Last week, the state Department of Behavioral Health and Developmental Disabilities announced that its psychiatric hospital in Thomasville will close Dec. 31.
The closing of the Southwestern State Hospital continues the restructuring of the state’s services for people with mental illness and developmental disabilities in the wake of Georgia’s landmark 2010 agreement with the U.S. Department of Justice.
The DOJ accord — hailed by consumer advocates as a model for other states — aims to increase community services across the state, including housing, crisis teams and stabilization units, so people with disabilities can avoid the need for hospitalization. Hundreds of people with developmental disabilities have been moved from hospitals to community settings.
Frank Berry, who took over as commissioner of DBHDD nine months ago, is presiding over this rapid transition of state services. GHN last week interviewed Berry about the upcoming Thomasville closure, problems with past hospital closings, and what he sees as the future of services for people with behavioral health problems and developmental disabilities.
Q: Is closing the Thomasville hospital your biggest challenge so far?
A: It certainly is one of the top challenges, to make certain that we taken the lessons we learned with the closure of Rome and Central State [in Milledgeville], and that we do a better job of building communities while we are in the process of closing a hospital.
Another challenge is the settlement agreement overall, and then you’ve got building capacity around the state to serve people with developmental disabilities.
Q: Why close the Thomasville hospital?
A: Two main points. One is building communities so that people can receive their services closer to home. Once they get discharged from a facility, it’s better if they are closer to home, so services can be connected prior to discharge, instead of moving people far distances to go to a hospital.
The data showed that large numbers were being admitted to Southwestern State Hospital who were coming from surrounding areas, not just Thomasville. [Places such as] Valdosta and Albany. We want those people to receive services closer to home.
The other piece of it had to do with the dollars and cents. As we move out people with developmental disabilities from the state institutions, as part of the settlement agreement with the Department of Justice, it leaves fewer and fewer people in these large institutions.
Right now there are 100 to 120 people at that hospital. There are about 50 of them with developmental disabilities. When you move them out, . . . federal dollars [for their care] follow them into the community. The hospital would cost $27 million a year to operate, to serve a little over 50 people. From a dollars-and-cents standpoint, you cannot sustain that on an ongoing basis. Those dollars can be much better spent serving people closer to home.
Q: How do you avoid the transition problems that plagued the hospital closings in Rome and Milledgeville?
A: A couple of the new services are tied to the settlement agreement. A new service that’s being developed in that area [is the operation of] crisis service centers, which are a little more intensive than even a crisis stabilization unit. They are emergency receiving facilities for law enforcement to bring people to drop them off. The services are navigated for that person from that location.
Law enforcement will have easier points to drop [people] off. The doctor-and-nursing coverage is a little more enhanced than a crisis stabilization unit. There is also going to be capacity for 23-hour observation beds, so that people who have historically come in and out [of a hospital], now . . . can get there and be transitioned quickly to the next level of care they need.
Another lesson was building the community prior to the closure of the hospital. For instance, Valdosta, which has been sending its people to Thomasville, will have a 24-bed crisis service center plus six temporary observation beds. Albany is going from 30 to 36, with six beds being temporary. Thomasville will have a crisis service center as well.
You’re putting the crisis, deep-end services where people have historically been going into a hospital at more of a local level. This will be short-term stays, for the most part.
The people in the forensic unit in Thomasville will be going to the Columbus hospital.
[For] the ones who are chronic long-term, we will build in the capacity to purchase some limited-capacity, private psychiatric beds. There will also be capacity in our existing state hospitals.
Q: Are the services sufficient in those areas to handle the load?
A: The settlement agreement also brings in ACT teams, intensive case management, case management. Mobile crisis is ramping up, so the capacity in that community will be built up by the time the hospital closes.
Q: How many [psychiatric] hospitals will the state have after Southwestern State Hospital closes?
A: After this closure, we will have Savannah, Central East Georgia, Atlanta, Columbus, and the forensic unit at Central State. The number of hospital beds will have shrunk, and the number of crisis service center and crisis stabilization beds will have increased.
Q: Will the state save money with the closure?
A: Ultimately, there will be [savings]. But it takes a little while to realize those savings, because you’re closing at midyear. [The fiscal year runs from July through June, so the Dec. 31 closing will fall at its midpoint.] You still have to staff it to serve the people who are there. There’s a bond on the facility, a $10.5 million bond. That issue will ultimately be addressed.
The goal by 2015 is that some portion of hospital dollars where we have closed hospitals will go to sustain all the settlement agreement services.
Q: Will there still be any staffers or activity on the grounds at Southwestern State?
A: Because of the location and the heat and humidity down there, there will be a core group of probably 10 to 15 people to maintain the campus. All the utilities will be maintained year-round. If you don’t, there will be mold and mildew in those buildings. There is some discussion of some local community behavioral health providers using some parts of the campus for their community programs.
Q: Will the state try to sell the property?
A: We would welcome that opportunity, if that could happen. It’s a beautiful campus, 240 acres. The buildings are in good shape. If there was the right partner interested in using it, we would certainly entertain selling it or partnering with other state agencies or giving it to another agency.
Q: Does the state still own the Rome hospital property?
A: Rome is owned by the state and being well maintained. There are constantly ideas floated around of how to use it from a community standpoint. We’re always interested in talking with other state agencies and state properties authority on how that campus can be re-purposed.
Q: What was the response of employees to news of the closure?
A: Certainly there is disappointment from the employees. I would say there’s hope for the future by both employees and legislators, because we are building the communities at the same time. I have asked the employees to focus on [the fact] that we need them to continue to serve people, just not at a hospital, but in a community setting.
As we’ve laid that out, I’ve asked providers to give our employees preference for interviews and strong consideration [for hiring]. They have come out publicly and agreed to do that. There’s hope employees will be able to follow some of the clients on the developmental disabilities and mental health sides in some of the crisis service centers and crisis stabilization units.
Q: Will there be a number of people who will lose employment?
A: There will be some. There are a little over 600 employees there now. There’s a community need for 400 jobs from private providers, on the mental health and developmental disabilities side. Certainly there will be a significant decrease in state employment, but the hope is they will transition to some of the private providers.
Q: What has been the response of the business community?
A: Certainly they’re concerned about the loss of jobs. However, the buildup of the crisis service centers and crisis stabilization units demonstrates that we have thought about the economic development that comes with the construction of these facilities along with job creation. Group homes on the developmental disability side, which serve four people [each], take 20 to 24 people to staff. There will be purchasing of homes that have been on the market for a while, and renovating them. There is opportunity that it can be a nice win for the local community.
Q: You’ve talked before about the difficulty of talking to parents of disabled people who don’t want them to leave the institutions.
A: From now through 2015, we have probably 275 people who will be leaving state institutions and moving into the community. I believe it’s the right thing to do. I’ve seen tremendous success stories, of people who had spent a majority of their lives in institutions, and are now living in their own homes and doing things that you and I do in the community. The challenge is showcasing those success stories to some of the parents who are getting older and are very concerned about a change for their loved one. They feel the state institutions have provided great care.
I think over the last few years, the quality of care in the institutions has been much better than it had been previously. But I believe the quality of care will ultimately be better for them when they’re living in their own homes.
Q: Is law enforcement buying into the changes? They have been major critics of how the Rome and Milledgeville closings played out.
A: Rather than trying to sell them a bill of goods, we’re trying to show them in different ways. These three facilities will follow the emergency receiving facility guidelines in a much more stringent manner. The goal is for law enforcement to see that this will make their lives easier, because it will be a dropoff point for people with behavioral health problems. The goal with these three new ones [is that law enforcement] can bring them straight there. This is an opportunity to show them this is a better model. The best way to do that is by demonstrating its success. We have kept law enforcement informed of the decision, so the hope is over the next six to eight months, they’ll become part of the biggest cheerleading group for this type of initiative.
Q: What’s the Department of Justice’s reaction to the upcoming closure?
A: As we move from a facility-based model of care to a community-based model of care — which is what the settlement agreement is all about — this is another strong demonstration of our commitment, so they’re pleased.
Q: How are the consumer advocacy groups responding to the closing? Are they pleased?
A: Many of them are. We’re bringing services out to them. They have been pushing us to develop more community-based services. Part of the advocacy groups serving people with developmental disabilities . . . have been more vocal in their concern about moving their loved ones out. We are trying to show them that these can be successful transitions. There are two different sides of the story.
Q: What have been some problems related to moving people with developmental disabilities out of hospitals?
A: Ensuring continuity of care as people move from a hospital to a community placement, when they have known their doctor and nursing teams for so long. We are addressing that by making a commitment to keep on staff some of the doctor-and-nursing teams that will follow them into the community.
I think the other issue of moving people out is you have large providers and smaller providers. Making sure the quality is consistent among all of them. So it’s oversight.
Q: You have recently put a freeze on placing developmentally disabled patients in the community.
A: In 45 days, we’ll begin to move people from the institutions into the community. The population we’re now starting to focus on has more complex medical needs than people moved out previously. I wanted to make certain that the level of oversight and quality of placements was in place prior to their moving out, rather than trying to do something after the fact.
Q: What will the public system look like in five years?
A: In the next several years, we’ll have a comprehensive system of care in the community, where people can access a variety of housing and clinical treatment options that will meet their needs. I think the reliance on state hospitals will decrease.
The goal is get away from our system focusing on the deep end and be able to serve people before they need the deep-end services. The state will continue to provide some long-term chronic mental health beds and continue to be in the forensic business. The goal is to have robust local systems of care so people can have easy access to high- quality services, and they can lead a life of recovery and independence.
Q: Will the state close other hospitals?
A: We are constantly looking at what our bed capacity needs will be as the settlement agreement services get ramped up. I don’t want to make that decision until we see what the system looks like as we continue to build up communities.
Q: A major criticism of Georgia’s settlement agreement is that it does not include services for children. What can be done about improving this care?
A: One of the opportunities that has presented itself, with the juvenile justice reform and rewrite, that many state agencies are now going to be forced into looking at children’s issues in a much more comprehensive way, and work together on them.
Over the next six months, the governor will be pulling together the agencies, and asking for a comprehensive approach [toward care of] children. It will be breaking down some of the historical silos. I do agree we need to do something big with children, and I think this will be the opportunity to do that.