State’s Sick In The Head

Rome News-Tribune
Editorial
February 4, 2010

THE FEDERAL government appears to be really, really ticked off with Georgia regarding unresolved problems at its seven state-run mental hospitals. It has good cause, and Georgians themselves should be outraged by this failure to fix problems known to have existed for more than a decade.

Appalled by continuing mistreatment and violation of patients’ civil rights, the U.S. Department of Justice has gone back to court to install a federal monitor to horsewhip the state into moving instead of dragging its feet regarding an earlier consent agreement. Such a monitor would “set binding targets and timetable[s] for reducing the number of residents at the hospitals and expanding appropriate community-based services.”

Based on what has happened in other states on such matters, the old plaints of “too expensive” and “we didn’t understand this” won’t cut it. Georgia will either have to find funds — quite possibly hundreds of millions of dollars due to long neglect creating an urgent catch-up period — by taking it out of other parts of the existing meager budget or by raising taxes.

The U.S. isn’t going to pay for this; Georgians are. And, it should be remembered, Georgians were in a lot better shape to do so 10 years ago in times of prosperity than they are now.

North Carolina has had such a federal psychiatric hospital monitor for four years; some states rapped for inadequate health care for prison inmates have been under federal oversight for more than 20 years. That last could well be the next shoe to drop in this state.

LET’S BE PLAIN: The situation for the patients is horrible, shocking, atrocious. For the public the state’s dillydallying is utterly revolting.Indeed, even now faced with a 700-page motion of evidentiary ammunition dropped in January to back up the federal takeover motion, the state plans to do the usual — fight it in court. That’s becoming the favored stalling tactic regarding everything, just as in the “water wars.” Georgia lost that one, too.

Sure, the state has recently been “acting” in a day-late, dollar-short manner — shuffling the administrative oversight, asking for an extra $70 million in next year’s budget.

What is it, in modern times, that Georgia’s leaders don’t understand about a “civil rights” issue? Telling Washington that schools might be integrated in the sweet by-and-by didn’t cut it either.

The road to hell, as the proverb goes, is paved with good intentions. Those patients who have earlier been discovered by journalists and federal agents to have been killed, raped or committed suicide, plus those eternally damned for lack of anywhere else to go, already are in hell.

Treating those with mental disabilities decently and as human beings has been the “law of the land” since 1999. That this took so long to determine is itself a sad commentary.

THAT’S WHEN the U.S. Supreme Court in Olmstead v. L.C. and E.W., a case arising from where else but a Georgia psychiatric hospital, offered the opinion that “states are required to place persons with mental disabilities in community settings rather than in institutions when the state’s treatment professionals have determined that community placement is appropriate.”

For those who have to this point been paying insufficient attention, but will now take notice as tax dollars will soon be demanded, this from the 51-page letter to Gov. Sonny Perdue last December warning him what the state had been doing wrong. Perdue’s response, apparently, was that $70 million boost in a budget otherwise being decimated:

“The seven state psychiatric hospitals at any one time house approximately 2,000 patients who have mental illness, substance-abuse issues, and/or developmental disabilities. ... We note that the combination of these diverse populations within the same hospitals is unusual. Each population and the combination of these populations present unique health, safety, and treatment concerns. ...

“We have concluded that numerous conditions and practices violate the constitutional and statutory rights of the patients confined there. Specifically, we find that the hospitals fail to provide adequate discharge planning to ensure placement in the most integrated setting and to provide adequate supports and services necessary for successful discharge and continue to provide deficient services that subject patients both to actual harm, and to an excessive risk of serious harm, including: (1) inadequate protection from harm; (2) inappropriate mental health treatment; (3) inappropriate seclusion and restraints; (4) inadequate medical care; and (5) inadequate services to populations with specialized needs. ...

“HUNDREDS of patients currently confined have been determined by their teams of treatment professionals to be appropriate for community-based treatment, but nonetheless have not been discharged to the community or another more integrated setting. Scores of patients appear to be institutionalized because community services were not available to address their needs before admission; many of these patients never should have been admitted to an institution in the first place.

“There are numerous other patients who are admitted to the hospital for a brief period, given neither adequate treatment nor adequate discharge and transition planning, and then released, only to be re-admitted in weeks or months. In this population, frequently referred to as the “revolving door” population, it is not uncommon to find patients at any of the hospitals who have been institutionalized dozens of times in a period of a few years. Many patients, incredibly, have been re-admitted more than 100 times.”

State officials now appear prepared to argue they can’t fix all this “overnight.” It is quite understandable why the federal government is mightily miffed, an attitude all Georgians should share. To define “overnight” as lasting some 11 years since the remedy was defined in a court case from Georgia itself provides considerable evidence that the state’s leadership either has a very low IQ ... or is mentally disabled.

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