Monday, February 7, 2011

As Georgia closes mental hospitals, shortage of community care looms

From The Rome News-Tribune:

ATLANTA — For parents of children with mental illness, daily struggles are challenging enough, but many fear they’re reaching a breaking point because the state is releasing patients from regional mental hospitals.

It’s not that these parents want to see their children continue to spend decades institutionalized. It’s their worry that there won’t be adequate treatment options in their community after they’re released.

The closure of Northwest Georgia Regional Hospital in Rome later this year is the latest action to spawn widespread concern among patient families.

While the Rome facility will become the second state hospital to close in recent years, patients are being discharged from the other state hospitals that aren’t slated to close. In Augusta and Savannah, for instance, hospital staff are constantly searching for candidates for release.

Patient advocates have called for years for the transfer of services from in-patient to out-patient, but it took the federal government to make it happen. The settlement of one lawsuit requires the state to find homes each year for 150 of the 700 patients with developmental disabilities, what used to be called mental retardation. A more recent settlement of another federal suit is prompting the discharge of patients with other mental disorders like multiple-personality disorder and schizophrenia.

Parents and advocates like Roman Bonnie Moore want patients living at home or in group homes.

“It concerns me when we have people who are chronically mentally ill and the only place they can go is the hospital,” she said Wednesday to the House Human Resources Subcommittee meeting at the Capitol.

Dr. Frank Shelp, Georgia commissioner of behavioral health and developmental disabilities, agrees communities should have treatment options besides hospitalization. Half of all involuntary hospital admissions are unnecessary, he said. They happen because the courts, law enforcement and social workers think of the hospitals before they consider alternatives, according to Shelp.

He speaks passionately about the problems with state hospitals, such as the fact that the state’s newest hospital building is 40 years old. Twice he has fired two entire shifts of staff at separate hospitals for patient neglect and mistreatment.

In his first days on the job at the new department created 18 months ago, he learned of a staffer who had struck a patient. He was ready to prosecute until an assistant informed him of a legal exception for mental-health workers.

“I was told with a straight face that it was not against the law for the staff to hit a patient,” he said.

Eager to get patients treated in a community setting rather than in a hospital, he is trying to assure parents, advocates and legislators that his department is making arrangements fast enough to meet his target date of June 30 for the Rome transition.

Shelp’s department has had some miscues where it’s attempted the transition in other cities.

In Savannah’s Georgia Regional Hospital in 2009, staffers got pink slips with a date when that facility would close. So many legislators, advocates, employees and newspaper editorials objected that the closure plans were scuttled.

In Milledgeville, the department of Behavioral Health & Developmental Disabilities did shut the doors of Central State Hospital in 2010. But the local medical center has found 345 mental patients in its emergency room since and has had to hire off-duty cops to guard the dangerous ones.

The local sheriff has given himself a new title.

“I’m the director of the Baldwin County Mental Health Hospital known as the Baldwin County Jail,” says Sheriff Bill Massee, noting the 291 inmates requiring psychiatric treatment in the last 12 months.

Shelp is determined to get it right before the Rome hospital closes, or many more patients are discharged from the other regional hospitals. It has already reduced by 29 percent the number of people hospitalized, and by 2015 will hospitalize no one who is developmentally disabled.

New community services are being used, such as private hospitals, state-supported community service boards and new teams of therapists to make house calls when patients are facing a personal crisis.

And in the Rome region, providers are already setting up shop in the area.

These same strategies have been initiated in the Savannah region and will be rolled out in other regions, funded with the $5.5 million freed up by closing Northwest Regional.

And when the state has dealt with the institutionalized patients, it will face another large problem, according to Pat Nobbie, executive director of the Georgia Council for Developmental Disabilities. That’s the 19,000 adults with the mental functioning of a child who are already living with a parent older than 64. When those parents can no longer look after their children, they’ll also need community services like those being deinstitutionalized today.

“This is a tsunami that the state is not prepared to deal with,” she said.