State settlements called into question

As covered extensively in this blog, Georgia's mental health system has been under scrutiny and finally reached an agreement with the federal government to overhaul patient care (see "Georgia reaches agreement with feds.")
According to an NPR report today, however, the Justice Department's agreement with Georgia and five other states, including Hawaii, Washington, South Carolina, Tennessee and Connecticut, are on ice. According to the NPR report, "Advocacy groups say the terms of these last-minute settlements are inexcusably weak and that the agreements don't do enough to make sure the states fix their problems."Sphere: Related Content
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A brighter New Year for mentally ill prisoners in Hawaii, New York

Aloha: friendly, hospitable, welcoming
According to the US Department of Justice, Hawaii has been anything but the Aloha State for the mentally ill incarcerated. After launching an investigation in 2005 of the O’ahu Community Correctional Center, the feds in 2007 declared the facility had glaring deficiencies when it came to treating mental health and later filed suit against the state.
On December 31, the Honolulu Advertiser reported that the state reached a settlement agreement with the DOJ. Among the changes to be made:
• A ban on “therapeutic lockdowns” in which inmates were routinely isolated from staff or mental health professionals.
• Mandating that inmates placed in “individualized seclusion” be assessed by an appropriate mental health professional within four hours and routinely checked afterwards.
• Improving suicide watches.
• Increasing control of psychotropic medications.

New York’s state of mind
Seeing that 10% of their prison population is diagnosed with a psychiatric illness, New York’s Office of Mental Health and the Department of Correctional Services are unveiling a new “wellness self-management” program.
Starting in February, inmates will attend seminars to learn about coping with their mental health conditions, managing medications and side effects, and how to improve communication with clinicians.
The initiative begins at Fishkill Correctional Facility in Beacon followed by the Sing Sing and Bedford Hills prisons.
Read more about this at the Poughkeepsie Journal.Sphere: Related Content
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Georgia Edges Toward Eliminating Public Psychiatric Hospitals

Their mental health infrastructure in shambles, their services under investigation by the US Justice Department and their money pool evaporating, Georgia's Department of Human Resources may just go for broke. They are considering a plan which would privatize the state's entire mental health network. Such a move would put Georgia boldly where no state has gone before. Florida and North Carolina made overtures to the private sector in their recent pasts, parceling off pieces of their psychiatric system to for-profit entities who then delivered grim results in the form of substandard services and stagnant outcomes.
As recently as September, Human Resources Commisioner B.J. Walker was publicly floating proposals allowing a measured amount of privatization. But when the Department quietly met in November, Walker laid out plans for a total surrender of the state system. When word got out to the media, considerable consternation ensued. Ellyn Jeager of the advocacy group Mental Health America politely expressed "serious reservations" about the strategy, telling the Atlanta Journal-Constitution, "Private companies are in the business to make money. I’m not sure it will improve the system.”
Then again, maybe they will. Georgia's state-run system has been faulted for negligent care resulting in a dizzying 136 patient deaths between 2002 and 2007. It's hard to imagine any privately held corporation would tolerate that many risks to its bottom line.

PHOTO: NED HORTONSphere: Related Content
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California's Mental Health Services Act: Who Is Being Served

In the cash-strapped state of California, things aren't quite so golden these days. We like to govern by initiative, meaning all sorts of programs and laws are born without making much sense in the larger reality. So it was with Proposition 63 in 2004, the so-called Mental Health Services Act.

Well-intentioned but fundamentally flawed, the law imposed an additional levy on taxable incomes of $1 million or more. Out here in the land of swimming pools and movie stars, that can add up to a sizable chunk of change. So far, the Act has generated a handsome $3.2 billion for the state's coffers. Problem is, only $726 million has been distributed. What gives? Apparently not those administering the money.

As eloquently pointed out in Prop 63 consultant Rose King's opinion piece last Monday in the Sacramento Bee, the state's Department of Mental Health issued 67 pages of requirements in 2005 for the first applications. Their strategy was to share the wealth with new and innovative programs while telling the old timers to take a hike. Apparently to some bureaucrats up in Sacramento, the death rattles emitted by our suffocating mental health system are little more than passing wheezes. Never mind there are hundreds and thousands unserved and underserved by exisiting services or that the traditional safety nets are full of gaping holes or that we have lost many psychiatric hospitals to financial woes.

Proof once again that if bureaucracy gets involved in healthcare, it's bound to mess it up.

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