Coalition for Homeless People with a Mental Illness Meeting, March 21, 2012

 Monthly Meeting of  Coalition for Homeless People With A Mental Illness, Wednesday,

March 21, 3:30 to 5 p.m., First Presbyterian Church, 16th Street at Peachtree Street, Room 156.  The agenda includes updates on four important issues discussed at the February 15 Meeting.


Dr. Chris Gault, Director of Mental Health Outpatient Services at Grady Hospital, Michael Link, Regional Administrator for Region 3 of the Ga. Dept of BHDD, and Dave Lushbaugh, former national board member of NAMI agreed at our February monthly meeting to look into these concerns. Each was requested to provide an update of their efforts though some of them may not be able to attend our meeting. We hope to present you with their reports.


The issue of meds for the uninsured, indigent was not discussed except momentarily last month  but we are looking into this issue also.  Alan will report on the status of our efforts.


All these issues deal with homeless people's access--and lack of access--to mental health and addictive disease recovery services


Intercounty referrals for mental health outpatient treatment


Persuading GCAL & GDHBDD To Share Information About Fulton County's 5 mental health outpatient centers


Grady's Adult Mental Health Intake Unit (formerly Florida Hall)


Mental Health Meds: Should meds, like treatment is now,  be provided without a co-pay for all who are "unable to pAY." come and join in the conversation


Coalition for Homeless People with a Mental Illness Meeting Discussion with Sue Jamieson, Atlanta Legal Aid, 3:30 p.m. February 15, Atlanta First Presbyterian Church.
The discussion will cover 3 concerns and how they appear to be interconnected.

1. Problem getting a timely appointment at Grady MH OP and elsewhere in Fulton and DeKalb Counties

2. Effects of GCAL not being able to share information with callers on how to access the 5 MH OP Centers controlled directly by the Fulton County DBHDD

3. Effects of GDBHDD not enforcing the public's right to be treated at any MH OP center of their choosing regardless of county of residence if that center contracts with GDBHDD to do so

Here's The Situation
As best can be determined

Judging by the significant lengthening of the time it takes to get a first-time appointment at all 13 public adult mental health outpatient centers in Fulton and DeKalb Counties, it appears the demand for services has dramatically increased (or staff decreased). Nowhere has this demand been greater than at Grady's Adult Intake Unit and at the Auburn Avenue Recovery Center (AARC), especially in recent months. The demand appears to be greater than its ability to serve timely all of Grady's patients who need these services and also serve timely all central Fulton County residents seeking services, especially the homeless, who live in the AARC catchment area.

GCAL is intended to be the single point of entry for every Georgian to access public mental health services. As of February 9 the earliest routine appointment at Grady for mental health services through GCAL was for August 3 according to GCAL Grady currently allows GCAL to make only one appointment per day for its MH OP Center. Thus GCAL is frequently diverting callers to other centers far from their own neighborhood centers and often they have no means of transportation to get to those centers.

Should not Grady's center be provided with enough staff so it does not have to reduce GCAL's allotment of daily appointments to one a day? Should not every resident in central Atlanta have equal access to Grady's mental health services? Is there a need to open a new MH OP center in central Atlanta to meet what appears to be a growing need for services?

GCAL on February 9 said "urgent" appointments can be made only when a caller needs help within 48 hours and that Grady's earliest "urgent" appointment is for March 3.

Homeless people and all other residents who are indigent and uninsured who live in central Atlanta who have no means of transportation to other centers should have timely access to services. To have to wait until August for a first time appointment is not timely service. At what point does mental health service delayed equal service denied?

Mental illness and addiction are primary reasons for homelessness among people who have been homeless over a year or repeatedly homeless. The Tri- Jurisdictional Collaborative on Homelessness's "Population and Subpopulation" report to HUD shows in 2011, of the 6131 adults counted in the 2011 homeless census, 3093 were identified as "seriously mentally ill" and 3575 who were "chronic substance abusers". The very large majority of them live in central Atlanta and either get help for their mental illness and addiction from Grady or no help at all because they lack transportation to get to the centers that offer earlier appointments. Forty percent of all homeless people have been homeless over a year and 35% live outdoors. The huge majority can get neither transitional/permanent housing nor are in treatment for their mental illness or addiction.

GCAL reports that in Georgia, only Fulton and DeKalb Counties does it take more than a week or two to get a first time appointment at a public MH OP center. What is the GDBHDD doing to address this?

One of the selling points for bringing GCAL to Atlanta in 2003 was that it would produce data that would allow the GDBHDD to identify problems and address them. Is the GDBHDD not aware of the problems in Fulton and DeKalb Counties, especially at Grady?

No one expects the Behavioral Health standard of making "routine" appointments within 7 days to be met any time soon but taking 60, 90, or at Grady 176 days represents a crisis that needs to be addressed urgently.

Currently homeless and all other individuals or those assisting them cannot call GCAL for an appointments at Grady and cannot call Grady's MH OP center for an appointment. The only way they can get an appointment is to go in person to 48 Coca Cola Place when they open and hope to be one of few who can be seen as a walk-in. Is this not a completely unacceptable level of service by anyone's standard?

There are 13 MH OP centers for adults in Fulton and DeKalb Counties: 8 are in Fulton and 5 in DeKalb. One of the 5 DeKalb centers, North DeKalb, accepts only individuals who have Medicaid so it is off-limits to many individuals. Of the 8 in Fulton, 5 are under full control of the Fulton County DBHDD with the other 3 under contract with the GDBHDD. When an individual from Fulton County calls GCAL, they will as stated above be given the option of going to Grady, Northside, or Newport (which is located on the far east side of DeKalb County). Callers to GCAL will not be told about the 5 centers managed by the Fulton County DBHDD. Further, DeKalb County CSB, contrary to its contract with the GDBHDD, does not allow GCAL to make any appointments for anyone outside of DeKalb County. As a result, of 13 public MH OP centers in these two counties, Fulton County residents who call GCAL are offered only 3.

Of greatest concern for the majority of our homeless people with a mental illness is that Grady's actions though with the purest of intent, for all practical purposes has blocked GCAL from making appointments leaving only Northside and Newport for homeless people. Thus, Northside and Newport MH OP centers are overloaded. Northside's next open appointment is for April 16 and Newport's is April 10 as of February 9 according to GCAL.

What Can Be Done?

The GDBHDD should bring together the Metro Atlanta DBHDD Office, the DeKalb CSB, the Fulton County DBHDD, Grady Hospital and the Regional Commission on Homelessness to address these concerns:

1. act immediately to reduce, especially at Grady, the length of time it takes to get a first-time appointment with the goal of coming as close as possible to the standard of 7 days.

2. consider either the Fulton County DBHDD or the GDBHDD opening another MH OP center in the downtown area that perhaps would be dedicated to serving the 3000+ homeless individuals the Tri-J identifies as having a serious mental illness as well as those who have a substance abuse problem in light of the fact the Tri-J reports there are 3575 chronically addicted homeless people. Those who are chronically addicted but have, or say they have, no mental illness are not served by any of the 13 adult public mental health centers.
2. find a way so that GCAL can provide to every caller information about the 5 Fulton County DBHDD MH OP Centers such as the telephone number, address, etc. so they can call and get their own appointment. This should not be complicated!!!

3. enforce the right to choose any public mental health center in the state regardless of county of residence if that center contracts with the GDBHDD to provide core services. Specifically, enable GCAL to make appointments for Fulton County residents at any of DeKalb County's public mental health centers whenever it is to the advantage of the public.

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