LETTER TO THE EDITOR: Specialized hospitals needed for treatment of mentally ill

Dear Editor:

Once upon a time, not too many years ago, the state of Georgia maintained a hospital for the mentally ill in each Community Service Board region of the state.

Milledgeville State Hospital also provided housing for those judged to be criminally insane. There also was a long-term care facility for the mentally ill near Bainbridge. While conditions in these hospitals were somewhat spartan, the residents of these hospitals were receiving care for their problems from hospital personnel trained to deal with the mentally ill.

The federal government became concerned about conditions in hospitals for the mentally ill throughout the country, and convened a group of mental health professionals to recommend changes and improvements. This group of well-intentioned mental health professionals made a report that could be summarized in a single sentence. They reported that “Community care is better than institutional care, when it is properly funded”.

Many state governments, including Georgia, leapt upon the first seven words of this proposition with glad cries and visions of avoiding the admittedly substantial cost of maintaining hospitals for the mentally ill in Georgia, probably believing that the Community Service Boards, such as Aspire in Albany, would be able to provide all of the necessary community care for the mentally ill in Georgia.

Unfortunately, apparently no one in Georgia state government ever considered or investigated the possible cost of funding truly adequate community care. As it turned out, when the state hospitals for the mentally ill were closed, the state of Georgia actually began to budget less for community services for the mentally ill. As I watched this catastrophe begin to unfold, I felt compelled to resign from the board of Aspire (then known as the Albany Community Service Board).

Looking at the system as it exists today, I draw two conclusions. My first conclusion is that community care, even if properly funded, is based on a faulty premise. Since 1985, serving as County Guardian for several Probate Courts in southwest Georgia, I do not believe that there will ever not be a need for long-term institutional care for some mental health patients. As an example, for many years, I served as the VA Guardian for a veteran with severe mental issues. While he was a patient at Milledgeville State Hospital, he was prescribed a new drug called Clozaril. This drug made him into a functional human being. The drug is very powerful and very expensive. Moreover, a patient taking the drug must have laboratory blood work every month.

Every two or three years after I became his VA Guardian, the VA would insist on trying (or retrying) other less powerful and less expensive drugs. The consistent result was that the veteran would decompensate and become unable to live outside of an institution. In 2016, after the VA mandated another attempt to use a less powerful and less expensive medication, this veteran, as predicted, decompensated. Unfortunately, there was no longer any place in Georgia by 2016 where the veteran could be cared for during the five months minimum hospitalization period required to get this veteran back on Clozaril. Only because I was willing to take the veteran to a VA hospital in Florida, where he could stay for a month and then be discharged to the Northeast Florida State Hospital in Macclenny, Fla., for four additional months, was the veteran able to return to a mostly normal life.

My second conclusion is that closing the hospitals for the mentally ill in Georgia is not actually an overall savings. It is simply a shifting of the roughly predictable expense of housing the mentally ill in hospitals run by the state of Georgia to the unpredictable and almost certainly much larger expense of housing the mentally ill in the jails and prisons of the 159 Georgia counties. It has been estimated that 60% of the prisoners in Georgia jails and prisons are mentally ill.

A significant (and mandated by federal law) cost of housing prisoners with mental illness is providing those prisoners with the medication prescribed for their illnesses. Psychotropic drugs are almost all very expensive. If the state of Georgia were purchasing these expensive medications for an entire system of hospitals, the state could bargain for a bulk price, with significant savings. The sheriffs who run prisons and jails in Georgia have no such option.

Also, many counties do not provide in their budgets for such drugs. In one Georgia county not very far from Albany, the policy of the county sheriff is that if he becomes aware that such medication for a prisoner is required, to simply release that prisoner, regardless of what any judge might have to say about the situation. He has no budget for the medications, nor any expectation of getting a budget for the medications, so he has no alternative but to release the prisoner, rather than violate federal law.

A hospital for the mentally ill is probably going to be staffed with personnel with at least some training in dealing with the mentally ill. Proper equipment, including restraints, is going to be available in such hospitals to deal with patients who sometimes become violent. Jails and prisons are not going to ever be staffed with the specialized personnel and equipment needed to deal with the mentally ill. Conversely, hospitals for the mentally ill do not require the kind of physical security needed for jails and prisons, such as razor wire atop high fences.

Putting the mentally ill into jails and prisons, which must be more common than necessary because there are no hospitals in Georgia for the mentally ill, is putting square pegs into round holes. Dealing with prisoners who are being punished requires an entirely different staff mindset from dealing with patients who need medical care. At the end of the day, more of the citizens’ tax money is being spent every year and fewer mentally ill citizens receive proper care. Specialized hospitals are needed in Georgia to treat and care for the mentally ill and should be re-opened.

Michael C. Hall

Albany