Georgia shuts down adult mental health services at state's oldest psychiatric hospital

From The Atlanta Journal-Constitution:

State officials said Jan. 20 they are shutting down adult mental health services at Central State Hospital (pictured) in Milledgeville, the age-old hospital that symbolized the darkest days of psychiatric care in Georgia.

Yet even as Georgia discontinues this care at the 168-year-old facility, the state remains under fire from federal officials attacking the safety and treatment at the state's seven mental hospitals and demanding improvements.

Georgia faced a Jan. 15 deadline to be in substantial compliance with improvements laid out by the U.S. Justice Department, and state officials say they are awaiting the federal assessment on meeting that goal.

The sprawling ancient hospital had problems long ago and in recent times. The facility in the Macon area repeatedly has been the target of investigations by The Atlanta Journal-Constitution.

In November, federal officials found so many shortcomings at Central State, with patients attacking one another and receiving poor treatment, that state officials announced the facility would no longer accept new patients.

By Wednesday, the adult mental health population had dwindled from 95 in November to just 30 due to discharges. Officials, needing significant funding to renovate the aging facility, decided to simply move these 30 patients to other state hospitals. The goal is to shut down adult mental health services by March 1.

Some of Central State will survive. That includes about 150 patients in the forensic unit, which is comprised of patients assigned by the criminal courts who are considered mentally ill. A few hundred patients will remain in the units that serve a nursing home, as well as patients with mental retardation and other developmental disabilities. Two hundred employees will be transferred or laid off, said Tom Wilson, spokesman for the state Department of Behavioral Health and Developmental Disabilities.

The hospital stopped treating children last summer, Wilson said.

"If they can't keep patients safe at Milledgeville, then they have to find somewhere else," said Ellyn Jeager of Mental Health America of Georgia.

Advocates were worried the transfer of patients might cause overcrowding in other facilities, and that patients from the Milledgeville area might be moved away from their families and loved ones, which could hamper their recovery. State officials said the change will not create any overcrowding elsewhere.

For many Georgians, the hospital that opened in 1842 still strikes a fearful image, representing a time when society sent its unwanted or problematic people to an isolated location. The place many know only as "Milledgeville" has had its own fire department, ZIP code and huge cemetery. As it grew to a population of some 12,000 patients, it boasted the largest kitchen in the world.

In 1869, Berry Hall, an inexperienced attendant, became the first staff member killed by a patient, according to an Oct. 5, 1997, story in the AJC.

The hospital's creation was part of the 19th century's social reform movement. Mentally ill people often were hidden away in the homes of families or sent out to live in the street. Care at the hospital thrived in the mid-1800s as its leaders abolished such physical restraints as chains or ropes, according to the New Georgia Encyclopedia.

However, its population growth overwhelmed the staff, and such brute-force interventions as insulin shock and electroconvulsive therapy occurred in massive numbers, the encyclopedia said.

Thousands of patients were buried there with only numbered stakes as grave markers. In the 1960s, groundskeepers pulled up many stakes and tossed them aside to mow the lawn. In recent years, volunteers have conducted a cemetary restoration project.

In 1959, the hospital was the nation's largest mental institution, housing 12,500 patients. Jack Nelson's series in the AJC exposed the following factss: Only 48 doctors were on staff, and a dozen of them had alcohol or drug problems (several had been hired off the hospital's wards); doctors took money from pharmaceutical companies to try experimental drugs on patients, and other abuses.

Nelson's stories led to numerous reforms.

More recently, the AJC in 2007 pointed a harsh spotlight on the hospital in a series of stories that revealedsince 2002 that more than 100 patients had died under suspicious circumstances in the seven state mental hospitals.

The Justice Department has stayed focused on the inadequacies at Central State over the past year, sending state officials a series of letters detailing conditions that continue to endanger patients' safety.

Federal authorities said a recent visit to Central State confirmed that "grave harm continues to occur at the state psychiatric hospitals."

Josh Norris of the Georgia Advocacy Office said the state needs to move away from placing people in these hospitals and provide more community-based services. State mental health officials say they are heading in that direction.

But Jeager, the advocate, said the difficulty with that strategy is the same as it was 150 years ago: many people don't want facilities for mentally ill people in their neighborhood.