Mental health budget under assault

By Matt Flumerfelt

VALDOSTA — With Georgia’s new legislative session set to begin on Jan. 12, mental health advocates are gearing up to challenge Gov. Sonny Perdue’s plan to privatize the state’s mental health system and to oppose further attempts by the governor to cut the budget of the already under-funded system.

The National Alliance for Mental Illness (NAMI) has been inundating the governor’s office with letters, said Nancy Tennyson, a longtime NAMI member who lives in Brooks County. NAMI sent a letter called Gray Matters to all its members, requesting them to print it on gray paper and send it to the governor’s office.

Gray Matters asks the governor to take a number of steps to improve the state’s mental health system, including exempting mental health from any further budget cuts, going forward with plans to separate mental health and addictive diseases from the Department of Human Resources and Behavioral Health and make it an independent department, and fully funding the recommendations of the governor’s mental health commission.

NAMI is also preparing to release another National Survey of Mental Health Services in the U.S. this year, Tennyson stated. Georgia received a grade of “D” on the last NAMI survey.

This past summer, the governor shifted $8.4 million from the mental health budget to, “other programs in the State Department of Human Resources to meet administrative expenses and cover funding deficits,” according to the Atlanta Journal-Constitution.

The governor’s mental health commission, in their final report released on Dec. 4, 2008, questioned the wisdom of cutting the mental health budget at a time when Georgia’s mental health system is already under investigation by the U.S. Department of Justice for “critically deficient conditions.”

Given the state’s current budget deficit, however, the commission’s recommendation for “an ambitious five-year blueprint to reform Georgia’s troubled mental health system,” seems unrealistic.

The governor’s commission does not endorse the privatization plan, according to its own report.

The U.S. Justice Department opened a civil rights investigation into all seven of Georgia’s state hospitals, following the publication of a series of articles entitled “A Hidden Shame,” in the Atlanta Journal Constitution beginning on Jan. 1, 2007, that exposed deplorable conditions in state mental facilities. The Perdue commission was created in the wake of those articles and subsequent investigation according to the Constitution.

An article in “Out of Control,” a publication of the Reason Foundation, states that Georgia’s push to

privatize its mental health facilities has gained momentum because “service quality under state operation has literally deteriorated to the point that lives are at stake.”

Following the lead of Washington, D.C.’s Department of Mental Health (DMH), which announced in October 2008 that it plans to privatize its mental health centers in 2009, Georgia state officials want to hire for-profit companies to build and operate three new psychiatric facilities to replace all seven existing state hospitals, according to the Constitution.

Proponents claim that privatizing saves money and improves care. D.C.’s Department of Mental Health Director, Stephen T. Baron, is quoted in the Reason Foundation article saying that, “If DMH privatizes its centers, it will save a lot of money and have a chance to increase the number of residents it helps.” DMH spokesperson Phyllis Jones, in the next paragraph, identifies the source of the savings. “The private providers tend to have cheaper labor costs.”

Critics of privatization complain that combining competition and the profit motive with medical care is risky, with Georgia’s mental health consumers being those at greatest risk under such a plan.

NAMI member Lisa Majersky, in a letter printed in the Athens Banner-Herald on Dec. 4, 2008 stated, “Putting the profit motive into medical care is, in my opinion, a crime against humanity.” Majersky argues that private corporations would be less motivated to cooperate in cases of possible wrongdoing because negative publicity could affect profitability.

Sue Gupton, executive director of the South Georgia Community Service Board d/b/a Behavioral Health Services of South Georgia (BHS), stated that she opposes privatizing the state’s mental health facilities.

“I’m sure the current administration is looking to save money,” Gupton stated, “but so often with privatization the services are cut to accomplish this.”

“I support NAMI’s opposition and like many I am wondering why there is such a rush to make these monumental changes when a new department is likely to be created in July,” Gupton said. “Why wouldn’t you wait six months and have the new commissioner of behavioral health make those decisions for the future?”

Gupton stated that funding cuts have already resulted in major downsizing for BHS, which has gone from a staff of 400 to approximately 250 and from programs in every county to programs in only three of the 10 counties they serve. Even with the cuts, however, they continue to serve all 10 counties, but with severely diminished resources, Gupton stated.

“If BHS had not experienced years of funding crises, the impact of the budget cuts could be managed, but given the history of the funding, the next round of cuts will severely impact the already underfunded service delivery system in South Georgia.”

Gupton pointed out that when the economy takes a downturn, there is always an increase in the demand for services — increased anxiety and depression, increased stress leading to increases in substance use and abuse, domestic violence and child abuse, etc. If the resources are not available or if there’s a long wait to get into services, these problems will be handled elsewhere, i.e. through the criminal justice system, emergency rooms and so forth.

“Cutting social services during an economic downturn seems unwise,” Gupton stated. “These issues have to be addressed and paid for somewhere, either at the front end through better access to the services, or on the back end through the corrections system or ERs. A question to be pondered,” Gupton stated, “is where will those entering through ERs go if state hospital access is so limited?”

Nora Lott Haynes, president of NAMI Georgia, said that the state’s plan is backwards. “First,” Haynes said, “we need to fix the community mental health treatment system before we look at changing the hospital system. And,” Haynes stated, “nothing will work if we don’t have adequate funding.”