Need for Improvement: Mental Health Ombudsman's Year One Report

Former AJC writer and current Georgia Health News CEOAndy Miller brings us the story that's being missed amidst all the press coverage of the settlement agreement between the US Department of Justice and the State of Georgia concerning the treatment of persons in its mental health system. An interim report summarizing Georgia's Disability Services Ombudsman Jewel Norman's first year on the job cites the need to improve clients' access to timely care and concern over the continually growing role of Law Enforcement in the lives of many Georgians who are living with mental illness. Miller writes that despite the high profile of the settlement between Georgia and the Feds, there are many issues that need addressing in the state's network of mental health service providers:

A little-noticed state report says an independent review team found poor medical care in the deaths of 23 patients at Georgia’s mental hospitals during the past fiscal year.

The report, from Georgia’s disabilities services ombudsman, also shows that the state’s mental health system remains plagued by other major problems, despite more than a year of scrutiny by the U.S. Department of Justice. Many patients still sit for hours in general hospitals’ emergency rooms, waiting for mental health treatment. And jails across the state still house a high percentage of people with psychiatric illnesses, the report adds.

Still, the state ombudsman who produced the report, Jewel Norman, said she sees improvement in the seven state-run psychiatric hospitals.

The report, itself, addresses the critical issue that there are not adequate resources throughout the state to assist people when they are experiencing a mental health emergency:

Georgia law requires the sheriff’s department of each county to transport mentally ill persons who are a danger to themselves or others to an emergency receiving facility. State policy requires medical clearance before any state hospital or Community Services Board Crisis Stabilization Program (CSP) can accept such a transfer. Most of the time the closest destination to achieve the required medical clearance is a general hospital emergency room (ER)...

In a late spring meeting of the Psychiatric Council of the Georgia Hospital Association, the Ombudsman discovered that many people with mental illness were experiencing excessive periods of waiting in the emergency rooms after medical clearance...

The average wait time for these patients, many of whom were experiencing an acute episode of their illness, was 36 hours... The average time for those persons exceeding the 36-hour mean time was 64 hours or 2.67 days.

These long wait times do more than put Georgians living with mental illness at risk, they have a multiplier effect on society as they tie up vital law enforcement, emergency medical services and hospital resources while these placements are being made. And then there is the worst-case scenario--an unfortunate societal situation that happens far too often in Georgia and elsewhere around the world--in which mental health consumers are adjudicated and incarcerated until a suitable placement can be made in a state forensic unit .

Preliminary data suggests that the corrections system, both local jails and our state prisons have become major providers of mental health services. For example, the Chatham County Sheriff provides data that, on any given day, he has between 200 and 250 people with mental illness in his jail. The Augusta Chronicle, in a July 11, 2010 article reported by Sandy Hodson, stated, “184 men and women who have been deemed mentally incapable of standing trial are locked in jails for weeks and months because there isn’t enough room in the state’s seven mental health hospitals [Forensic Units].” "That's what jails have turned into -- mental hospitals," said Richmond County Sheriff's Maj. Gene Johnson, who oversees the county's overcrowded jail. The Georgia Department of Corrections reports that 15.6 percent of the inmate population is receiving mental health services.

The settlement agreement with the federal government is forcing Georgia to make revolutionary changes to the way people receive treatment in the state's mental health system. In order to realize those anticipated outcomes, Georgia will have to conquer some of the most challenging sets of circumstances seen in the history of the treatment of mental illness. The Justice Department is requiring Georgia to allot the resources necessary to meet the federal government's benchmark of providing care in the most integrated setting appropriate to an individuals’ needs, but it will take the dedication of the Governor-elect, the entire General Assembly, many departments of state government and the people of the State of Georgia to decisively bring an end to this sad chapter in the state's history.