Northwest Georgia Regional Hospital

Northwest Georgia Regional Hospital was one of the state hospitals closed down after a 2010 settlement agreement between the state and the Justice Department. / File

Early this year, in the waning days of his tenure as Georgia governor, Nathan Deal wrote the U.S. Department of Justice a four-page letter asking for an end to federal oversight of the state’s mental health and developmental disabilities system.

The oversight role stems from a 2010 settlement agreement between the state and the Justice Department. In that landmark pact, Georgia agreed to improve conditions in its psychiatric hospitals and provide robust community services for people with mental illness and those with developmental or intellectual disabilities.

“Georgia has made tremendous improvements in the quantity, quality and availability of community-based services,’’ Deal wrote in his Jan. 8 letter, obtained by GHN through an Open Records Act request.

“Given this remarkable progress, and given the substantial compliance that Georgia has achieved, it is time to end the federal oversight’’ of how the state delivers services to people with mental health issues and developmental disabilities, Deal said.

The most recent reports by the independent reviewer of the settlement agreement, however, point to continued deficiencies in Georgia’s current delivery system.

The reviewer, Elizabeth Jones, said Georgia has made significant progress in expanding community services. But in a September report, she also noted gaps in the state’s program to provide supported housing to those people who need those services. She cited, in particular, such housing and services for people who are repeatedly in and out of jails or hospital emergency rooms, and for the homeless.

And Jones said the state isn’t meeting its obligations to provide needed services and support to people with developmental disabilities, especially those with “challenging behaviors.’’

Georgia officials followed up the Deal letter with a meeting in Washington earlier this month with DOJ officials. The administration of Deal’s successor, Gov. Brian Kemp, would not comment on the meeting, and neither would Justice officials.

Josh Belinfante, an attorney representing the state of Georgia, said in a March 11 letter to DOJ that “Governor Kemp agrees fully with Governor Deal’s letter and his (Kemp’s) executive counsel, David Dove, will be joining us for the meeting.”

Advocacy organizations agree that while Georgia has made major progress, significant gaps remain.

“While it’s clear the state has made remarkable progress, I’m not sure how the state can say they’re in full compliance” with the settlement agreement, said Susan Goico of Atlanta Legal Aid. Her organization is part of the “amici,” or friends of the court, involved in the Georgia settlement agreement. ‘‘The job’s not done yet,’’ she said.

Many people with complex mental health needs “are cycling in and out of jails,’’ Goico said. She also cited a shortage of specialized providers.

“The independent reviewer and her experts have done exhaustive work examining the strengths and weaknesses of Georgia’s system and whether the state is complying with all of the provisions of the settlement agreement,’’ Goico said.

“She (Jones) has found, and I agree,” Goico said, ”that there is still more work to be done to make sure people with mental illness are connected to the housing and community supports they need, as required by the settlement agreement. The settlement agreement is not at a place where we can walk away and hope for the best. ... I have a real concern that leaving the job undone will only set us back.“

The Department of Justice, contacted by GHN last week, declined to comment on the Georgia situation.

The DOJ involvement in Georgia several years ago followed a series of 2007 articles in the AJC that reported on dozens of suspicious deaths in state mental hospitals and a lack of funding for community services.

The 2010 settlement agreement was extended in 2016. Deal, in his letter, said Georgia has spent $263.5 million in its efforts to comply with the terms of the agreement.

He said that as a sign of the improvement in community services, the state has reduced the number of its psychiatric hospitals from seven to five and cut the number of beds to serve people with mental illness or developmental disabilities.

Of those remaining in the hospitals, Deal said, more than half are forensic patients, i.e., those involved in the criminal justice system. People with developmental disabilities, Deal pointed out, are no longer being admitted to the state-run hospitals.

Georgia, he said, “remains committed to sustaining the gains achieved and the continuous improvement of the system.’’

In the 2010 pact, Georgia agreed to establish community services and housing for about 9,000 people with mental illness, and to create community support and crisis intervention teams to help people with developmental disabilities and mental illness avoid hospitalization.

The attorney for Georgia, Belinfante, said in his letter to DOJ that from October 2010 to June 2018, the state provided supported housing to 8,532 individuals.

Goico questioned many of the numbers in the Belinfante letter.

Devon Orland of the Georgia Advocacy Office, part of the amici group, said, “There’s no question the state has put forth a significant effort. I’m thrilled they have made progress” toward reaching their goals, but “they’re not there” as of now.

She said it would be up to the federal judge involved in the settlement case to approve any final agreement to end the Justice Department oversight.

“Deal wanted (the settlement agreement) to end during his administration,’’ Orland said. Deal was elected governor in 2010 just a few weeks after Georgia and the feds reached the agreement.

In a supplemental December report, the independent reviewer said the state has failed to conduct sufficient outreach to people who are frequently seen in hospital ERs and those in jails and prisons.

“This results in under-counting the numbers of individuals who may need such support,’’ the report said. “The state, at best, only has the current capacity to provide supported housing to slightly over 3,100 individuals and the potential capacity to provide supported housing to approximately 4,700 individuals.’’

Such housing is a highly effective strategy to help individuals with serious mental illness achieve recovery, greater independence and meaningful participation in integrated community activities, the report said. It can also reduce the frequency and length of psychiatric hospitalizations, the report added.

Belinfante concluded his letter to Justice by saying that “in the past eight years, the census of the state hospitals has drastically (been) reduced, with no new admissions of persons with a primary diagnosis (of intellectual or developmental disabilities) to any state hospitals, and the state has developed a robust network of community providers’’ to serve people with mental illness and developmental disabilities.

A spokeswoman for Kemp, Candice Broce, responding to a query from GHN, said that “although we respect the independent reviewer’s work, we do not agree with recent claims regarding the state’s compliance. However, at this time, we decline the opportunity to get into further details regarding the settlement.’’

Georgia Health News, a nonprofit 501(c)3 organization, tracks state medical issues on its website georgiahealthnews.com.