Posted on Wed, Jun. 22, 2005
Shrink mental hospitals, move funds to communities
By Don Schanche Jr.
Telegraph Staff Writer
ATLANTA - Georgia's mental hospitals would be downsized again with the savings reinvested in a community mental-health system in which public and private agencies would compete for contracts to provide high-quality services.
That's the vision put forth Tuesday at a meeting of the state Task Force on Community Care for Behavioral Health and Developmental Disabilities.
Although some task force members expressed concern that the group may be acting too hastily without sufficient knowledge of the problems and solutions, they nevertheless reached consensus on a set of recommendations.
"This is a big push," task force Chairman Bruce Cook said.
Among the
recommendations:
* Reduce the use of state psychiatric hospitals to an appropriate level and reinvest saved dollars into community care. Cook said he expects about $50 million of the $300 million that Georgia now spends on hospital services could be redirected to community agencies. As part of this effort, the state would make community-based services available to 1,300-1,500 people with disabilities who are now long-term residents of state institutions.
* Pay providers of community services on a fee-for-service basis instead of the current system in which they receive an annual appropriation based on the services they expect to provide. A contractor would be hired to provide a "single point of entry" - basically, a telephone referral service for new clients - and to keep track of how services are used.
* Require that treatment and services be based on evidence that they work.
* Allow service providers to compete anywhere in the state. This would apply even to the independent public agencies called community service boards, which now serve limited areas. The competition between the CSBs and private agencies would help improve quality of services, according to the task force.
* Establish greater accountability for all service providers.
* Streamline and coordinate mental health services for children and adolescents. The task force members said young people often face a bewildering, uncoordinated array of state services provided by the Department of Human Resources, Department of Juvenile Justice, the Medicaid system and the public schools.
* Establish a task force to recommend ways to treat the mental and addictive problems of inmates in Georgia's jails and prisons. As many as 15 to 20 percent of inmates have a mental illness, and as many as 75 percent have a chemical addiction, according to the task force.
The task force is part of Gov. Sonny Perdue's Commission for a New Georgia. It was initially asked to look into reports of problems among the 26 community service boards but expanded its role to examine the state's entire mental health system, which many complain is fragmented and difficult to use for people with disabilities and their families.
The task force held several meetings this spring. At Tuesday's meeting, they were presented with a draft of the proposed recommendations. Some members asked for more time.
Becky Butler, who works with the Annie E. Casey Foundation, said, "I have a little bit of concern about the process because it has felt so fast."
Another task force member, Judy Fitzgerald, questioned whether the recommendations fully account for the political and legal environment surrounding mental-health care.
But Cook said it was important to move ahead to provide momentum for changes now under way at the Department of Human Resources. The DHR's Division of Mental Health, Developmental Disabilities and Addictive Diseases already plans to reduce by 20 percent the funding for core services provided by the CSBs and allow companies to bid for those services.
Cook said the biggest new element in the task force recommendations is the push to move funds from state hospitals to community services. Although that was the plan back in the 1960s and '70s, when the state began downsizing state hospitals, critics said the savings were never passed along to community agencies.
The hospital downsizing - often called deinstitutionalization - took place all over the nation during the past few decades, as modern medications enabled people with severe mental illnesses to live independent lives outside of the psychiatric wards.
State Sen. Johnny Grant represents Milledgeville, home of Georgia's oldest and largest public mental hospital. In an interview Tuesday, Grant said he does not oppose increased support for community services. But he said there will always be people who need the secure setting of a psychiatric hospital. And he said that as Georgia's mental hospitals emptied out, the state's prisons have become full of people with mental illnesses.
"These people, who 10 or 20 years ago were being taken care of in a state hospital, are now being institutionalized in a jail or prison," he said. "I don't know that that's best for that individual."
