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Mental Health

Camp with a special focus gives comfort and fun to grieving children

Camp Magik helps grieving children deal with their loss.

Camp MAGIK provides grieving children with professional counseling and fun activities

Weekend sleepover camps for children can be about more than crafts and canoeing.

During the past two decades, Rene McClatchey has helped hundreds of  grieving youngsters recover from devastating losses.

Every year, McClatchey, an assistant professor of social work at Kennesaw State University, runs three weekend-long sessions called Camp “MAGIK,” an acronym for “Mainly About Grief In Kids.” Registration is open now for this year’s first camp, which takes place April 25-27 in Cartersville.

Supported by charitable donations and volunteers, all three camps are free. They are divided into two groups, one for ages 7 to 11 and the other for ages 12 to 17.

While the children spending the weekend at camp get professional counseling for grief, they also get a chance to just be kids having fun. They go swimming, climb a rope course and hike the foothills of North Georgia. “Diversions” are important for these kids in a very literal sense.

The camps are especially for children suffering from what professionals call “complicated grief,” a condition that differs from normal mourning but can be hard to identify.

Children can be hit so hard by loss that they question the value of their very existence, said McClatchey. “It’s thinking, ‘I don’t know how I can go on, life has no meaning anymore.’ ”

“It becomes complicated when these feelings keep hanging on and there is no relief from them,” said McClatchey. Her camps are intended to get kids past this point, to give them hope, and to keep them moving forward. Sometimes it can be difficult to know which kids need help.

 

The unrecognized need

 

“The kid that gets into trouble at school after Mom dies, he’ll be sent to camp because they know something is going on with him. But the kid who is quiet and overachieves is the one that I’m concerned about,” said McClatchey, “because you usually miss that one.”

CampMAGIK_KidRepressed grief can have devastating consequences down the line, including suicide.

It doesn’t help that our culture pressures people to get over loss quickly.

“We don’t allow people to stay in a state of bereavement for very long, whereas in other cultures there can be a whole year of mourning,” said Betsy Vonk, Ph.D., a professor of social work at the University of Georgia and McClatchey’s research collaborator.

The timing of the death and whether it could be anticipated determine how a family responds. McClatchey and Vonk recently published a study showing that treatment may be more effective if the cause of death is taken into account, and counseling is tailored to the individual in bereavement.

When a loved one’s death comes as a shock, Vonk said, survivors might be left with “some very complicated relationship dynamics that were unresolved when the person died, and the grieving person can’t let go because they’re still trying to sort it all out.”

Environmental factors can also complicate grieving, and McClatchey says many of Camp MAGIK’s kids come from inner-city neighborhoods. “They hear ambulance sirens more often and there are more gunshots. So they become hypervigilant.” Children from low-income families are less likely to have access to mental health services, too, and Camp MAGIK may be their only chance to receive professional counseling.

 

Parents welcome

 

“We accept based on need,” said McClatchey. “We have to give preference to those who have lost a parent or sibling.”

Roughly 55 to 60 kids attend each camp. McClatchey says it would not be therapeutic if the camps were any larger. Due to high demand, they do not accept repeat campers.

Besides Cartersville, the camps are held in Hampton and Clarkesville.

Although Camp MAGIK focuses on children, McClatchey says the experience also helps parents who come along for the weekend. In fact, parents are encouraged to attend.

“What happens is that the child won’t talk to the parent because they don’t want the parent to start crying, and the parent doesn’t talk to the child about the loss because the parent doesn’t want the child to cry,” said McClatchey. “We encourage them to grieve together and we encourage them to answer questions honestly.”

For more information, visit http://www.campmagik.org/ or call 404.790.0140. Thanks to a grant from The Moyer Foundation and other private donations, Camp MAGIK sessions are free for children. Reservations are necessary.

 

Andrew Lowndes is a graduate student pursuing an M.A. in health and medical journalism at Grady College at the University of Georgia. He studied neurobiology as an undergraduate at the University of Wisconsin – Madison and hopes to explore mental health topics as a science writer.

 

 

Ex-addict helps former inmates escape the bondage of drugs

Charles Sperling (left) and Raymond Duke of STAND Inc., which provides services to former prisoners and people with HIV/AIDS

Charles Sperling (left) and Raymond Duke of STAND Inc., which provides services to former prisoners and people with HIV/AIDS.

Charles Sperling knows the torment and desperation of drug addiction.

More than 30 years ago, when he was young and living in New York, far from his Alabama roots, he got hooked on heroin.

In 1986, though, Sperling stopped using the drug and started to turn his life around. “I got drug-free and I got busy,’’ he recalls now.

He volunteered to help parolees dealing with their own addiction issues, “guys who were just struggling.’’

Now 64, Sperling runs STAND Inc., a Decatur-based nonprofit organization that serves people with substance abuse problems. He is its founder and CEO.

STAND (Standing to Achieve New Direction) helps former prisoners from Johnson State Prison in Wrightsville with re-entry into society, offering behavioral health services, housing and employment assistance.

It also works with jail inmates who have drug problems, runs a domestic violence program, and does HIV/AIDS prevention and treatment. It offers free housing for clients trying to get back on their feet.

STAND’s success is reflected in a three-year, $1.2 million federal grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), a branch of the Department of Health and Human Services.

The nonprofit organization, established in 1999 by Sperling, serves more than 200 people a year. Many are among the most challenging patients, says Neil Kaltenecker, executive director of the Georgia Council on Substance Abuse.

Helping those who need it most

“They have always been a program that has reached out to typically hard-to-reach populations –- men and women coming out of jail or prisons, with HIV/AIDS, with backgrounds of domestic violence,’’ Kaltenecker says. “They have done a remarkable job in engaging people and keeping them in services.’’

“Charles treats people with respect by meeting them where they are,’’ she says. “He does not assume that he has all of the answers for someone to get their life on track, but he is always willing to share where he has come from and to walk beside a person in support of where they want to go and how they want to get better.’’

One such person is Anthony Rivers, 60, who was addicted to crack cocaine, and now has been sober for eight years. He’s now a full-time employee of STAND, working as an intake coordinator.

Roderick Keith Arnold (left) and Anthony Rivers

Roderick Keith Arnold (left) and Anthony Rivers

“Had it not been for STAND, I would still be on the streets, if not dead,” Rivers tells a reporter in the organization’s offices in DeKalb County.

Roderick Keith Arnold, 52, enrolled in the program a year ago, after being addicted to alcohol and crack.

“There was a whole lot of fear going on,’’ Arnold says. “I just started listening to the staff.”

Arthur Stewart, 64, has a 40-year history of doing drugs — heroin, cocaine, crack.

“I relapsed about six months ago, and went through detox,” says Stewart, who adds that he has HIV and diabetes.

“STAND gave me another chance at life and dealing with psychological problems,’’ he says. “It brought me closer to God.”

Edward Purdy, 30, was addicted to methamphetamines and marijuana, and he came to the program from jail. “I was the problem, not the drugs,’’ he says.

STAND “has been a tremendous help for me,’’ Purdy says. “It brought me and my wife closer. I feel like I’m on a road home instead of a road of destruction.”

Artis Anderson, 47, says STAND has helped him deal with his guilt and shame. “I’ve been to 10 different programs,’’ he says. “STAND is the best program I’ve been in.’’

Fighting violence as well

Sperling notes that there is still a much greater need for substance abuse services than there are providers available.

Drugs always pose a challenge to society, he says, and he has witnessed the harm they do countless times. Recently, he has noticed an uptick in heroin use, the very problem that almost ruined his life all those years ago.

The organization has an annual budget of $1.3 million. It receives donations and grant funding, along with contracts with government agencies.

The domestic violence program is a recent addition. After six or seven group sessions, Sperling says, “you see these breakthroughs’’ in anger management and relationship skills.

“Anybody who comes in our door gets HIV testing for free,’’ he adds.

“We have different pathways for people to get services,” Sperling says. “That’s what I love about this agency.’’

“If a person is stable for six months, they have a good chance.’’

Though he’s now at what many would consider retirement age, Sperling shows no sign of pulling back on his work.

“I love what I do,’’ he says. “I don’t see a retirement where I go fishing. I see myself as a part of this as long as I have a passion for it.’’

Big change in psychiatric hospitals: What the commissioner has to say

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 BerryFrank 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.

 

Guns and mental illness: What’s a merchant to do?

At Gateway Jewelry and Pawn in Athens, the most sought-after items are guns

At Gateway Jewelry and Pawn in Athens, the most sought-after items are guns

Over the years, Michelle Tenorio has seen all kinds of people buy all kinds of things.

At her store, Gateway Jewelry and Pawn in Athens, Tenorio sells jewelry, electronics, musical instruments and a range of other goods. But the store’s most sought-after items are guns.

The purchase of those guns potentially could come at a much higher price than the one on the tag hanging from its barrel.

“We’ve had a customer come in, just seemed completely normal,” she said, “and he got into a taxi going home and was playing with the gun,” scaring the driver. The driver immediately called the police.

The gun was confiscated by local authorities, who then discovered that Tenorio’s customer had a history of serious mental disorders.

Under federal law, it is illegal to sell firearms or ammunition to anyone whom the seller knows to have or has reasonable cause to believe “has been adjudicated as a mental defective or has been committed to any mental institution.” But Tenorio had no way of knowing about this buyer’s mental history.

Merchants try to comply with current law and keep guns out of the hands of dangerous people.

Pawn shops like Gateway require customers to fill out a Firearms Transaction Record. Once the forms are filled out, the clerk types the buyer’s information into the National Instant Criminal Background Check System database, a program created by the FBI to determine whether a buyer is eligible to buy firearms or explosives. Minutes later, the person’s criminal history and approval status show up on the computer screen.

The buyer’s mental health status, however, does not show up on the background check. That form of screening does nothing to prevent a person with mental illness from purchasing a gun.

That leaves Tenorio and others like her to rely on their personal judgment to make up for what the databases lack. Tenorio is within her legal rights to refuse to sell to a person who appears worrisome, but in doing so she has to rely on her gut feeling, and that is not foolproof.

“We go for the criminal background, so if they come back clean, there’s no way of knowing” about possible mental problems, she said.

Advocates for people with mental illness, meanwhile, emphasize that people with mental health conditions are no more likely than others to commit homicides or other violent acts. Most violent crimes are committed by people who do not have a mental illness, the advocates say.

 

Complicated legal issues

Attorney Jason Sterzer is interested in the delicate balance between adequate gun control and the public’s constitutional right to bear arms — especially since the mass shootings at Virginia Tech in 2007 and in Tucson, Ariz., in 2011.

When those massacres were reported, Sterzer was immediately bothered by the fact that both shooters, despite well-documented histories of threats and bizarre, menacing behavior, were able to purchase guns legally.

“In my view, the most crucial thing to understand about firearm regulation is that more regulations targeted at the law-abiding general public or regulations targeted at the type of weapon will not solve the problem,” said Sterzer, who wrote about these issues in the March 2012 issue of The Journal of Legal Medicine. “The solution, rather, lies in identifying those who would use the weapon to commit crimes and preventing them from gaining access to firearms.”

Sterzer’s research reveals a seeming paradox: States with the most restrictive gun laws have the highest rates of gun murders.

These crimes, he emphasized, are often committed by people with no history of mental illness.

“A blanket federal gun ban on mental disorders would not be fair,” Sterzer said. It would be a great injustice to strip constitutional rights from people who’ve been labeled as having depression or other common emotional disorders, he said. “This is not the answer. Rather, lawmakers have looked and should continue to look at whether the individual is a danger to themselves or others.”

Stricter state and federal regulations, Sterzer says, are not the best way to do it.

“More firearm regulations does not equal less firearm violence,” he said. “States which have the tightest gun control laws have the highest murder rates by firearms. Smart laws and effective implementation of those laws will make a difference.”

Gun rights efforts

Gun control advocates are not the only people pushing their cause. In some states, there are efforts to expand gun rights.

Last month, the Georgia House approved legislation that would allow individuals who have been voluntarily admitted for inpatient mental illness or substance abuse treatment to get a gun license.

The bill, which was supported by the state gun rights organization GeorgiaCarry.org, would have required officials to check whether applicants have ever been involuntarily committed for mental health treatment in the past five years.

Under the legislation, judges would be given the power to grant a license to anyone who has sought treatment, voluntarily or not. The bill would require applicants to authorize the release of their treatment records and provide recommendations from their providers. The involuntary treatment records would then have to be entered into a database. Judges would have to run checks, using the information in the database, before issuing a license.

Also under the bill, a person currently being represented by a guardian or conservator due to a mental illness, or who has threatened others in the past five years, would be banned from purchasing a gun.

The bill gained considerable support but ultimately did not win approval of the full Legislature. It died on the last day of the General Assembly session over a provision to allow guns on college campuses.

In the wake of the 2012 Connecticut school massacre, President Obama has proposed national legislation on gun control. Those proposals include bans on certain weapons and expanded background checks to prevent firearms from ending up in the hands of criminals or people with mental illness.

Political analysts say expanded background checks are more likely to pass Congress than weapons bans, because polls indicate that expanded background checks have greater public support.

But under current background check laws, Tenorio, the pawn shop owner, believes that relying on her gut may be her best line of defense against selling guns to people who appear to be dangerously mentally ill.

 

Alicia Smith is currently pursing her master’s degree in Health and Medical Journalism at the University of Georgia.

 

 

‘Whole person’ treatment: New approach combines physical, mental care

Whole Person Treatment

Sharon Hix, along with Stephen Schweitzer (left) and John King, attend a Dalton mental health program. Consumers soon will get medical care, too, in the same building.

Sharon Hix and Brenda Jeffers regularly come to a Dalton day program for people with mental illness.

Each has medical problems in addition to mental health issues. Hix, 65, is pre-diabetic, has high cholesterol and a thyroid problem. Jeffers, 52, is battling a cholesterol problem and attempting to beat her smoking habit. Both women are trying to exercise more and eat healthier.

Their mental health services are delivered in a building that will soon offer medical care as well. Hix and Jeffers, and others like them, will be able to get both kinds of care under one roof. Ideally, that will mean overall care that is better coordinated.

Their Dalton mental health service organization, and a local community health center, are among 93 programs nationally that have won a federal grant intended to improve the “whole health’’ of a person with behavioral health problems.

The trend to merge care for the brain and for the rest of the body has taken off in Georgia, thanks to collaborations between two segments of the safety net: community service boards and community health centers.

Under this integrated model, people with mental illness, who often let their physical ailments go untended, get immediate access to primary care. And many patients who enter the system with medical complaints are diagnosed and treated for depression and other behavioral health problems.

Some behavioral health patients have not seen a primary care doctor in 10 years, says Frank Berry, commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities.

Before being chosen as commissioner, Berry ran a community service board in suburban Atlanta, which created sites in Lawrenceville and Conyers that combined mental and physical health care.

This type of mental/physical health collaboration “is going to provide better outcomes,’’ Berry says. And it will reduce costs by addressing a patient’s needs earlier.

This integration of services seeks to address a longstanding problem: Individuals with severe and persistent mental illness die 25 years earlier than the general population.

These deaths are often the result of largely preventable physical problems — such as tobacco addiction and related illnesses, as well as obesity and diabetes. People with serious mental illness often “don’t exercise, have very unhealthy lifestyles,’’ says Dr. John Bartlett of the Carter Center’s Mental Health Program.

Psychotropic drugs often lead to weight gain, experts say.

Highland Rivers Health, the public behavioral health provider in Dalton, and the local federally qualified health center, Georgia Mountains Health, were recently awarded a four-year, $1.6 million federal grant to improve the care of adults with mental illness who also have diabetes, cardiovascular disease or hypertension.

The money from the Substance Abuse and Mental Health Services Administration (SAMHSA) will help “bring together the mind and the body,’’ says Jason Bearden, CEO of Highland Rivers. The grant will also allow mobile care in vans that will reach nearby rural areas Murray, Gilmer and Fannin counties.

Bearden says of those with serious mental illness at Highland Rivers, up to 90 percent have significant physical issues as well, including high rates of obesity, diabetes, and smoking.

Poverty is a problem for large numbers of people with mental illness. Many don’t get medical help, says Natalie Davis of Dalton, who has fought major depression and now works as a certified peer specialist, trained to assist people with mental illness in their recovery. Many people with mental illness “can’t afford the healthy foods,’’ she adds.

Hope in a hard-hit area

Integration of care will start in early 2013 in Dalton, the northwest Georgia city that’s called the “Carpet Capital of the World’’ but has fallen on hard times since the economic downturn began.

The housing and building slump cut carpet sales drastically, and Dalton suffered the third-worst employment drop of America’s 372 metro areas in 2011, according to government figures.

Dalton’s unemployment rate in October of this year was 11.2 percent, much higher than the state average.

The area has a large homeless population, says Steven Miracle, executive director of Georgia Mountains Health.

People here with mental illness tend to cycle in and out of emergency rooms, jails and homeless shelters. Prescription drug abuse and methamphetamine use are major problems, Miracle says.

The new Dalton program will be a one-stop shop. A primary care physician will be posted at a Highland Rivers behavioral health location. The community health center will do preliminary mental health screenings of its medical patients. Children and teenagers with mental health issues will eventually come to the same center that houses the health clinic.

This integration of care is part of the movement toward what are known as patient-centered medical homes.

A medical home is a single practice or facility that provides as much of a patient’s overall care as possible. “We’re trying to take care of every issue they have,’’ says Duane Kavka, executive director of the Georgia Association for Primary Health Care, which represents community health centers.

Georgia, he says, “is a little ahead of the curve’’ nationally in the move toward integrated care.

The effort in Georgia got a jump start through the Carter Center’s Mental Health Program, which brought together community service boards and health centers from the same geographic areas in a series of meetings beginning two years ago.

The goal was to help facilitate new relationships between safety net providers of physical health and behavioral health, says Bartlett of the Carter Center, who hosted the meetings. He says there are now 20 such partnerships across the state.

The coordination can improve care no matter where the patient enters the system, either from the physical or mental health side, Bartlett says.

He also points out that many people visiting a doctor for physical health needs often have their behavioral health needs unrecognized in the rush of a 15-minute medical appointment. “It’s not a setting that’s designed to address behavioral health.’’ Bartlett says.

And he adds, ”people who are depressed and/or have problem drinking or drugging have worse clinical and financial outcomes for their medical conditions.’’

Integration aims to reinvent primary care to address the whole person through a team approach, he says.

Trend felt in several parts of state

In coastal Georgia, where the Gateway community service board partnered with a health center, behavioral services and medical care are delivered together at three Savannah sites.

“What we’re trying to do is provide treatment for the whole person,’’ says Frank Bonati, CEO of Gateway. State funding has helped in this effort, Bonati adds.

Berry, the commissioner of Behavioral Health and Developmental Disabilities, told GHN that he is working with his counterpart at Community Health, David Cook, on getting technical assistance on these integration efforts from the National Council for Behavioral Health.

Dalton is the third area in the state to get a SAMHSA grant, after Columbus and Cobb/Douglas.

The Cobb and Douglas community services boards, through a four-year, $2 million grant with West End Medical Centers, has installed nurse practitioners and nurses in an outpatient mental health centers in Austell. Patients have access to fitness experts and peer specialists as well.

The collaborative has seen more than 600 patients, and has more than 430 active clients. Peer specialists encourage people with mental illness to get medical care and adopt wellness practices, such as exercise and weight loss.

The Cobb/Douglas and West End program is helping Felton Keyes, 54, who has fought mental illness and substance abuse. He lives at a Marietta residential program run by the community board, and during the day goes to the organization’s Austell clinic for group therapy and other services. He receives medical care at the same location, and help for his high blood pressure.

He even gets his exercise there. “I stay on the treadmill,’’ he says.

Keyes is impressed with the concept of the program. It treats the “biological, emotional and psychological,’’  he says.

Tod Citron, CEO of the Cobb/Douglas community services boards, says 78 percent of patients there have no insurance. The Affordable Care Act could help sustain this project financially by insuring more of them, he says.

Bearden of Highland Rivers says the collaboratives ‘‘are going to be a model of the future.’’

“Reimbursement is going to shift,’’ he says. Government programs and insurers “will want to pay for these types of services.’

 

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