Georgia MH System Adopts Cure for Decades of Troubled Care

Georgia is likely to increase its focus on and public resources devoted to community-based mental health care as part of an agreement with the Department of Justice (DoJ) and patient-advocacy organizations, with implementation expected in the coming months.

The ongoing negotiations were ordered by a federal judge as part of a federal examination of the state's public mental health system, which followed a series of publically reported deaths in its state psychiatric hospitals. U.S. District Judge Charles Pannell and DoJ attorneys initially focused on obtaining state commitments to improve Georgia's psychiatric hospitals but expanded their examination to the community-based mental health system at the urging of patient advocates in Georgia (Psychiatric News, December 4, 2009).

According to state mental health officials, the negotiations are expected to expand the state's growing financial commitment to community-based care, including increased funding through Medicaid and use of Crisis Intervention Teams (CITs). The nearly 400 CIT programs nationwide—which train and coordinate law enforcement and mental health professionals to improve interactions with people suffering from a mental-illness-related crisis—have increased the safety of people with psychiatric conditions. For example, one study found CIT-trained police were much less likely to resort to force in situations in which they were confronted with someone who appeared to be mentally ill (Psychiatric News, November 20, 2009).

Georgia has already undertaken numerous initiatives in the last year to improve its public delivery of and attention to mental health care, including the establishment in July 2009 of a separate government department—the Department of Behavioral Health and Developmental Disabilities—solely focused on mental health and directed by a psychiatrist, Frank Schelp, M.D., M.P.H.

“The opportunity presented by this new department brings with it both a higher profile and higher expectations,” said Schelp in a written statement at the department's launch. “And while we know that the challenges we face in Georgia won't disappear overnight, I'm confident that, with new thinking and new initiatives, our efforts will result in better care and stronger support.”

Schelp's outreach efforts to patient groups have included statewide “listening sessions” over the last year and his attendance at the 2009 annual meeting of the Georgia Mental Health Consumer Network, which was a first for the state's chief of mental health care. Additionally, he has increased resources to expand the use of “peer support,” or training people recovering from mental illness to provide ongoing guidance, but not treatment, to other people with such illnesses.

The organizational change in the state's public mental health programs—previously housed in the state's Department of Human Services—came with a boost in its Fiscal 2010 and 2011 budgets, even as every other department has seen cuts, according to state officials.

Policy changes over the last year have included an end to the institutionalization of children and adolescents, who will instead receive treatment in community-based settings.

The changes so far have been hailed by consumer advocates and psychiatrists. Lasa Joiner, executive director of the Georgia Psychiatric Physicians Association, described the new initiatives as “as much clinically focused as budget driven.”

“Allowing them to deal with mental health as a full department—I think that helps,” she said.

In terms of the ongoing negotiations, a final agreement could come in June or several months later, according to state officials. Then the federal judge will need to sign off on it.

More information on the initiatives of the Georgia Department of Behavioral Health and Developmental Disabilities is posted at <http://dbhdd.georgia.gov/portal/site/DBHDD/>.