Privatizing Mental Health Hospitals: Don't Rush to Hand Off Care of Patients in Need

By Thomas Bornemann

Dec. 19, 2008

This op-ed was published in the Dec. 19, 2008, edition of the Atlanta Journal-Constitution.

Georgia continues to experience the effects of a mental health system that is tragically broken. Georgia Department of Human Resources (DHR) has responded with some new proposals, one of which is privatizing and downsizing state mental hospitals.

In their 2007 series "A Hidden Shame," Atlanta Journal-Constitution reporters Andy Miller and Alan Judd exposed 115 suspicious deaths in Georgia state mental hospitals from 2002-2006, and even while the state of Georgia was under investigation by the U.S. Department of Justice for that, the reporters found that the number of questionable deaths as a result of abuse, neglect and poor medical care climbed to 136. The ongoing safety of the remaining mental health consumers and staff in state mental hospitals is paramount and should be monitored carefully.

Privatization is a tactic done in the service of reform and should not be viewed in and of itself as a broad strategy. The issues associated with hospitals are part of a larger systemic problem. The system is underfunded, fragmented and plagued by serious service delivery gaps.

Before launching into such radical reform, it is imperative that a clear and comprehensive vision for mental health system transformation be articulated. This vision should include both inpatient and community-based care and services that would support individuals with severe mental illnesses to build meaningful lives — with families, friends, employment and dignity. We also can't ignore the complex needs of children and adolescents, which are central to system transformation.

While some privatization may have merits, it is imperative that Georgia's decision-making process be transparent and incorporated into a larger system of reform. The recent final report of the Governor's Mental Health Service Delivery Commission recommends that a complex set of questions drafted by the commission be addressed prior to awarding any contracts to private agencies in a privatization process.

DHR should carefully review the records of other states that have attempted privatization including Florida, North Carolina, Pennsylvania and Indiana. The privatization record is mixed at this point and there is no clear evidence that privatization alone saves money or improves care. What assumptions is the state operating under? What are the projections for future revenue? Will this decision decrease access to community-based services? What facts has DHR put forth to justify having private companies build two new hospitals?

The proposal is expensive. While private companies may pay construction costs up front, Georgia taxpayers will pay for those costs (plus profits) for the private companies over the next 20 years.

This time of crisis calls for a new way of doing business that opens the doors to policy-making through optimal transparency and public engagement. The DHR must do a better job of soliciting public comment, especially by those most affected — consumers, families, and mental health professionals — before decisions are made, not after.

The recent settlement between Georgia and the U.S. Department of Health and Human Services Office of Civil Rights in the Olmstead case requires that the state involve consumers and advocates in "planning how best to provide adequate community services that will meet the needs of all Georgians." A great deal can be learned from their experiences.

Georgia will be better equipped to address its mental health crisis through an inclusive, deliberative process that involves consumers, families and other key stakeholders, rather than the current rush to privatize. We cannot ask for less for those with mental illnesses who have been entrusted to the state for safe, humane and appropriate care.

Thomas Bornemann is director of the Mental Health Program at The Carter Center.