Georgia joins the 21st century by agreeing to stop shuffling patients into its antiquated, poorly-funded state hospitals, and allowing patients instead to seek out and receive services within their own local community. This is apparently the first settlement with the federal government that invokes the American with Disabilities Act (ADA) to suggest that public inpatient psychiatric hospital care isn’t integrated within the community enough (at least in Georgia’s case).
The agreement was reached as a settlement with the federal government to give patients more choices when it comes to how they receive publicly-funded treatment for a mental illness or developmental disability. The settlement between the U.S. Department of Justice and the State of Georgia was reached on Tuesday, October 19.
The effort to move patients out of warehoused state hospitals started in the 1960s, with John F. Kennedy’s backing of a federal Community Mental Health Center model. That was nearly 50 years ago. Some states quickly adopted this new model and by the 1980s, were closing their state hospitals and moving patients into community-based care and treatment. Other states, like Georgia, have taken their old time in shuttering the ineffective state hospitals — while 130 patient deaths have been attributed to the hospitals.
Now with a little prodding from the feds, Georgia will join the 21st century in providing the typical standard of care for people with serious mental illness and developmental disabilities.
The agreement impacts over 9,000 Georgians over the course of the next five years, as well as 750 people with developmental disabilities. The intent of the agreement is to try and move more Georgians out of the state hospitals and into community-based care and treatment.
The settlement agreement is far-reaching and a good start, according to the Carter Center’s news release:
Under this agreement, the hospitals will no longer be the sole point of entry for people with mental illnesses into Georgia’s public mental health system. Now Georgians will be able to access community-based crisis services when they need inpatient or acute care.
They also will be able to access the types of long-term supports — like supported housing, supported employment, and intensive case management — that they need to maintain healthy, independent lives in the community. There also is a commitment to expand peer support services, a nationally-recognized model started right here in Georgia in which people with mental illnesses help each other to manage symptoms and access services.
The Bazelon Center — which represented a coalition of stakeholders that has advised the federal district court in the case — also commented on the settlement:
“While not a panacea, this agreement takes the first step to ensuring that Georgians are afforded mental health services that are fully integrated into the community, as the Olmstead Supreme Court decision and the American with Disabilities Act demand,” said Robert Bernstein, PhD, executive director of the Bazelon Center.
Georgia’s public psychiatric hospital are some of the worst in the country. More than 130 patients died under suspicious circumstances in Georgia’s public psychiatric hospitals over the past seven years, according to an earlier investigation by the Atlanta Journal-Constitution newspaper.
After the lack of official or public response to the suspicious deaths, staff at The Carter Center began mobilizing the statewide mental health community as well as other stakeholder groups and initiated a partnership with the national Bazelon Center for Mental Health Law to help identify solutions to the crisis in the hospitals.
The advocacy coalition’s efforts became more urgent in early 2009 when the state of Georgia and the Department of Justice were ready to settle a lawsuit on the deaths without adequate stakeholder involvement. At issue was ensuring safety in the hospitals as well as improving the community-based mental health and substance abuse systems, so that Georgians with serious mental illnesses receive appropriate treatment before they require hospitalization and have access to adequate services once they are discharged from the hospital.
“This is the best way to move forward and serve the people of this state,” said Dr. Thomas H. Bornemann, director of the Carter Center’s Mental Health Program. “We know when people are engaged with the community, they can move beyond chronic patient-hood and move toward recovery.”
While not ideal — since it doesn’t directly close the state hospitals or give a specific timetable for doing so — it’s a solid first step in helping bring Georgia public mental health care into the 21st century. And only 10 years and at least 130 lives too late.
Perhaps North Carolina, Alabama and Texas — amongst other states struggling with their own public mental health care systems — can learn something from this case.
For Further Information
- Carter Center Statement on Georgia Mental Health Services Settlement Agreement
- Bazelon Center Lauds Agreement to Serve Georgians with Mental Disabilities in the Community Instead of State Hospitals
- 2010 U.S./Georgia Settlement Agreement (PDF)