For nearly a decade, Georgia has operated its mental health care system under federal supervision. It has shut down decrepit psychiatric hospitals and moved hundreds of disabled people out of institutions where they had languished for decades. It has spent millions of dollars on services that had been perpetually underfunded.
Despite all of that, the state still hasn’t fully complied with an agreement that called for transformative change, according to a new report that recommends an extension of federal oversight.
The report by Elizabeth Jones, a court-appointed independent reviewer, says the state has demonstrated good faith and has fulfilled many promises to improve care. But, she wrote, “the work to be completed is at a pivotal point.”
The report lists numerous unresolved failings: People with developmental disabilities who now live in community-based group homes often don't receive the services they need, and some have died because of poor care. State hospitals continue to discharge people with mental illness to extended-stay motels and homeless shelters – and in greater numbers than it did a year earlier. And only a few patients leaving state hospitals are even offered help with finding a place to live.
“Change,” a state official told Jones, according to the report, “takes time.”
How much time, however, remains a matter of dispute.
In a statement Wednesday, the Georgia Department of Behavioral Health and Developmental Disabilities did not directly address Jones’ criticisms. Nor did it say when, or even whether, state officials will ask U.S. District Judge Charles Pannell Jr. to lift the federal oversight.
But the department said increased funding allowed it to “fundamentally transform and enhance Georgia’s hospital and community-based services for our most vulnerable citizens.”
“We are proud of this progress and the positive impact on the people we serve that facilitates recovery and independence,” the department said. “We are confident that we can continue to provide quality community-based services in a sustainable and systemic manner without federal oversight.”
The federal intervention began more than a decade ago, after The Atlanta Journal-Constitution reported on dozens of suspicious deaths in the Georgia's state psychiatric hospitals. In 2010, state officials agreed to begin massive, expensive improvements. The deadline for completing those changes was ultimately set at June 30 of this year.
Advocates for people with mental illness said they’ve been pleased by the state’s progress. “It’s never going to be perfect,” said Cynthia Wainscott, one of the advocates who asked Pannell to maintain oversight of Georgia’s system in 2010. Now, though, she said, “the question is how do we move forward building on the progress and allow our system to begin to build something way outside the settlement agreement - a public health-based system for behavioral health.”
In her latest review, Jones found numerous improvements. The average number of patients in state hospitals has dropped by almost 40 percent since the agreement took effect, her report says. The state is moving at a “reasonable pace,” she said, in moving people with developmental disabilities from psychiatric hospitals to group homes.
But “the state’s progress in achieving substantial compliance … has not been uniform,” Jones wrote.
Forty-nine former patients with disabilities died between March 18 and June 30, the report says. But state officials have not determined yet whether the operators of their group homes should be sanctioned.
Three residents of one group home in Macon died in the past 10 months – two of them within six months of their release from state hospitals. State investigators found that medical neglect contributed to two of the three deaths.
Other people with developmental disabilities have been housed indefinitely in crisis centers, which were designed for stays of less than 30 days. The state does not give service providers adequate resources to intervene with patients who have behavioral issues, the report says.
“The state is supposed to be operating a system that provides needed services and supports … in the community,” Jones wrote. “This is not occurring to the extent required, especially for people with challenging behaviors.”
When people with mental illness leave state hospitals, according to Jones’ report, few are offered “supported” housing that could lessen the chance they would return to the hospitals.
Instead, at least two of the five hospitals still follow a longstanding practice of discharging patients to extended-stay motels or homeless shelters, Jones said. Few of those patients continue to undergo mental health treatment, and many return to a state hospital within months.
Under a policy adopted in 2016, the mental health system’s medical director must approve discharges to places like homeless shelters.
Still, in the six months ending June 30, state hospitals in Atlanta and Savannah released 19 people to motels and 29 others to homeless shelters, a 40 percent increase from the previous six months.
The state’s slow progress in finding homes for former psychiatric patients, Jones wrote, “does not reflect the kind of positive movement one would expect” as the deadline to comply with the settlement agreement approached.
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