already transferred to group homes and other community settings – where more than six dozen former hospital patients died during the past six years. Officials also will conduct thorough investigations when residents of those facilities die.

The new promises came five days before the U.S. Justice Department was scheduled to present evidence in court that Georgia had failed to deliver on its promises in a 2010 agreement that settled a lengthy federal investigation. Justice Department lawyers were prepared to ask U.S. District Judge Charles Pannell to hold state officials in contempt of court. Now, they are joining with the state in asking Pannell to approve a new agreement.

The state’s lawyers had complained earlier this year that federal authorities were trying to make Georgia meet conditions not contained in the 2010 agreement. For example, they argued in court documents that the original agreement didn’t define how good facilities had to be before former hospital patients were placed in them.

In a statement Wednesday, however, Deal described the new agreement as “a significant accomplishment for the state of Georgia.”

“Over the last six years,” Deal said, “Georgia has invested tremendous resources in improving services for people with behavioral health and intellectual and developmental disability needs. I am proud of the work we are doing, and I look forward to our continued progress in this area.”

Deal inherited the challenge of overhauling the state’s mental health system from Gov. Sonny Perdue, who signed the original settlement agreement in 2010. Under the new agreement, the state will remain under federal supervision for most of the time left in Deal’s term, but it could reclaim control of the mental health system by the time a new governor takes office in January 2019.

The Justice Department opened its investigation in 2007 following articles in The Atlanta Journal-Constitution documenting more than 100 suspicious, preventable deaths during the previous five years. The newspaper revealed substandard medical care, neglect and abuse of patients, and a lack of oversight that contributed to dozens of deaths and injuries.

Advocates for people with disabilities praised the new agreement, saying it indicates the state will try much harder to ensure quality care for patients transferred into community facilities.

“It’s a really serious commitment from the state to make sure the community system can support all people with developmental disabilities,” said Alison Barkoff, the director of advocacy at the Bazelon Center for Mental Health Law in Washington. She represents advocacy groups that pushed for strict enforcement of the 2010 agreement.

The state’s new efforts will specifically focus on former hospital patients with particularly complex medical issues, such as those who rely on feeding tubes or who cannot eat solid food without choking. Many facilities don’t have the ability to care for such patients.

Of the first 503 people transferred out of state hospitals, 79 died within a few months, according to reports by a court-appointed monitor.

The state Department of Behavioral Health and Developmental Disabilities suspended the transfers at least twice, citing a lack of suitable facilities.

Advocates hope the new agreement will finally bring the matter to an end.

“We think this is a very strong agreement,” Barkoff said. “It lays out a very good road map.”