Former first lady Rosalynn Carter said Friday that she has concerns about how Georgia’s restructuring of its Medicaid program will affect the state’s revamped mental health system.
Mrs. Carter also noted that while the state’s 2010 agreement with the Department of Justice to improve Georgia’s mental health system is ‘’a good settlement,’’ it fails to address the needs of children and adolescents.
A longtime advocate for people with mental illness, Mrs. Carter spoke to journalists at a media briefing at the Carter Center in Atlanta during the annual Rosalynn Carter Georgia Mental Health Forum.
A state official, meanwhile, pointed to data to show the Justice Department settlement has led to improvements.
The patient readmission rate to psychiatric hospitals within 30 days – historically high in Georgia – has dropped from 13.4 percent prior to the settlement to a current figure of 7.7 percent, said Dr. Frank Shelp, commissioner of the Department of Behavioral Health and Developmental Disabilities.
The state’s hospital patient census has also declined, Shelp added. And in the northwest region of Georgia, where a state psychiatric hospital has been closed, more people at risk of hospitalization have received mental health services for a lesser amount of money, Shelp said.
Under the settlement with the Justice Department, Georgia agreed to establish community services, including supported housing, for about 9,000 people with mental illness, and to create community support and crisis intervention teams to help people with developmental disabilities and mental illness avoid hospitalization.
Georgia pledged to end all admissions of people with developmental disabilities to the state psychiatric hospitals. It also promised that patients with developmental disabilities already in those hospitals would be moved out of them by July 2015.
Mrs. Carter and the Carter Center were instrumental in the negotiations leading to the landmark agreement, which has been hailed as a national model.
“It was not everything we wanted, but it was good,’’ Mrs. Carter said.
Concerns on Medicaid, children’s services
Prior to the settlement, she noted, psychiatric hospital patients were discharged to homeless shelters and other inappropriate settings. Now the state is building an array of community services, including housing and employment programs, to reduce the need for hospitalizations.
The former first lady, though, expressed concern about what would happen to such nontraditional but effective community programs under a Medicaid restructuring.
The state Department of Community Health is working on a “redesign” of how Medicaid and PeachCare are run. Community Health is expected to announce its plan for the restructuring soon.
Mrs. Carter also wondered about the fate of the Department of Behavioral Health and Developmental Disabilities, created by the Legislature three years ago, under the Medicaid redesign.
A task force working with state officials on the Medicaid restructuring recently gave rise to a new group that’s specifically concerned with mental health and substance abuse issues. It’s composed of representatives from professional mental health and substance abuse associations, and from consumer advocacy groups and another state agency. Consumer advocates say they appreciate the opportunity for input.
It’s critical for Georgia to have good services for children, Mrs. Carter said. State agencies involved with children should work together on a unified strategy, rather than remain silos, she said. “We need a lot of help in the schools,’’ she added.
The Carter Center Mental Health Program has hosted town hall meetings on children’s mental health services and has published a preliminary report on recommendations for improving those programs.
Dante McKay of the advocacy group Voices for Georgia’s Children, in a separate interview, echoed the need for “deliberate and coordinated care and attention’’ in children’s behavioral health.
Housing help is a crucial need for people with mental illness, said Thom Bornemann, director of the Carter Center’s Mental Health Program.
Shelp, the commissioner of Behavioral Health, said that federal agencies now will give people with disabilities a priority in obtaining subsidized HUD housing.
The goals for the Justice Department settlement ‘’were set very high and aggressive,’’ Shelp said.
The state recently closed its mental hospital in Rome. Now, Shelp said, “we’ve served about twice the people on less money’’ in that region.
The community services there include employment help, crisis teams, case management services and ‘’peer wellness centers.’’
Shelp said the state would work on rolling out these services across the state. Crisis stabilization units are being created in Columbus and Valdosta, he said.
‘Out of the starting block’
Consumer advocates say much work lies ahead for the state to achieve the settlement’s goals.
Talley Wells, director of the Disability Rights Project of Atlanta Legal Aid, said Georgia “has made enormous progress getting out of the starting block.’’
Statewide, he said, people battling mental illness are now getting connected to housing, treatment teams and employment programs.
“Now is when we’ll really determine if individuals are getting what they need to recover,’’ Wells said.
Bonnie Moore, a leader of the Rome chapter of the National Alliance on Mental Illness, said there is more housing available for people with mental illness in that region.
But she also said that more people in Floyd County with mental illness are being incarcerated in jails, and that NAMI is getting more phone calls from people needing services.
Sherry Jenkins Tucker of the Georgia Mental Health Consumer Network told GHN recently that she is impressed with the improvements in community services.
“Is the picture perfect? No, it’s not perfect,’’ she said. “From where I sit, it’s so much better than it was before.’’