Report scolds Georgia on housing for people with mental illness

Georgia is not meeting its court-supervised obligations for creating housing for people with serious mental illness, according to a recently released report.

State-run psychiatric hospitals, in fact, have discharged dozens of patients to homeless shelters, and many of them wind up being re-hospitalized, the report from an independent reviewer says.

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Thirty-four of these individuals had histories of 10 or more admissions to mental hospitals.

This ‘’revolving door’’ phenomenon has echoes of the Georgia situation nine years ago, when a series of articles in the AJC reported that about 5,000 times between 2002 and 2006, the hospitals released patients to homeless shelters or such places as bus stations, motels and — in some cases — streets and abandoned buildings.

Many left the hospitals with no more than a week’s worth of medicine and only a vague plan for continued treatment, the newspaper reported. That helped make the readmission rate to Georgia psychiatric hospitals more than 50 percent higher than the national average.

Those articles helped lead to a historic 2010 settlement agreement between the U.S. Department of Justice and the state of Georgia about improvements in the state-run system for people with mental illness and developmental disabilities.

That pact was updated in May, addressing compliance problems that the Department of Justice and the independent reviewer, Elizabeth Jones, have pointed out since the settlement was reached six years ago.

Most of the renewed agreement focused on improving services for people with developmental disabilities, but it also reaffirmed the state’s pledge that it would provide supported housing for 9,000 individuals with mental illness.


But the independent reviewer, Jones, says in her June 20 report, “At this time, as a result of the lack of inclusion of individuals exiting most jails, all of the state’s correctional institutions and state/private psychiatric hospitals, the [Department of Behavioral Health and Developmental Disabilities] has not demonstrated that it has met the threshold requirement of identifying the need for supported housing for the target population.”

A spokeswoman for DBHDD, Angelyn Dionysatos, said in an email statement to GHN last week that “we highly value the reflections and recommendations offered by the independent reviewer and her experts. Their thoughtful work will continue to inform our planning as we embark on the next phase of our strategic transformation, which will position us to fulfill the obligations expressed in the extension agreement that was signed in May.”

In the new report, Jones writes that DBHDD reported that in fiscal 2015, there were 217 discharges, for 195 individuals, from three state hospitals to shelters for homeless people. (Some individuals were discharged to a shelter more than once.) Most of these discharges occurred in the Atlanta area.

The Department of Behavioral Health and Developmental Disabilities recently revised its protocols for discharges to shelters.

File photo
Stock photo

In the first three months of 2016, though, there were 14 individuals discharged to shelters from Georgia Regional Hospital in Atlanta. Of the 14, five individuals have been re-hospitalized since at the same facility, the report says.

While compiling the report, Jones made unannounced visits to Atlanta shelters.

“The conditions are simply unacceptable,’’ the report says of one shelter. “During her last visit, shelter staff reported that the Department of Health makes two to three visits weekly to test for tuberculosis. It was necessary to walk through standing water from a broken pipe in order to reach the area where the shelter’s residents remain during the daytime hours.”

Jones recommends that DBHDD “intensify its efforts to prevent discharges to shelters. Staff should be instructed to begin planning for discharge at the time of hospital admission.’’

Talley Wells, director of the Disability Integration Project at Atlanta Legal Aid, called the discharge pattern “frustrating and disappointing,’’ noting the lack of mental health services in homeless shelters.

“No one should go to Georgia Regional Hospital and then be discharged to a homeless shelter,’’ he told GHN. “Clearly people who need housing aren’t getting it.”

The plight of ‘forensics’ patients

Jones’ report gives more attention than did her previous reports to individuals in the forensics units in the state hospitals. More than 600 people fall into this category. These people were admitted to the hospitals from the legal system after being judged incompetent to stand trial on charges they faced, or after being found not guilty of a crime by reason of insanity.

The discharges of such people who are judged to pose no danger to themselves or others do not show a consistent pattern and are complex for the individual, family and the court system to navigate, the report finds.

The state’s patient recovery teams use varying standards when deciding to recommend individuals for either release or ongoing civil commitment, it adds.

The report also cites serious staffing issues within the DBHDD hospitals, finding that 38 percent of all Registered Nursing positions are vacant, while 37 percent of psychiatrist positions and 26 percent of psychology positions are vacant across the five hospitals. While DBHDD has made arrangement for contract psychiatrists and other clinicians, “these temporary employees may or may not understand the DBHDD system, the law,’’ and the practices within the respective hospitals, it says.

Talley Wells
Talley Wells

Susan Walker Goico, a staff attorney with Disability Integration Project, said the Jones report “shines a light on people in forensic hospitals who could leave the hospitals if connected to the right supports.”

Many people “have been kept in expensive hospital settings for too long,” Goico said. Crimes that forensics patients are accused of include aggravated assault, making threats and obstruction of a police officer, she said. Many such charges would have resulted in only brief incarcerations if the accused had been judged competent and been convicted in court. “Some have spent many years unnecessarily in the hospitals,” Goico said.

The report also reviews discharges of people with developmental disabilities into community settings. One group of four that were recently served by the “Pioneer Project” are doing well, Jones reported.

“In particular, one of the three women placed has shown a remarkable response to her new setting,’’ the report said, adding that Jones had observed the woman on three separate occasions when she was still at the state hospital.

A state hospital in Augusta
A state hospital in Augusta

“Each time [at the hospital], she was seen with a blanket over her head, huddled in a chair, refusing to interact with the staff who approached her. In her new home, she is responsive to staff; allows them to touch her hand or shoulder; is showing signs of active listening (she was thought to be hearing-impaired at the state hospital); and is becoming comfortable with her daily route, including enjoying taking a bath. (She refused showers in the state hospital and had to be escorted by two staff.)”

But among a group that had been discharged without the Pioneer Project help, the report finds “significant gaps in the provision of health care.”

“The failure to meet professional standards in both nursing care and the implementation of health care interventions led to the finding that 35 percent of the individuals in the sample did not have their serious physical health care needs met as expected,’’ the report says.