Its like Deja Vu all over again...and again...and again...and again...and again...and again...and again

The Rome News-Tribune is reporting that Northwest Georgia Regional Hospital will stop admitting mental health consumers April 1 and close its doors sometime around June 30.

Northwest Georgia Regional Hospital will not close until all necessary services are in place to absorb the patients into the community.

That's the promise made to the legislature's joint appropriations committee this morning by Dr. Frank Shelp, commissioner of the Department of Behavioral Health and Developmental Disabilities.

He was noncommittal when asked if that means the proposed June 30 closing date of the hospital might be pushed back, reiterating that it's important to set deadlines.

"We have dates as targets," he said. "But we're not under any compulsion to close the Rome hospital prior to having those other services up and running," he said.

Just like in Milledgeville, the announcement came early in the legislative session and the community's legislative delegation can do little more than pepper the Commissioner of Behavioral Health and Developmental Disabilities with questions during budget hearings at the Capitol.

The announcement of the closing of NGRH is the latest news about the fundamental changes taking place in Georgia's mental health system as a result of the settlement agreement between the State of Georgia and the US Department of Justice concerning the care of people with mental illness and developmental disabilities in the state's network of regional mental health facilities and the state's failure to meet the standards for serving consumers in the most integrated community setting possible, per the Olmstead v. L.C. decision, which originated in Georgia.

This Justice Department press release is a pretty succinct summary of what's going to happen in the next several years.

Under today’s agreement, over the next five years, Georgia will increase its assertive community treatment, intensive case management, case management, supported housing and supported employment programs to serve 9,000 individuals with mental illness in community settings. The agreement will also increase community crisis services to respond to and serve individuals in a mental health crisis without admission to a state hospital, including crisis services centers, crisis stabilization programs, mobile crisis and crisis apartments; create at least 1,000 Medicaid waivers to transition all individuals with developmental disabilities from the state hospitals to community settings; and increase crisis, respite, family and housing support services to serve individuals with developmental disabilities in community settings.

Central State Hospital was the first, and Northwest Georgia Regional Hospital won't be the last. But in a strange note that spooked me when I first read it, the News-Tribune writes:

[Department of Behavioral Health and Developmental Disabilities Spokesman Tom] Wilson said 54 of the current patients have been admitted to the mental health ward, and 73 patients admitted by a court. They will have to be moved to state hospitals in Milledgeville or Atlanta.

Then I remember that the Payton Cook Building just opened a few years ago.

But Rome will not have a new forensics unit to save any state jobs as Georgia moves non-criminals living with mental illness and developmental disabilities into non-profit and for-profit private mental healthcare providers. Again, from the News-Tribune:

The state-run mental health hospital has about 180 patients and 764 employees, according to Tom Wilson, spokesman for the state Department of Behavioral Health and Developmental Disabilities.

Though it should be noted that DBHDD will be creating a lot of these community care settings, and that will create job opportunities for some of the employees who will be affected by the closings.

I share all this because it should be a warning the entire State of Georgia, especially those in the mental health system, those with family in the system and employees of the system: Don't think this is just something happening at some other hospital, in some other part of the state. The Federal Government and the State of Georgia are revolutionizing the delivery of mental health services--for better or for worse. We simply don't know yet.

And residents of Augusta, Columbus, Decatur, Savannah and Thomasville should heed these words state Rep. Rusty Kidd uttered roughly nine months ago:

Kidd said it is clear from legislators’ reactions that people from different parts of the state outside of the Middle Georgia region are not hearing about the closing of Central State and the fate of employees there.

“I hope [legislators and DBHDD officials] hear this and take it to heart, so that they will be more sensitive to employees — all employees not just new or long-time employees — now and in the future,” he said. “Everyone needs to be aware that these are people who have had jobs there for a long time, and to lose a job is very serious. [The legislature and state government] need to help them transition into new jobs.”

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.

If You Know He Has the Solution, Why Didn't You Tell Us to Hire Him Before?

The Telegraph's Travis Fain gets the skinny on the newest state partnership to get Georgia's Mental Health Delivery System up to snuff.
Get the details about the plan, the man--including a good background about National Mental Health Czar Dr. Nirbhay Singh--and legislators' thoughts here.
Reading the piece, it seems the state may have jumped the gun on this one as it sounds like Singh's contracted scope of work centers on the hospitals.
The U.S. Department of Justices' January filing clearly requests the proposed monitor to oversee the process of putting the state in compliance with the Olmstead Decision by making the hospitals a last-resort service provider, as opposed to the front door--if not only entrance--to the state's mental health delivery system.
You can read more about Olmstead here.
Note Johnny Grant's concerns at the end of Fain's story:

State Sen. Johnny Grant, R-Milledgeville, said he’s criticized the state for spending money on private consultants instead of patient care. But he said the Department of Justice, with its difficult demands for a quick turnaround in a massive system, “changes all of the equilibrium,” Grant said.
Said Grant: “I don’t know where all of this will take us.”

As a side note: Georgia's Old Capital Museum will present a lecture by mental health advocate and local historian Bud Merritt at 7 p.m. Tuesday in the Old Capitol Building's Legislative Chambers.
"Silent Witnesses: Cemeteries at Central State Hospital" explores the strange relationship between the Milledgeville community and one of the nation's largest mental health institutions, focusing on the discovery and restoration of several of the hospital's nearly forgotten cemeteries.
I recommend this as a must hear for those who want greater insight into this watershed moment in the community's history.

Macon to Milledgeville Rail-to-Trail?

Macon.com has this article about a proposal to imbue the Middle Georgia region with plenty more bicycling options for transit and leisure.
I was holding my breath about how this might affect Milledgeville until I read this:

"Of particular interest to Clark is the Macon-Milledgeville Rail-to-Trail, an effort to convert an abandoned CSX rail line to connect Macon’s Ocmulgee Heritage Trail to Milledgeville’s proposed Fishing Creek Trail."

I'll see if this is on anyone else's radar at the ole U-R, and get back to this.

Troubling News Out of Central State

We in Milledgeville all have to be concerned when we read headlines like this*.
But what I gathered from reading the three available stories on the subject--I'm not counting the AP blurb the UR site has--scares me a little more.
Vaishali Patel, our new reporter, says that the 2,500 jobs at CSH are safe for now. Read into that whatever you'd like.
The AJC reports this:

The state's move will thin a patient population that stands at about 450 and free up staff to undergo training, implement new policies and procedures, and change potentially dangerous conditions at the hospital, Wilson said. Overcrowding is not an issue driving this action, he added.

And then we have the Telegraph reporting this:

Central State has had staffing problems for years and that remains a challenge, Wilson said. Current figures were not immediately available Thursday, but in 2007 state figures showed a 23 percent vacancy rate in the hospital’s staff and nearly a 42 percent vacancy rate in licensed practical and registered nursing jobs.

Excuse me, but what on earth is going on with the staffing at the state's largest mental health facility?
2,500 employees seeing to the treatment of about 450 mental health consumers, and the hospital is running an overall 23 percent staff vacancy rate, with licensed practical and registered nurse positions exhibiting a 42 percent vacancy rate.
I'm just not smart enough to tell you what that means, but if you can, please leave a comment to clue me in.


*Is anyone else bothered by the fact that I have to link to competing news sites to provide compelling content about events happening in our own community?

Unemployed Georgia: Land of Opportunity

Georgia Public Broadcasting aired this story about a private corrections company going to Georgia's most employable county (read: the community most desperate for economic development) "to educate job seekers and generate support for the project within the community."
Something tells me the educational aspect of this meeting will be something along the lines of 'we need a whole bunch of tax credits and other incentives to write your town into our bid.'
Although vague on the details, I couldn't help but wonder if this Georgia Department of Corrections' Request For Proposals to construct a 1000-bed public-private institution is the same Corrections RFP that inspired the Milledgeville City Council to extend the city's opportunity zone all the way across South Milledgeville to Baldwin State Prison in order to attract a similar bid from a private corrections company.
In South Milledgeville, an expanded opportunity zone--a Georgia Department of Community Affairs program that offers tax credits to employers for job creation--creates opportunities for business development of any size, and largely shields the municipal and county governments from bearing the burden of incentivizing a private company's locating their new facility in your community.
But what happens when another community is desperate enough to give away the farm just to get the milk?