Georgia’s grimmer health realities
Friday’s editorial (“Improving health in Georgia cities?”) shared some quasi-encouraging Georgia numbers from the latest Commonwealth Fund study of 306 urban health care “markets” in the United States. The encouragement is in the fact that Georgia’s urban health “scorecards” have substantially improved, and that Columbus ranks second highest in the state, behind only Atlanta.
But context and perspective matter. Georgia as a whole and each of the seven cities individually still rank in the bottom half nationally, and only Atlanta, at No. 189, made the “top” two-thirds. More perspective: While one of the important categories in which Columbus showed improvement is care of nursing home patients, Georgia Public Broadcasting reported last week that statewide, almost half of Georgia’s nursing homes have low ratings, and according to a report by the Kaiser Family Foundation, the state “consistently ranks at the bottom in terms of care and quality.”
That’s a disheartening health report for one of our most vulnerable health care constituencies, the elderly. A recent report on another vulnerable population, the mentally ill, paints an equally or more depressing picture, and in considerable detail.
Some background: Investigative reporting by the Atlanta Journal-Constitution revealed that between 2002 and 2006, Georgia mental hospitals, mostly in the Atlanta area, had released approximately 5,000 patients to homeless shelters, motels, bus and train stations, even at abandoned buildings or just on the street. Not surprisingly, the Georgia psychiatric hospital readmission rate was half again the national average.
The situation led to a 2010 agreement between the state and the U.S. Department of Justice. But as reported in Georgia Health News, a May update of the agreement alludes to lingering problems in the state Department of Behavioral Health and Developmental Disabilities. Among them is the continuing discharge of mental patients to homeless shelters. According to the DOJ report compiled by independent reviewer Elizabeth Jones, 34 of those patients had already been admitted to mental hospitals at least 10 times.
“At this time,” her report says, “… [the DBHDD] has not demonstrated that it has met the threshold requirement of identifying the need for supported housing for the target population.”
Only last year, Jones notes, the state’s own records document 217 discharges from three state hospitals to homeless shelters, mostly in and around Atlanta.
Some of the conditions into which patients are released are at least as appalling as the policies that allow them to be released there: During unannounced visits to shelters where mental health patients are discharged, Jones wrote, “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.”
One of the problems, as has long been the case in social services for children (another vulnerable population), is staffing. Georgia Public Broadcasting recently reported that both the number of psychiatrists and the availability of inpatient psychiatric space are decreasing in the state. The Justice Department report found that in the five state Behavioral Health hospitals, 38 percent of the registered nurse positions, 37 percent of the psychiatrist positions and 26 percent of the psychology positions are unfilled. The facilities make do with temporary clinicians who “may or may not understand the DBHDD system [and] the law,” the report notes.
Georgians in need of mental health care do not have a large, vocal or well-funded lobby to compete for money with other interests that are quite adept at getting it. That doesn’t change their need for our help, or our moral obligation to provide it.
This story was originally published July 16, 2016 at 5:49 PM with the headline "Georgia’s grimmer health realities."