Georgia's plan to rescue its mental health system calls on national team of experts

From Macon.com:

ATLANTA — The state’s plan to rescue its struggling hospitals rests heavily on a multi-million-dollar plan to hire a national team of experts to overhaul its mental health treatment process, from admission to discharge.

The state has brought in a doctor from Virginia with a history of working with the U.S. Department of Justice, which has threatened a complete takeover of Georgia’s system if the state can’t get its act together. A string of suspicious deaths in the hospitals and admitted problems with protocol and building design in the state’s aging facilities have brought the state to the brink.

Story: Spending big money on medical-care consultants not novel idea
And if the Department of Justice implements a full takeover, it could cost the state billions of dollars in upgrades, according to the Georgia Department of Behavioral Health and Developmental Disabilities, a department created last year to focus specifically on care for mentally ill and physically disabled Georgians.

To avoid that, the state has hired Dr. Nirbhay Singh, who has been part of similar efforts in California, Kentucky and Connecticut. Singh will bring in other consultants from a range of disciplines to examine nearly every area of the state’s care.

He will hire 28 others to train state workers at seven state hospitals, including Central State in Milledgeville, in new treatment methods. Singh’s effort will cost the state as much as $3.5 million this year, with options to extend his contract for several years to come.

But even that may not be enough. Federal overseers already have asked a federal judge to appoint an independent monitor to watch over the process — a job Singh himself has performed for the Department of Justice in a similar case in Kentucky. And in its most recent court filing, the department focused more on the need to improve outpatient mental health services as opposed to improving the hospitals themselves.

Though the state has said for several years now that it wants to improve those services, its more immediate focus has turned to the hospitals. Gov. Sonny Perdue recently proposed an extra $70 million in state spending for mental health and physical disability care, most of it targeting the hospitals.

“Last year we served approximately 23,000 people in our psychiatric hospitals,” said Tom Wilson, spokesman for the state’s Department of Behavioral Health. “The people we serve deserve to be safe and receive effective treatment now and in the future. That’s what this training and the new policies and procedures are about.”

Singh’s résumé lists him as a senior scientist at ONE Research Institute, a nonprofit “devoted to services, training, research and consultation focused on people who are disabled or disenfranchised.”

He is a retired medical professor at Virginia Commonwealth University in Richmond, and his résumé lists three degrees in psychology, all from the University of Auckland in New Zealand, earning a doctorate in 1979.

Singh has been a consultant for “60 Minutes,” his résumé states. He is the author of 450 publications and 12 books, and his résumé includes pages full of two-line citations summarizing most of that work.

He has been an overseer for the Department of Justice in hospital reviews in Kentucky and Connecticut. He also has been one of California’s chief consultants as that state tries to turn around five of its hospitals in a case similar to Georgia’s. In fact, Singh is still under contract in California, said Nancy Kincaid, assistant director of the state’s Department of Mental Health.

Slowly but surely, California’s hospitals are improving, Kincaid said. And while the state’s internal team is working with Singh, Kincaid said he and other consultants have helped change the culture at the facilities.

They take longtime employees, many of them baby boomers trained in outdated therapies, and teach them new methods, she said. They’ve also helped create a more home-like environment in the buildings themselves and helped prevent suicides by addressing problem areas in the facilities.

Georgia has had several problems with old buildings, with too many sharp corners that pose a danger and too many rigid handles that troubled patients can use in suicide attempts, Department of Justice reviews have found. That’s one of the major reasons the state shut down the Powell Building at Central State Hospital’s campus in Milledgeville.

The department would not facilitate an interview with Singh, and Telegraph attempts to reach him through the telephone number and e-mail address on documents he submitted to the state with his contract were not successful.

Wilson, the Behavioral Health Department spokesman, likened Singh to the general contractor in a home renovation project, “not the architect or the homeowner.” He provided a list with dozens of the department’s goals, including a January push to hire new nurses and address a long-standing staff shortage at the hospitals.

“This isn’t one man doing all of this implementing and training at seven different hospitals,” Wilson said in an e-mail to The Telegraph. “Someone’s name has to go at the top of the contract, and Dr. Singh does have valuable experience and expertise, but ultimately it’s a team of people doing the work. Furthermore, everything they’re doing is under the direction of the department.”

But only Singh’s name appears on the contract. He is empowered to hire his own staff, develop new protocols and train teams that will station themselves at all seven hospitals to retrain the permanent staffs there.

The state’s contract with Singh began Oct. 19, 2009, and lasts into October 2010.

It covers nearly every area of mental health and disability care in the state’s public hospitals. According to the contract, he will develop new policies from patient admission to discharge.

— He also will provide a project manager and 28 trainers, four per hospital at a time, to teach state workers the new way facilities will be run. He also hires 12 part-time experts across a range of disciplines, including psychiatry, nursing, rehabilitation therapy and risk management. The effort also allotted three part-time staffers for administration.

— The contract lists all seven state hospitals, located in Milledgeville, Augusta, Savannah, Columbus, Decatur, Rome and Thomasville.

Singh’s staff will need to be at the hospitals “across shifts, as necessary,” according to the contract.

— He is specifically authorized to hire others from “American Health and Wellness Institute and other agencies as needed.” American Health is a consulting firm Singh is part of, according to the state.

— Singh “has the responsibility for ensuring the health and safety” of all patients. If there’s an emergency, the contract says to call 911, protect patients “from any possibility of harm” and preserve evidence for a potential investigation.

— He is to “push back” against Department of Justice recommendations when they are unreasonable. State officials have complained about some Department of Justice directives, particularly the department’s recent focus on community services after telling the state it needed to fix its hospital system.

— Singh will be given $291,666 per month for his services, after the state gets documentation of his costs and the department approves them. The total, all expenses included, is not to exceed $3.5 million.

The initial contract lasts a year, and it started nearly four months ago. But the department has a renewal option at the end of the contract at $3.5 million annually for two more years, then $2 million annually in years four and five.

If a hospital is privatized during the process, without a “substantial” increase in beds at another hospital, the contract pays one-seventh less of the total amount, starting from the day of privatization.

Legislators and others who have followed the state’s treatment system for years said they knew a private consultant was being brought in. But all they knew about Singh last week came from the state officials who hired him.

There are some concerns that the department is spending too much on this outside help. But the department’s response is, essentially, that it doesn’t have the people in house needed to address the system’s problems. And Shannon Harvey, CEO of the River Edge Behavioral Health Center in Macon, said it’s “always helpful to have the best minds” on an issue.

“I’m excited,” she said. But health care, like politics, is local, Harvey said. And what worked elsewhere may or may not work in Georgia, she said.

Gov. Sonny Perdue’s administration says it has tried to put more emphasis on community care in recent years, as opposed to hospitals. That’s an effort to comply with the Olmstead court decision, a landmark Georgia case that affirmed patients’ rights to live outside of a hospital where possible. But critics believe the Perdue administration has often shifted people out of hospitals without having adequate community programs established for them to rely on. Then patients can go off their medications, commit a crime and end up in jail.

State Rep. Rusty Kidd, I-Milledgeville, said he fears Singh and his team will sap funds from state hospitals’ existing budgets. Wilson said they will not. Though each of the state’s seven hospitals had to contribute funding up front for this effort, that money will be replaced from the extra $20 million for mental health and disability care included in Perdue’s 2010 amended budget.

That budget is moving through the General Assembly now. Wilson also said the state doesn’t plan to close state hospitals, though some may be consolidated, as was done with the Powell Building in Milledgeville.

Harvey said she hopes to see a consistent strategy come from the state, which has shifted directions on mental health care repeatedly in recent years. State Sen. Johnny Grant, R-Milledgeville, said he’s criticized the state for spending money on private consultants instead of patient care. But he said the Department of Justice, with its difficult demands for a quick turnaround in a massive system, “changes all of the equilibrium,” Grant said.

Said Grant: “I don’t know where all of this will take us.”