How Georgia ended up with so many homeless people on the streets
My late wife was born in Milledgeville, where Georgia’s first and largest state-run mental hospital (then known as the Georgia Lunatic Asylum) was first opened in 1842.
Her family is from that area and has been there for hundreds of years.
In the 1970s, I worked for the poverty program in Baldwin County, my first professional job. Central State Hospital, once housing over 13,000 patients and the largest state-run mental hospital in the nation, was a major employer there.
Area residents knew that care there was completely inadequate. They were disgusted and open about it when discussing it with other locals like me. Eventually, the rest of the state figured it out, as described below.
From unacceptable care to failing to fund outpatient care enough
Studies estimate that well over half our nation’s homeless residents are currently burdened with mental problems. According to a comprehensive analysis of the available literature, “prevalence rates ranged from 56.3% to 93.3%.”
Our state and national politicians — of both parties — have created this unacceptable situation and must act to remedy it. I know firsthand because, as Georgia’s first director of health planning, I was part of Georgia’s earliest deinstitutionalization efforts, aimed at closing these unsanitary and understaffed so-called hospitals that were run more like poorly staffed prisons.
Georgia’s psychiatric hospital system has undergone drastic downsizing over the past few decades, including closures of much of the state system of inpatient care. The state now operates five much smaller hospitals, located in Milledgeville, Augusta, Columbus, Savannah and Decatur.
And we are not alone; there has been a national trend, shifting away from large state-run mental health institutions. These institutions were virtually detention centers, providing horrible quality of care, and reform was absolutely needed.
I know because, as a top state planner, I visited every one of them. I was disgusted at what I saw and reported back to state health officials.
The original idea was to close these mental health prisons … and move toward community-based, state-funded mental healthcare, including locally based mental health boardinghouses. However, although the state claims to have a “continuum of care,” this did not happen in Georgia — or elsewhere.
These institutions simply closed down with many needy individuals literally dumped on our streets.
I helped to bring the problem of unacceptable care in Georgia’s state-run mental facilities to the attention of political officials back in the 1980s when my units constructed the first State of Georgia Health Plan, including a mental health section. I personally presented that plan to then-Lt. Gov. Zell Miller and other political figures.
The mental health portion of that document made specific recommendations regarding:
- Closing state mental institutions dues to quality-of-care issues.
- Utilizing savings to fund outpatient mental healthcare, including mental health boardinghouses staffed by professionals.
Politicians need to stop looking the other way
Over time, Georgia politicians did close these facilities due in large part to investigations by the federal government. Specifically, a U.S. Department of Justice investigation threatened the state, indicating that the U.S. “Attorney General is empowered to initiate a lawsuit to correct deficiencies … ."
The facilities shuttered their doors per the state’s Olmstead Settlement Agreement with the DOJ.
Georgia Department of Behavioral Health and Developmental Disabilities Commissioner Kevin Tanner has glowed about progress, stating that the state “transform(ed) Georgia’s behavioral health system” and made “extraordinary progress … in expanding access, improving quality and building a more comprehensive continuum of care.”
However, despite his proclamation, as I have written previously in the AJC, Georgia is second worst of 50 states in mental health providers per capita and sixth worst in health expenditures per capita.
Instead, Gov. Brian Kemp and other politicians gloat about cutting taxes while ignoring the problem. Thus, these mentally ill people are on our streets while politicians look the other way.
Jack Bernard was the first director of health planning for the state of Georgia. He served four terms on two county boards of health and is currently chair of the Fayette County Board of Health. He is also on the executive board of the Georgia Public Health Association.
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The opinions expressed are those of the writer and do not necessarily reflect the views of The Atlanta Journal-Constitution.