Georgia's gaps in mental health care may have contributed to singer Vic Chesnutt's death

From Flagpole Magazine in Athens, Ga.:

On Dec. 22, Athens songwriter Vic Chesnutt (pictured), who was suffering from deep depression, was to be admitted as an inpatient at a private psychiatric care center outside Clarke County. According to longtime friend Erica McCarthy, Chesnutt was about to leave his house for the facility when the center called to report their van’s handicapped lift was broken. Chesnutt’s wife Tina was told the driver had to be contacted to see if he was willing to physically lift Chesnutt—a quadriplegic confined to a wheelchair—in and out of the van.

The 45-year-old was asked if he could give the facility three days to resolve the complication. As the world now knows, he could not—or would not. Not this time. Chesnutt’s packed bag contained a newly filled prescription of 100 muscle relaxants, medicine he took to keep his body from seizing. Around 11 p.m. that night, it is believed he swallowed the pills and, on Christmas Day, after being in a coma two days, Chesnutt consummated his on-and-off affair with death.

“That’s the big tragedy of Vic’s death,” says McCarthy. “He was seeking help and he was rejected.”

Chesnutt’s suicide is an opportunity to examine Georgia’s impaired mental health care system, area professionals say, and to highlight steps that can be taken locally to help people in mental health crisis find treatment.

The U.S. Department of Justice investigated state mental health practices after a 2007 series by The Atlanta Journal-Constitution reported a litany of ills that resulted in injury and death in the state’s seven mental hospitals. In a settlement reached between the state and the DOJ, Georgia promised to be in “substantial compliance” by Jan. 15, 2010 with 345 specific provisions, according to a Nov. 13 AJC editorial. “In a report filed in September, the state acknowledged meeting just 21 of them,” the editorial stated.

On Jan. 13, Gov. Sonny Perdue announced an increase in state funding—the first in seven years—for mental health care. He earmarked $20 million for 2010 and an additional $50 million in 2012. “Well, for the first time I heard a governor talk about mental health in the State of the State address,” wrote Ellyn Jeager, director of public policy and advocacy, Mental Health America of Georgia, Atlanta office, in an email to employees.

Georgia received a "D" on the 2009 National Alliance on Mental Illness report card. “Even a 'D,' however, cannot fully convey the horrendous scandal that has scarred the state,” the Alliance states on its website, in reference to the AJC investigations.

In the summer of 2008, Georgia, in response to the investigations, created the Department of Behavioral Health and Developmental Disabilities. The mental health budget previously was under the huge umbrella of Human Services. “We just got lost,” says Dr. Cindy Darden, CEO of Advantage Behavioral Health Systems, a regional nonprofit and resource for mental health issues.

“We are exceptionally happy” with the proposed influx of mental health dollars, she says. “Several things have happened in the last couple of years to raise our legislative body’s awareness, and the Department of Justice investigation was definitely one of them.”

She says the funding most probably will be directed at the state’s seven public mental hospitals. “But if they don’t cut (our funding) that will be the first time in seven years. We’ll take it,” she says.

At present, however, Darden says “there is a big hole in the safety net in the state of Georgia.” Advantage Behavior Health Systems offers the only residential mental health care in Athens-Clarke County, Darden says. “We have 14 beds and we’re always full.” Athens Regional Medical Center's sixth-floor psychiatric ward closed down several years ago, leaving no inpatient services in the area. “That’s the state of our state mental health system right now,” Darden says. “It’s excruciatingly painful to all of us. Funding has been cut to such a level that it is difficult to find a hospital, and we don’t have the outreach we had at one point in time. We used to have the personnel to check on someone (in crisis) and that’s what we are now lacking.”

On Dec. 1, in an interview on NPR’s Fresh Air with Terry Gross, Chesnutt freely discussed his automobile accident in 1983 that left him paralyzed from the waist down and with limited use of his arms; his attempts at suicide before and after the accident; and the songs such as "Flirted With You All My Life," in which he sang, “Oh, death, I’m not ready.” He told Gross it was “a break-up song with death.”

He seemed to have put thoughts of suicide behind him, guitarist and friend Guy Piccioto told Gross on a January 7 Fresh Air program dedicated to Chesnutt. “He was in a good space,” Piccioto said. “That’s why it was so shocking.”

McCarthy agrees. “He was excited about his life, but felt this coming on. It took him a week to find a place that would take him and he was out the door when they called.“

Darden says someone contemplating suicide can present a calmness and optimism that can be deceiving. “It isn’t unusual to see a lifting of spirits because they know there’s going to be an ending. For the people who love them, they want to claim that as hope—oh, we’re on the road to recovery; but when you’re on the road to recovery it looks the same.”

Eddie Whitlock, executive director of Mental Health America of Northeast Georgia, an Athens advocacy group, says mental health should be as openly discussed as physical well-being.

“Winston Churchill referred to depression as his little black dog,” says Whitlock, who also suffers from depression. “The black dog came around when you didn’t want him, and when you thought he was gone, he’d show back up. It’s a constant battle with people with depression…”

For Whitlock, there is no excuse to turn away a person needing mental health care. “Crisis mode in mental health is the same as for someone who goes to the emergency room for chest pains. You don’t tell them to wait three days. There should be a system capable of accepting an emergency case coming in; a threat of suicide should be the same red flag as chest pains in the ER.”

Athens has several mental health organizations that work to fill the gap in public care. One of the most distinctive is Nuçi’s Space, a non-profit resource center aimed at preventing suicide by providing treatment for musicians.

“We work as a conduit for those seeking professional therapy and getting them to the people who can provide that service,” says Director Bob Sleppy. “Sometimes it’s difficult for a person to even know who to call. There’s such a stigma attached, people don’t talk about it amongst their friends.”

Nuçi’s, believed to be the only such health and music resource center in the country, does not provide therapy, Sleppy says. “We’re very adamant about that and make sure that’s clear. We’re simply here to get [those seeking help] to the people they need to see.” If a person cannot afford treatment, we work out a system with those doctors and therapists and are able to bring down their fee” to as little as $10. Nuçi’s is billed the remainder.

“We’ve helped more than 650 musicians since we opened in September 2000. We’ve spent over $100,000 in direct financial aid for that program… That’s what makes it difficult when we lose someone like Vic or anyone in town. There is a lot of good we’re doing but it’s heartbreaking when it doesn’t work. The sad thing about severe depression and other mental illness is that death is sometimes the result, and that’s what makes this disease so frustrating.”

The Treatment Advocacy Center in Arlington, VA is a national nonprofit organization that works to eliminate barriers to treatment for people with severe mental illness.

One of its major findings suggests that states should provide a minimum of 50 psychiatric beds per 100,000 residents, but only Mississippi meets that goal. Georgia falls in the “severe shortage” category, providing only 18.5 beds per 100,000 people.

“There should not be so few hospital beds that when someone needs treatment they can’t get it,” says Rosanna Esposito, deputy executive director of the center. “The key is, there have to be enough hospital beds for those who want to get into the hospital, and also for those who aren’t aware they’re ill but desperately need hospitalization.”

If the state fails to make hospital beds available, Esposito says, “you need to look at options to make sure services both voluntary and involuntary are available in the community. If someone was in any other type of medical crisis we would make sure he would get into the hospital immediately. Severe mental illness is no different.”