Mental Health: The Hidden Cost
Lack of local care options costs Coweta
by Clay Neely - firstname.lastname@example.org
When on-duty Coweta County deputies are more than 70 miles away from the communities they are assigned to serve, Sheriff Mike Yeager is not happy.
“I’ve said it before and I’ll say it again, I still believe jails and prisons are the largest providers of mental health services in the state of Georgia,” said Yeager.
Those services often force the sheriff’s deputies to transport inmates and others to mental health facilities far from Coweta. Mental health services, including treatment and transportation, costs the county hundreds of thousands of dollars annually.
According to the National Institute of Mental Health, 16 percent of Georgia’s prison inmates suffer from mental illness. Between 1999 and 2006, the number of Georgia Department of Corrections inmates receiving care for mental illness increased by 73 percent.
Inmates who are determined incompetent to stand trial are remanded to the custody of the Georgia Department of Human Resources and remain in jail due to a lack of bed space. The average length of stay at one county jail is five months. The sheriff’s department becomes the primary mental health care provider.
In 2010, Yeager was appointed by then-Governor Sonny Perdue to serve on a panel regarding the issue of mental health in the state of Georgia.
While Yeager believes not much came from the meeting, he did reveal some staggering statistics as to what the lack of a localized in-patient mental health care facility is costing Coweta citizens.
“We had an annual total of 1,600 inmates that exhibited symptoms of mental illness and the cost of the psychotropic drugs for them was $104,898 dollars,” said Yeager, reading from his report.
“Our total cost for inmate medical care was near $500,000,” said Yeager. “The cost of inmate care outside of the jail was near $250,000. Now, we’re approaching three quarters of a million dollars.”
Outside care is not only expensive, but means deputies are out of the county. In 2010, Coweta Sheriff’s Office was responsible for transporting approximately 343 patients to facilities across the state for treatment — the closest being West Central Regional State Hospital, more than 70 miles away in Columbus.
“That’s around 29 individuals a month, with the average time span for transports ranging from two to six hours,” said Yeager. “Coweta’s annual cost of conducting mental health and substance abuse transports was near $100,000. That’s a lot of manpower and vehicles.”
At any given time, deputies are transporting patients to Henry County, Clayton County, LaGrange, Dublin and even Milledgeville. Yeager estimates that up to six of his deputies may be on the road at the same time.
The deputies often experience long wait times during the process of committing patients and then moving them to emergency receiving facilities or approved treatment centers.
Yeager cited numerous examples to sum up his frustration with the process.
“We had an individual who was involuntarily committed to a facility in Columbus. He was medically cleared by Piedmont and ready to transport. Then, the Columbus facility called to report there was no available bed and told us to wait,” said Yeager. “We transported the patient back to the jail to wait.”
The next morning, Columbus called to report a bed was ready.
Both deputy and patient made the long drive to Columbus. Upon arrival, a staff member of the hospital handed the paperwork back to the deputy.
“This paperwork is from yesterday,” the staff member said. “We need paperwork from today.”
Ultimately, the deputy took the patient to a local ER in the area to be medically cleared, then returned to hospital immediately only to be told, “Sorry. We don’t have a bed now.”
“At this point, I’m ready to pull my hair out,” said Yeager. “Can you imagine what the deputy is going through? I just said, ‘Bring him back.’”
By the end of the entire ordeal, the deputy was gone for a total of 12 hours.
Additionally, not every deputy-transported patient is admitted.
“The 1013 form the judge fills out clearly states it is the duty of the sheriff’s department to deliver the patient to the facility. Once delivered, the hospital decides if the patient will be admitted,” said Yeager. “We’ve taken care of our end of the order by delivering the patient. But the hospital then holds the officer until a decision is made.”
If Columbus, or any other facility, determines the person won’t be admitted, it the responsibility of the sheriff’s office to return the subject to Coweta — and that’s where the process gets tricky.
One of the most common problems for deputies is the refusal of mental health providers to accept patients. Law enforcement is told it must stay at the facility until the examination concludes.
Yeager recalls a time he threatened kidnapping charges against a hospital in Milledgeville that refused to let his deputy leave until they made a determination in regards to a transported patient.
“We’re under a court order to deliver. We don’t have an order to return the subject. If we have to transport the patient back, we’re liable for anything that happens to that person along the way,” said Yeager.
Despite these obstacles, Yeager has worked hard to build a better working relationship with the forensic doctor in Columbus and he’s also quick to praise Frank W. Berry, commissioner of the Ga. Department of Behavioral Health and Developmental Disabilities.
“He has a good, open dialogue with the sheriffs and has even given us his personal number. I’ve called him a few times and he’s been very helpful,” said Yeager.
However, in Yeager’s experience, there has been an ongoing issue with the sheriff department regarding transporting the mentally ill or those who have mental or substance abuse issues.
“That is money that is being spent out of your budget. There is no reimbursement, and in my 20 years as sheriff, there’s never been any kind of resolution to it,” he said.
With patients being returned to the community without any meaningful disposition being made in their case, a revolving door is created, with both the patient and the community suffering the consequences.
“A local facility would be beneficial for not just our department, but for the entire community,” said Yeager.
“These people belong in a hospital bed, not a jail cell.”
A behavioral hospital has been proposed by U.S. Healthvest for the former Piedmont Newnan Hospital/Coweta General facilities on Hospital Road in Newnan. The company was recently denied a Certificate of Need by the Georgia Department of Community Health and has appealed the decision.