State health officials have major work ahead to meet a July 2015 deadline with the federal government on improving care for Georgians with mental illness and developmental disabilities.
That’s a key message of a report this month from an independent reviewer regarding the state’s five-year settlement agreement with the U.S. Department of Justice, reached in 2010.
The state has improved the mental health system significantly, with “increased access to affordable housing, competitive employment, clinical and peer supports and crisis services,” said the Sept. 15 report by the reviewer, Elizabeth Jones.
And overall, the report continued, Georgia’s Department of Behavioral Health and Developmental Disabilities (DBHDD) has shown “a good faith effort” to ensure the terms of the settlement agreement have been met.
But the state “remains out of compliance” with services for the developmentally disabled, Jones said.
“The system of community-based supports for individuals with an intellectual/developmental disability has fallen seriously short of expected practice despite earnest attempts to improve the quality of residential programs and other critical services,’’ Jones said. “The state’s plan for remedial actions is very promising but remains unfulfilled at this time.”
Jones added, “The next few months will be extremely important in determining whether sufficient reform can be realized and whether resources and skills are adequate for the serious tasks ahead.”
Problems in community living plan
The reviewer’s report comes as an update to the groundbreaking settlement between the state of Georgia and the U.S. Justice Department. Under the terms of that pact, Georgia agreed to establish community services 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.
As part of the settlement, Georgia pledged to end all admissions of people with developmental disabilities to state psychiatric hospitals. It also promised that patients with developmental disabilities already in those hospitals would be moved to more appropriate settings by July 2015.
But problems involved in the care delivered in these community living situations led DBHDD to stop transferring people with developmental disabilities from hospitals to community lodgings. Over the summer, media outlets reported that almost 10 percent of the 480 Georgians with developmental disabilities who have moved out of state hospitals since July 2010 have died after being placed in community residences.
About 290 people with developmental disabilities remain in the state’s institutions in Augusta, Milledgeville and Atlanta.
Those transitions from hospital to community are still suspended, DBHDD officials said Wednesday. “We’re reviewing all the processes,’’ said Judy Fitzgerald, deputy commissioner of the agency.
Fixing a troubled facility
And earlier this month, GHN reported that a federal agency has warned Georgia officials that it would end Medicaid payments to an Augusta facility for the developmentally disabled unless the state improved conditions there.
The federal Centers for Medicare and Medicaid Services (CMS), in an August report, said the state-run Gracewood Developmental Center had repeatedly failed to ensure the safety of patients, who had been subjected to physical and verbal abuse.
The feds also described inadequate employee training and frequent failure to investigate possible instances of abuse.
Fitzgerald told GHN on Wednesday that CMS has accepted the state’s plan of correction for Gracewood, and that an interim hospital administrator has been hired to oversee the improvements.
DBHDD, meanwhile, is overhauling its processes regarding people with developmental disabilities whom it serves as part of an agency restructuring.
Eric Jacobson, executive director of the Georgia Council on Developmental Disabilities, said earlier this month that he welcomes the agency overhaul.
“They have to rethink the way things are being done,” Jacobson said. “These are the most vulnerable of folks.”
Possible extension?
During the course of the settlement agreement, crisis services for people with mental illness have been created and expanded, Fitzgerald said. “We feel like we’ve made substantial progress,’’ she said.
On supported employment, the state is serving twice the number of people as required under the federal agreement, the agency noted.
“There are a lot of success stories,’’ Talley Wells, director of the Disability Integration Project at Atlanta Legal Aid, told GHN. “The mental health system, for people in crisis, is much more robust and has solid supports for people.”
The mental health system still needs more housing for individuals, and more work should be done for people who are in the forensic system, Wells said. These are people who may have been found not guilty by reason of insanity, or judged unfit to stand trial.
Jones, in her report, said that “individuals with forensic histories are not obtaining adequate access to community-based supports. As a result, they remain confined in institutions or are at risk of recidivism upon their release from custodial care. A significant part of this problem rests with discharge practices in jails and other forensic settings.”
Wells said it’s possible the agreement could be extended beyond the July deadline, to resolve the problems in the developmental disabilities area.
“We have not built up a sufficient infrastructure to welcome these people with developmental disabilities” into community living arrangements, he said.
DBHDD announced last week that it has awarded a contract to ValueOptions to help the agency with administrative functions, including data management.
“It’s state-of-the-art technology to help get people to the right care at the right time, factoring in their history’’ of services, Fitzgerald said.
The new technology system will reduce the administrative burden for medical providers, she said.