Georgia's mental health system still struggles to fix numerous problems

From The Atlanta Journal-Constitution:

The state's new mental health agency created four months ago was born in crisis.

Dr. Frank Shelp (pictured), commissioner of the state Department of Behavioral Health and Developmental Disabilities, inherited services that had been buried in the state’s sprawling bureaucracy, and which were loaded with problems.

The U.S. Justice Department last year found dangerous conditions that caused preventable deaths, injuries and illnesses for patients in the state's mental hospitals. Federal officials agreed to a settlement with Georgia in January that would allow the state to fix the problems.

But after Shelp’s first four months, that settlement is in danger. This month, the Justice Department, which has clashed with Shelp's agency, told a federal judge that Georgia has done little to stop the patient-on-patient assaults, suicides and other problems.

Beyond that, Shelp has angered some mental health advocates who say he has accomplished little toward fixing the hospitals and hardly addressed the lack of community services for people with mental health issues.

“We were hoping for a new day. It hasn’t come,” said Alison Barkoff, a lawyer for the nonprofit Bazelon Center for Mental Health Law in Washington, which represents several Georgia-based advocacy groups in the settlement case.

On the other hand, some mental health advocates are optimistic about the 55-year-old psychiatrist, whose experience includes management positions with a managed care insurance company and a firm that helped improve state Medicaid and mental health offices in 28 states.

“I think he's trying new things, and I'm hopeful they are the right things,” said Ellyn Jeager of Mental Health America of Georgia, a nonprofit advocacy group. "He has certainly opened the door for communication."

Jeager believes Shelp is communicating with the advocacy community, and even starting to address the need for more community services for people with mental health problems.

She is particularly happy that Shelp dropped the state’s prior plan to improve the seven state mental hospitals by handing them over to the private sector. She saw that as trying to avoid the problem by passing it off.

Shelp, who makes $225,000 a year, acknowledged that he has been dropped into a mental health system in need of vast repair. At the same time, he is constrained by an ever-tightening state budget during hard economic times. Even so, he said he will ask for more money next year but doesn't have a figure yet.

His $1 billion agency must also oversee services for addictions, mental retardation, and other developmental and intellectual disabilities.

“I have my own plan,” he said confidently.

Essentially, Shelp is making nuts-and-bolts changes in leadership, bringing in fresh expertise and forming partnerships with academic institutions, other state agencies and the community of mental health advocates.

He replaced the leadership at the psychiatric hospital in Augusta with experts from the Medical College of Georgia. The college's psychiatric school will provide medical students that he said will boost staffing and bring state-of-the-art treatment.

He is hiring a consulting firm to bring in 30 experts -- psychiatrists, psychologists and social workers -- to work at the mental hospitals. A special team of five will target high-priority problems.

He has put existing leadership on notice.

"Everyone's intentions are good. But they are not getting the job done," Shelp said. Some will last, he said, and some may not.

His hurdles are high. He acknowledged that staffing is down about 20 percent at the seven mental hospitals. The agency fills most of those positions through temporary workers, who Shelp said are costly and tend not to have the loyalty of full-timers.

He has replaced the leadership of the state's maximum-security treatment facility, which handles people referred by the criminal justice system.

The Justice Department investigation began after The Atlanta Journal-Constitution reported that more than 100 patients had died under suspicious circumstances in the state mental hospitals since 2002.

Weeks ago, the Justice Department told the federal judge that it could no longer support its own motion for the court to accept the settlement with Georgia. The state's pace has been sluggish, the department said, and there have been several incidents since the settlement was signed 10 months ago: a suicide, a patient-on-patient killing, two alleged sexual assaults.

Responding in court papers last week, the state mental health agency defended its pace and said it will meet the first major benchmarks of the five-year agreement in January.

The agency also rejected the call by advocates and the Justice Department for a court-ordered hearing to revisit the state's plan of action. Thomas Wilson, a spokesman for the mental health agency, said such a review would be premature before January, and that agency officials are concerned the advocates and Justice Department will try to expand the settlement.

Ruby Moore, executive director of the Georgia Advocacy Office, said she wants the settlement modified to reflect a stronger commitment on the part of the state to provide community services for people with mental health issues.

She had hoped that Shelp would bring such a commitment to the agency.

"We haven't seen the shift in focus or the urgent need to expand community services," she said.

Shelp, for his part, said he wants to change what he sees as a culture in Georgia to look to the state psychiatric hospitals for too many solutions, and he wants more services in the community. He is working with the governor's office and advocates on a newly formed committee to look at such issues as community-based housing and transportation for people with mental health issues.

For now, advocates say they are waiting for those ideas to be put into action.