Tuesday, February 8, 2011

Georgia pumps $73 million into efforts to move mentally ill, developmentally disabled individuals out of mental hospitals and into community.

From The Atlanta Journal-Constitution:

ATLANTA -- Depressed and in physical pain, Elijah Reid sat in a state mental hospital for months - waiting for a way out.

Then one day last fall, the 55-year-old native of Jamaica, a diagnosed paranoid schizophrenic, received good news. Reid qualified for a Medicaid waiver to transfer to a personal care home - not for his mental illness, but because he is a paraplegic.

While Reid's physical disability opened doors, other mentally ill Georgians haven't been so fortunate. Many are stuck in institutions when they don't have to be, said Reid's attorney, Sue Jamieson.

That could soon change.

The state is pumping nearly $73 million into an aggressive effort to move mentally ill and developmentally disabled individuals out of mental hospitals and into the community.

Slated to unfold over the next five years, the effort stems from a precedent-setting agreement reached last fall between the state and the U.S. Justice Department, which began investigating Georgia's psychiatric hospitals after a series of articles in The Atlanta Journal-Constitution revealed the deaths of patients caused by abuse they suffered while under the state's care.

Among the goals of the effort, the state will target 9,000 individuals with severe mental illness to help those in hospitals transition into a community setting and support others who are readmitted to institutions frequently, are chronically homeless or are being released from jail.

More than 40 support teams made up of psychiatrists, nurses, peer counselors and other professionals will help individuals make the transition. The state also plans to fund 35 beds in community hospitals to allow people to be treated closer to home and have easier access to specialty care.

"We want to touch as many of these individuals as possible," said Frank Shelp, commissioner of the Department of Behavioral Health & Developmental Disabilities.

The changes come at a time when the state is facing a significant budget shortfall and many agencies are facing severe funding cuts. The department's plan calls for $13.4 million in the amended annual budget and nearly $60 million in the 2012 budget. The total price tag is unclear, however, because other agencies will also play key roles, Shelp said.

These are the hardest of economic times, he said. "Our budgets are tight. ... If we can achieve this now at this point in time, it really points to hope for individuals in the future."

The changes have been slow in coming, advocates say.

This is a crucial step in creating a 21st-century mental health system, said Talley Wells, an attorney with the Atlanta Legal Aid Society.

"We basically have an 1800s system, where we lock people up and that's the only place they can get treatment," Wells said.

For years, people were being confined for long periods of time - sometimes decades - without getting better and with no way to transition into the community, he said.

People were dying, said Ellyn Jeager, director of public policy and advocacy at Mental Health America of Georgia.

One young man on suicide watch left a state mental hospital, went to Piedmont Park and hanged himself, she said. "Who was watching? Who was paying attention?"

Then in 1999, the U.S. Supreme Court ruled in a Georgia case that it was unconstitutional to institutionalize people with developmental disabilities who were capable of living in a community setting. Two Georgia women who had been hospitalized sued Tommy Olmstead, then the commissioner of the state Department of Human Resources.

Starting in 2007, in a series of articles called "A Hidden Shame," the AJC revealed that dozens of mentally ill patients in state hospitals died from abuse and the state was slow to provide community-based care. The Justice Department began an investigation, and the state ultimately created a new mental health agency.

The state has made some strides.

In the past year, the 30-day hospital readmission rate has dropped from 16 percent to below 10 percent, and there has been a 20 percent drop in the number of people entering hospitals, Shelp said.

Changes may be under way, but advocates remain skeptical.

"I think they have to prove themselves," Jeager said.

Starting in July, the state will stop admitting people with developmental disabilities - who have lifelong mental or physical impairments that prevent them from living on their own - into institutions.

As part of the agreement, the state will also provide up to 750 new waivers to move people with developmental disabilities such as cerebral palsy or autism out of institutions. Nearly 1,800 people are in state mental hospitals - more than 670 have developmental disabilities.

An additional 400 waivers will be made available to help developmentally disabled individuals who already live in the community but are in danger of being institutionalized for various reasons, such as an aging parent who can no longer provide care.

One hundred waivers a year aren't enough, said Pat Nobbie, deputy director of the Georgia Council on Developmental Disabilities. There is already a waiting list of 5,700 people waiting for services, who could fall into risk at any time, Nobbie said.

Finding enough affordable housing for those transitioning from hospitals will also be a challenge, she said.

Ultimately, getting people into the community could be a savings for the state, Nobbie added. Hospitalizing an individual can cost anywhere from $75,000 to $150,000 a year - enough to fund three people in a community setting, she said.

Jamieson, with the Atlanta Legal Aid Society, said one of her biggest concerns is the closure of Northwest Georgia Regional Hospital in Rome slated for June 30, a move that is expected to save the state $5.5 million. Available housing needs to be in place before it closes, she said.

Shelp, the behavioral health commissioner, emphasized that though June 30 is the proposed closure date for the Rome facility, the hospital would not be shuttered until support teams and other services were in place. "We are not on a time line to close Rome to save money," he said.

Tom Wilson, a spokesman for the department, said that housing supports wouldn't be put in place until later, although many patients are only there for three to six days and won't be prevented from being released because of a lack of housing.

Advocates say they are cautiously optimistic but are waiting to see how plans unfold.

It could be a whole new world for people like Elijah Reid, Jamieson said.

Today, Reid is a transformed man.

He was wary and quiet when he first came to the group home, said administrator Michael Brown with Unlimited Loving Care, which runs the Stone Mountain facility.

But he came to see his new surroundings as home and his roommates as a family.

The staff occasionally even cooks Jamaican food for him. "Over the months, he just blossomed," Brown said.

While Reid is happy in his new setting, he still hopes to have a slice of the American dream.

"I would like to live in a home of my own at some point," he said. "I want to be independent."