The Journey is Ongoing

July 9, 2019

When people think about our state’s safety net for people with psychiatric disorders, they may think about Georgia’s five state hospitals. Our hospitals are an essential element of the safety net continuum. They provide a vital resource for individuals with serious behavioral health issues. DBHDD’s hospital system has served as the cornerstone of Georgia’s mental health landscape for nearly 200 years, beginning with the opening of Central State Hospital in Milledgeville in 1842. Our second hospital, Gracewood, (now a part of East Central Regional Hospital in Augusta) was built in 1921. Like most states, Georgia continued to expand its hospital portfolio throughout most of the 20th century.

Until recently, state hospitals were the primary service delivery sites of the safety net. In the 1990s, we had nine state hospitals in our network. However, along with the national trend to “deinstitutionalize”, we reduced the footprint of our hospital system and expanded our capacity to care for individuals in the community. In 2009, we closed the child and adolescent units in our hospitals, and in 2011, we stopped admitting individuals whose primary diagnosis was an intellectual or developmental disability (I/DD). We now have five state hospitals which serve primarily forensic individuals (who have a serious mental disorder and are involved with the court system) and also individuals whose chronic mental health and substance use needs cannot be met in a community setting. We continue to facilitate transitions for individuals with I/DD that can safely live and thrive in community homes.  

Since becoming a standalone agency in 2009, DBHDD has led a remarkable transformation of our entire system, shifting from a hospital-centric system to a more comprehensive continuum of care. With the generous support of many elected officials, we have significantly enhanced our community crisis system, adding 355 community crisis beds. This has allowed us to use our hospital beds to primarily focus on forensic individuals and Georgia’s most vulnerable individuals with serious and persistent mental illness. We rely on our hospital system to provide safe and secure settings. It is so important that our citizens, often stigmatized as a result of their symptoms and behaviors, can receive high quality, recovery-focused care that prepares them for a successful life in the community upon discharge. The shift to a focus on recovery and wellness was intentional, as recovery is at the heart of our work.

We have modernized our hospital system and work in collaboration with community-based services to help individuals experience sustainable recovery. In a recent report, we confirmed that our 30-day Readmission rate (the percentage of people discharged who are readmitted to the hospital within 30 days) was 5.1 percent. This represents a 35 percent reduction from the readmission rate five years ago. This is a testament to our investment in community resources and improved discharge planning.  

So how does “recovery” take hold within the walls of a state hospital? We have infused hope and wellness in our hospital system through therapeutic work programs and a recovery-based approach to treatment. For the last 20 years, Georgia has led the “peer” movement in this country. Peers are individuals that have experienced mental illness or substance abuse and are successfully navigating their recovery journey. Peers are specially trained to use their lived experiences to help motivate and support individuals receiving services. Alongside clinical staff, they build relationships with clients and support them while they are in the hospital and as they transition back to the community.

While the aging infrastructure of our hospital system presents challenges, we have retained a firm commitment to modernizing components of our facilities to assure safety and enhance quality. We have also implemented dynamic and innovative programming that reflects our commitment to high-quality care. Here are a few examples:

We implemented trauma-informed care programs at West Central Regional Hospital (Columbus) and Georgia Regional Hospital in Savannah.
We upgraded our Treatment Malls in Georgia Regional Hospital Atlanta (2014), West Central Regional Hospital (2015) and Central State Hospital (2018), opening new, state-of-the-art facilities.
We use iPads on the forensic unit at East Central Regional Hospital to assist clients with developing technology skills and accessing information on the Internet.
We are designing a complete renovation of the cafeteria at East Central Regional Hospital in Augusta, embracing new technology and including recover-oriented concepts such as an outdoor seating area, and a sugar-free diet.
At Georgia Regional Hospital in Savannah, we are remodeling the old gymnasium into a new Treatment Mall space. We have taken our learnings from the previous renovation projects to make this our best service delivery model yet. Staff members in Savannah are participating in Cognitive Therapy for recovery, which brings a community-based approach into the hospital setting.
We completed the design phase for a new 40-bed forensic unit at West Central Hospital, which will feature the most natural light in any unit in our system, and promote recovery and wellness in the design and fixtures. We will break ground in the fall and look forward to this much-needed addition to our system.

Our state hospitals will continue to anchor Georgia’s safety net. We are grateful for the support of the General Assembly and Governor Kemp, whose team joined us for a visit in July. Of course, the heart of our hospital system is our strong team of skilled leaders and dedicated staff. Despite workforce shortages in every area of service, I am very proud of Georgia’s safety net hospital system, and we are excited to continue to improve the service we provide for Georgia’s most vulnerable individuals.

Judy Fitzgerald
Commissioner