Two weeks ago, Georgia reached a historic settlement with the Federal Government regarding treatment in mental health care for Georgia’s most vulnerable residents — those who live in state hospitals or under the state’s auspices.
Recently, I had the pleasure to sit down with Thomas H. Bornemann, Ed.D., the Director of the Carter Center Mental Health Program to talk to him about the settlement.
John M. Grohol, Psy.D.: What are some of the highlights of that settlement?
Thomas H. Bornemann, Ed.D. Well, we think this is a groundbreaker, and a lot of our colleagues from around the country that we talked to are also seeing it similarly.
What we were able to do is to take a lawsuit that is essentially about inadequate care in institutional settings — in our state hospitals, in particular — and forge out of that settlement, recognition of the central role in community based care if we are ever going to get our arms around these populations. This is not breaking news that state hospitals are a thing of the past — large monolithic state hospitals — and we still had them in this state and that had to change.
I think we are not the only state like that, and we are not the only state facing daunting budget challenges. But within that context we still have responsibilities towards the members of our state and citizens who, because of no fault of their own, need to have care provided by the state. The state is not resolved of responsibility for providing safe and humane care in the most appropriate setting.
So, what this settlement has been able to do is to immediately work towards safety issues associated with the hospital. But begin an aggressive process of transferring the vast majority of these people, these consumers to community programs that are appropriate to their needs.
And the settlement calls for a wide array of these services and we are very pleased. Everything from crisis intervention in the community services which will be needed from time to time and to supported housing, supported employment, increased number of ACT teams, a comprehensive array of services.
We want to work with the state very actively now to make this a success. We know that getting the settlement was really only a very small part of a larger challenge. And the challenge around implementation is going to raise lots more issues, so we are preparing ourselves for that. But, for right now, taking a little bit of a deep breath in acknowledging a major step forward with this settlement.
Dr. Grohol: If state hospitals are a thing of the past, are you concerned about the lack of specific timelines in the settlement to actually close some of Georgia’s state hospitals?
Dr. Bornemann: We are concerned that that happened and in part we are going to keep the pressure on. As you may know, they have appointed, they have agreed to, not been appointed yet, a person to monitor the implementation of the plan. And that person we are very familiar with her credentials. At this point she has superb credentials and knows how to do these things, is very constructive in her monitoring strategies. So, I am confident that she will do that.
There are timelines where we have to meet certain milestones. For example, they have identified 9,000 people who tend to be part of a larger group of people who recycle a lot or come to the attention of the system a lot. And they are going to work towards designing specific treatment programs for each of these people as they are enter in the community and comprehensive treatment programs for these folks going back to the community.
Now, this is a system that has historically done everything from discharging people to no services, to discharging them to homeless shelter. That is a quantum leap forward. We want it to happen as fast as it can happen. But some of these community services, we are going to have to get going on and don’t exist right now and they are going to have to stand up.
And one of the horrors that we have learned over deinstitutionalization is the disservice to consumers when we discharge people to inadequate or unavailable services. We got to have simultaneous processes of standing up additional services around the state. And at the same time keeping the pressure on to move people as soon as they are ready into the kind of services that they need. So it’s a dual challenge for us.
Dr. Grohol: Understood. What can other states learn from this settlement?
Dr. Bornemann: Well, our standpoint is that we can learn what a community can do when they stand together in solidarity, and that’s what we did on this one. We had virtually all the stakeholders who care about these issues, consumer and family groups, some of the major national organizations, such as NAMI Georgia, Mental Health America of Georgia, Georgia Parent Support Network, Georgia Mental Health Consumer Network.
We all stood with one voice for two years. And I can tell you at times, the pressure has been intense on individual stakeholder members as well as us as a group. And remember, the mental health community in Georgia is not that huge. We know each other and some of us have worked together historically. Some of us have personal relationships with people on the other side that they value.
Through all that difficulty and awkwardness, we were able to stay together as a community of people. And I think that’s one thing I would certainly communicate to any of our colleagues out in the country who are facing similar sorts of challenges, to build your coalition, to build it strong, nurture it, be facilitative.
In the beginning, there was a lot of talk, “Maybe we should just go sue them ourselves,” and start that process moving. In consultation of the Bazelon Center for Mental Health Law and some other groups we received excellent consultation — they advised us not to do that and to see if we could begin dialog, and we tried and we didn’t have much success for quite some time.
The legislature then chose to reorganize mental health into a new department reporting directly to the governor, a cabinet level post. A new leadership was brought in and after a period of getting to know one another, we have been in a continuous dialog with state officials. We weren’t always in agreement and sometimes we were in fairly intense disagreements, but we were in dialog. We didn’t walk away from them and they stayed in touch with us.
I think it’s really important that people build their coalition, build it strong, but these facilitators tried to keep the dialog alive with the state. You may be surprised at what you find, and we are pleased, and we are ready to go to work. And I think the state is too, so we don’t have a big time lag now. We know each other, we know each other well, and we know what our concerns are, so now let’s just roll up our sleeves and go to work.
Dr. Grohol: I think that’s such an invaluable observation that keeping the dialog open and going is key to really coming to terms.
Dr. Bornemann: I have been in this business 40 years next year and I sort of knew that, that dialog is better than not talking. But to see it so vividly come out in this exercise has been reaffirming for me as a grizzled old veteran that even when you think things are really abysmal and they just can’t work out and we had those moments along the way. If you keep talking, keep working and you begin to realize that they wanted to go to the same endpoint that we wanted to go to. It was a matter of how we get there. It was not gross differences in where we wanted to go. We had to get through some very sticky difficult challenges, but if we kept talking, kept moving, and kept reminding each other, this is where w e want to be, at least we that hopeful goal out there. That’s what so far has happened.
Dr. Grohol: I think it’s definitely a monumental step forward for Georgia mental health care and I was so happy to read about the settlement, so congratulations. Thank you very much for your time today, Dr. Bornemann.
Dr. Bornemann: Thank you and I appreciate the opportunity to share some of my ideas with you.