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Mental Health

Williams’ death underscores powerful link between depression, suicide

Robin Williams entertains U.S. troops stationed in Iraq in 2010.

Robin Williams entertains U.S. troops stationed in Iraq in 2010.

The death of brilliant comedian and actor Robin Williams shows how depression can devastate even someone with worldwide fame and success, mental health experts said Tuesday.

Williams, 63, died Monday of an apparent suicide. His publicist said Williams was battling severe depression. The actor who starred in such films as Good Will Hunting, Mrs. Doubtfire and Good Morning, Vietnam had also struggled with alcohol and cocaine abuse.

Last month, Williams went into rehab at Hazelden Addiction Treatment Center in Minnesota, and was expected to stay there for several weeks.

His death “shows anybody can become suicidal, no matter how funny, comical and happy they may seem,’’ said Nadine Kaslow, a professor in the Department of Psychiatry and Behavioral Sciences at Emory University School of Medicine. “It shows that depression is a big risk factor for suicide.’’

The work of a comedian such as Williams, she said, “can be a cover for distress and pain underneath it.”

Suicide rates differ by age, gender and race, Kaslow said, with older white men at higher risk.

Kaslow said she hoped that Williams’ death leads more people into treatment for their illness.

The tools of psychotherapy and medication and substance abuse treatment “can be extremely helpful’’ in helping someone cope better and giving them hope, Kaslow said.


The damage of substance abuse


Dr. Bill Jacobs, an addiction medicine specialist at Georgia Regents University in Augusta, said Tuesday that Williams’ death “is not just about depression; it’s also about addiction.”

Abusing cocaine and alcohol over years “can really change [a person’s] brain,’’ Jacobs said.

Robin Williams at a 2011 movie premiere.

Adding a depressant drug such as alcohol with depression symptoms “is a setup for bad things to happen,’’ he added. The risk of suicide is much higher for someone with a substance abuse problem, “especially with a co-occurring psychiatric disorder.”

Mental health consumer advocates in Georgia said Tuesday that they were shocked by Williams’ death.

“It shows you how serious depression really can be,’’ said Ellyn Jeager of Mental Health America of Georgia.

Depression can affect people of all economic classes, she said. “Money doesn’t determine whether or not you’re well.”

Jeager said Williams’ death underscores the importance of getting treatment.

She said the state of Georgia has a good suicide prevention program, through the Department of Behavioral Health and Developmental Disabilities, but she added that it needs more funding.


Recognizing depression symptoms


Pat Strode of the Georgia chapter of the National Alliance on Mental Illness said that the science of mental illness has advanced significantly in the past decades, but that more progress needs to be made. “There’s still not enough information about these illnesses,’’ Strode said. “There’s not enough treatment.’’

What should people do if they suspect they have depression?

Strode said people need to know the symptoms, and then seek treatment if they recognize they have signs of the illness.

The severity, frequency, and duration of depression symptoms vary depending on the individual and his or her particular illness. According to the National Institute of Mental Health, the signs and symptoms of depression include:

  • Persistent sad, anxious, or “empty” feelings
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details, and making decisions
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

If insured, people with depression symptoms should visit a doctor or mental health specialist with their health plan, Strode said. But if they don’t have insurance, they can get help through the Georgia Crisis and Access Line at 800-715-4225, she said.





Some unconventional health advice: Maybe you need a vacation

Getting away may be just what you need to relieve stress.

Getting away may be just what you need to relieve stress.

Is a vacation good for your mental health? And if so, is that a good enough reason to take one?

Most people enjoy out-of-town excursions. Lots of people take them annually. But as another summer begins to fade, many workers may be wondering if a vacation is worth the trouble and expense — especially in a time of high gas prices and airfares.

And modern travelers often face an added problem as they go on holiday: They take along their personal technology devices, allowing the stresses that they are trying to escape to follow them out of town.

Given all that, should you go or should you stay?

Many experts say you ought to take that trip if you possibly can.

“I’m certainly in favor of all vacations,” says Dunwoody psychologist Dr. Stan Hibbs. “I sometimes tell people that even a bad vacation is better than no vacation at all.”

Hibbs points to the shared memories that a getaway trip can provide. He says even the unpleasant experiences, such as bad weather or poor accommodations, can become part of family lore. (“Remember that dude ranch where the air conditioning didn’t work and the pool was closed?”)


The overworked American


Hibbs suggests that we Americans need to take better care of ourselves. We take much less vacation than other people in the industrialized world.

Every country in the European Union, for instance, requires that workers get at least four work weeks of paid vacation per year.

The United States, on the other hand, is the only developed country in the world without a single legally required paid vacation day or holiday.

Of course, vacation is far from non-existent in the United States. According to the Center for Economic and Policy Research, 77 percent of private-sector companies offer employees at least some paid vacation, and those workers get an average of 21 paid days, the Huffington Post reported last year. Many other working Americans are employed by the federal, state or local governments, which also offer vacations among their benefits.

Still, vacation is not the priority in America that it is in some other places. And that may be cause for concern.

Noted Dutch psychologist Jessica de Bloom says that until recently, vacations have been a somewhat neglected research topic, even though a vacation “is a presumably powerful weapon against work stress and its consequences.”

Another study from the Netherlands by Jeroen Nawijin and colleagues was designed to obtain a greater insight into the association between overall happiness and vacations.

The Grand Canyon is a popular vacation spot.

The Grand Canyon is a popular vacation spot.

These experts say that the more stressful the trip, the less you will benefit from being away.

They suggest that pre-trip happiness may come simply from planning the vacation. Many studies suggest that much of the fun is generally in the preparation stage, which is called a “mood booster.” Anticipating the enjoyment to come helps lift people’s spirits.

Occasionally, such anticipation can end in disappointment, says Hibbs. “If there’s a lot of conflict in the family, sometimes vacations can intensify it.” Many people can recall family reunions where everyone bickered as old grievances were revived over the dinner table.

When people plan a trip together, personality differences can be important to consider.

Hibbs talks about the widely known Myers-Briggs Personality Inventory, with “J” and “P” personality types. The J personality is great at planning and the P person is more spontaneous, says Hibbs.

“The J wants to have everything organized in advance,” Hibbs says. For example, such a person “would never begin a trip” without making hotel reservations first.

“Conversely, the P personality,” says Hibbs, “would rather go with the experience.” They might say something like “let’s just drive until we’re tired and then find a place to stay.” The P craves spur-of-the-moment adventures.

It’s when P and J travel together that the “fun” begins, says Hibbs. But whether or not they always see eye to eye, even P and J need to get away from work, technology, bad news and mundane distractions.

“We [Americans] work long hours, take little time off, and then wonder why we are so tired and have so many health issues,” says Hibbs.

The joy of disconnecting


Nowadays, can we stand to get away from the technology that’s so much a part of our lives?

Psychologist Dr. Mikyta Daugherty, associate director of clinical services at the Georgia State University Counseling and Testing Center, says a recent trip she took shows that we can go technology-free and enjoy ourselves.

Although she was slow to adopt the habits of a techno-geek, Daugherty now describes herself as an “avid technology user.” She says in today’s academic environment, she relies on using a cellphone, a computer, a tablet, and even a “smart watch.”

Moraine Lake in Canada

Moraine Lake in Canada

“There is not much time that goes by without interacting with these gadgets in some way,” she says.

But briefly last year, she found herself doing without her devices. She took a three-day cruise and had no wireless Internet connection and no cellphone signal. It was her first holiday from the technology that had become so important in her life.

How did Daugherty feel about that “disconnected” interlude?

“It was the best vacation I’ve ever had,” she says. The sense of being away from it all, she says, made the cruise feel like the only true vacation she had ever taken.

“I did not touch my devices once,” she recalls. In fact, she says, she didn’t miss using them or even think about them until the cruise ship was pulling up to the dock upon her return.

“The fact that my attention had been so captivated was astounding to me — and refreshing,” Daugherty says. The effect was so powerful that she has already booked a seven-day cruise for the coming winter.

Research from de Bloom shows that the “effect of job stressors on health and well-being of employees has been well established.” Yet, at the same time, the findings show that vacation effects fade quickly.

Many studies note that vacations are a potentially powerful recovery opportunity. They can make the stress and pressure from everyday life disappear, if only temporarily.

Daugherty agrees. “A vacation is really just a mental experience that we should probably learn to do more often,” she says.


Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.


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 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.


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