The decision to close Southwestern State Hospital in Thomasville announced last week will affect Valdosta and surrounding communities by limiting the options for placement of patients with a mental illness.
However, according to Dr. Nitin Patel, the medical director for Behavioral Services of South Georgia, other options will take the place of the hospital and the community need not fear that those with mental illnesses will be roaming the streets.
“They will always be taken care of, just in a different setting,” said Patel. “The Department of Behavioral Health & Developmental Disabilities is drawing up plans now for acute care facilities in communities.”
According to Patel, housing mentally ill patients in community-based centers allows them to stay closer to home while receiving treatment and they can be better monitored.
“Now, most patients are admitted against their wishes, and when they are released, they may or may not do as the doctor prescribed. They may miss follow-up appointments and not take their medications.”
Patel said that the community-based centers will be able to follow these patients more closely to provide a “better continuity of care.”
Currently, South Georgia Medical Center alone sees approximately 135 patients through the Emergency Room each month who have a form of mental illness, according to Randy Sauls, chief executive officer.
“Most of the patients we see in the ER have a serious issue, and they are in danger of harming themselves or others, or they have an inability to care for themselves.”
Of the 135, Sauls said approximately 50 are able to be discharged back into the community, with the remaining 85 requiring transfer to another facility for treatment.
“Of those 85
approximately 20 each month are sent to Southwestern in Thomasville and the others are sent to facilities around the state, in Albany, Columbus, Augusta, Milledgeville or Atlanta, depending on the patient’s needs,” he said.
According to Sauls, SGMC cannot legally let a patient leave until a place can be found for them, which could be a matter of a few days or longer.
“By law, we cannot discharge them. When we find a facility that can take them, we have a contract with the Lowndes County Sheriff’s Office to transport them,” he said.
Patel said often, these patients are handcuffed and restrained when they arrive at a treatment facility, which carries a “stigma.”
According to Patel, many of these patients are fine in outpatient centers with about 5 to 10 percent needing more care.
“These 5 to 10 percent include those with severe mental illness, such as schizophrenia, bi-polar disorder, major depression, severe anxiety or severe substance-abuse issues,” said Patel. “They need to be in a more secure, acute care facility.”
Although there are plans for an acute care facility locally, Patel said no site has yet been selected and the details are not yet finalized. However, Behavioral Health Services will open and operate these facilities in all of the counties they serve.
Sauls said he has not yet been informed about the future placement of these patients but as Southwestern isn’t slated to close until the end of the year, he feels certain that plans will be in place by then so they have somewhere to go.
“The decision to close Southwestern doesn’t just affect us here in Valdosta. It affects all of the region’s hospitals, including Berrien, Brooks, Cook and Lanier,” he said.
Patel said the decision to close Southwestern was partly economic and partly due to the Department of Justice lawsuit (see History sidebar).
“Operating Southwestern was very expensive,” he said, adding that the employees displaced by the state’s decision will have the opportunity to transfer to one of the community-based facilities.
“Those with severe mental illness will not be out walking the streets, being aggressive or violent. They will always be taken care of,” Patel said.
In Olmstead, Commissioner, Georgia Department of Human Resources, et al vs. L.C., a female with mental retardation and schizophrenia, was confined to Georgia Regional Hospital in Atlanta and held for an extended period. She sued the state of Georgia for discrimination based on her disability as a mental health patient under the ADA, the American Disabilities Act. The ADA states, “no qualified individual with a disability shall, by reason of such disability, be excluded from participation in, or be denied the benefits of, a public entity’s services, programs or activities.”
Doctors at the facility had determined that the female patient could be treated in an outpatient facility, but the state claimed that lack of financial resources led to her continued confinement. According to the U.S. Department of Justice, the patient won in court, including the state’s appeal in the U.S. Supreme Court.
The original case was brought in 1983, and the final decision was rendered in 1999 by the Supreme Court, but Georgia did not act on the decision sufficiently to satisfy the courts.
In 2009, the Civil Rights Division of the ADA launched an aggressive effort to enforce the Supreme Court’s decision, In 2010, the Department of Justice announced a settlement with the state to reform the system. The agreement forces Georgia to reallocate its resources for the treatment of mental-health patients to include community-based programs.