• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Multiple Interest Groups Involved in Central State Debate

Posted on: Monday, 24 October 2005, 21:00 CDT

By Don Schanche Jr., The Macon Telegraph, Ga.

Oct. 23--For years, advocates have pushed for more community services so Georgians with mental retardation can live in their own homes and leave the confinement of state hospitals and nursing homes. In fact, the courts say people are entitled to those services.

Yet when the latest round of downsizing was proposed for Central State Hospital, the parents of some of those disabled people begged lawmakers not to move their sons and daughters out.

"William's been there 19 years. That's his home. You take him out of that place, I don't know what would happen," said Betty Spillman of Locust Grove. Her 35-year-old son, who cannot speak or take care of himself, lives in the Allen Building at Central State. He and his neighbors will leave the hospital next year, if a Department of Human Resources budget plan is approved.

Meanwhile, supporters of people with mental illnesses like schizophrenia have struggled just as hard to free the consumers of mental health services from psychiatric wards and develop a network of community services.

Some of those same advocates also stood to protest the downsizing of Central State.

What's going on here?

Part of the answer is that families and advocates -- particularly those on the mental health side -- are skeptical about promises of community services from a state that has traditionally spent less on those services than other states.

"(Among) mental health advocates, there's not a one that I know of that wants centralized care. But they want community care available before (hospital patients) are deinstitutionalized, and that's never been the case from when they started all the way through," said Pearlie Tackett of Warner Robins, interim executive director of the Central Georgia chapter of the National Alliance for the Mentally Ill. "You will hear, 'We're going to save money by closing the hospitals.' ... Some funding needs to come to whatever community they go to. It never does."

The debate about Central State has also spotlighted another fact: Multiple interest groups are involved. Among them:

Disabled people and their families, who want decent places to live, good services and help for people who need a hand.

Developmental disabilities advocates, who say it's wrong -- and illegal -- to segregate people in large institutions just because they have conditions like mental retardation or cerebral palsy. They say that with enough creativity and resources, there's a community setting in which every disabled person and his or her relatives can benefit. Developmental disabilities stem from a mental or physical impairment, become apparent before age 22 and are likely to continue indefinitely. Autism, cerebral palsy, spina bifida, epilepsy and mental retardation are all developmental disabilities.

Mental health advocates, who want effective prescription medicines, counseling, job support and sometimes living support for people with mental illnesses like schizophrenia and bipolar disorder. But they also want to have a hospital available when mental illness erupts into hallucinations and delusions.

Public providers of mental health and mental retardation services, which in Georgia are called community service boards. They have traditionally been Georgia's safety net for people with chronic mental illness. And they say they have been getting budget cuts, not increases, as Georgia releases more people from state hospitals.

Private service providers, who want to be able to compete for state contracts to serve people with disabilities. They say competition makes all service providers try harder to find innovative approaches, improving services for people who need them.

Police and courts, who get involved when mentally ill people are homeless, delusional and behaving in ways that get them in trouble. Thousands of mentally ill people are now in Georgia's jails and prisons. Sheriffs and judges say they're fed up with serving as a substitute mental hospital system.

State employees and Milledgeville officials who fear for their jobs and their community's economy as the hospital shrinks. In the mid-1980s, Central State employed more than 3,600 and had about 1,800 clients on any given day. Now it employs about 2,200 with an average daily census of 824. Workers at Central State say it's a far better place than it was decades ago, when more than 10,000 disabled people were "warehoused" in the institution.

State officials who must manage a budget and a system of services. Top DHR officials say they can provide better, more cost-effective services in community settings instead of hospitals. They say they have done the planning for a good transition from hospital to community.

In Georgia, services for mental illness, developmental disabilities and substance abuse are under a single division of DHR. But the clients and advocates for the respective services do not all share the same priorities.

DHR's budget proposal for fiscal year 2007 would open up 1,500 new community placements, called "waivers," for people with developmental disabilities. The line item amounts to $26.5 million in federal and state funds. Advocates for people with developmental disabilities say it's a major step to "unlock the waiting lists" for community services.

"I think we are again guardedly optimistic," said David Blanchard, who directs a statewide "Unlock the Waiting Lists" campaign and serves as director of public policy and education for the Atlanta Alliance on Developmental Disabilities. "We hope that the governor and Legislature continue to stay committed and understand that that commitment needs to be long-term."

Tackett said she does not get the sense that the state has done as much planning to transition mentally ill people out of the hospital as it has for people with mental retardation.

State officials insist they have planned extensively for both.

Charles Hopkins, deputy director of the DHR's Office of Developmental Disabilities, outlined a detailed personal planning process that includes discussions with clients, family, hospital staff and service providers. He said officials try to address concerns and fears, set up a plan for services to meet each client's needs and to monitor progress throughout the transition. He said that when parents see the range of community options now available -- even for severely disabled people -- it often allays their fears.

"We feel that this is the right thing to do," he said. "People with disabilities tell us they want to be in the community. Every state in the country is moving in this direction. It's about people not being separated from their communities and having an opportunity to go back to their communities."

Cherry Finn, acting director of the DHR's Office of Mental Health, described a similar planning process to transition mentally ill clients back to the community.

"I think families have valid concerns that services in the community need to be available and appropriate for an individual before they leave. I do not disagree with that at all. That is the reason we have been working very diligently to move our service system to be more in a consistent delivery mode throughout the state, so the services that are provided meet the standards that are set and are delivered in a quality way that follows the standards."

There is a major difference, however. Developmentally disabled clients who move to the community take their Medicaid funding with them. On average, Hopkins said, that amounts to $60,000 per year, per client.

"Once the individual is accepted into this waiver program, those funds are his or hers for life," Hopkins said. "They're his or hers to be used as he or she and the family directs. Those funds don't go to some provider who says, 'This is the way it is, take it or leave it.' "

There is no similar funding provision to guarantee that funds follow a mentally ill person from hospital to community. But Finn said DHR plans to use savings from the hospital downsizing to provide and pay for community mental health services.

"Any funding that we would put out into the community would go on a competitive bid process," she said. "Everything we are trying to do at this point to create services we are trying to do competitively."

Betty Spillman, whose son lives at the Allen Building, is skeptical that her son will get the developmental disabilities services he needs if he leaves Central State.

"William cannot live in a place that is not 24-hour care. ... There's no place I know that can give these people 24-hour care unless it's a place like Central State," she said. "I don't like institutions any better than anybody else does, but sometimes they have to be placed in places like this. If I had my druthers, I'd have William at home. But I just can't keep him here. I just don't understand what they're trying to do."

-----

To see more of The Macon Telegraph, or to subscribe to the newspaper, go to http://www.macon.com

Copyright (c) 2005, The Macon Telegraph, Ga.

Distributed by Knight Ridder/Tribune Business News.

For information on republishing this content, contact us at (800) 661-2511 (U.S.), (213) 237-4914 (worldwide), fax (213) 237-6515, or e-mail reprints@krtinfo.com.

Source: The Macon Telegraph (Macon, Ga.)

More News in this Category