Monday, December 1, 2008

Privatizing Madness

Georgia is one of the leaders in both the privatization of corrections and privatizing probation services (in fact, I believe we're still only one of ten states in the country which allow "probation profiteering" for misdemeanor crimes/defendants).

Now the state is seriously considering privatizing what's left of psychiatric/mental illness care as well.

Under pressure to fix its mental health system, Georgia is embarking on an uncharted course: the total privatization of state psychiatric hospitals.

In an escalation of earlier plans for limited privatization, officials now want to hire for-profit companies to build and operate three new psychiatric facilities to replace all seven existing state hospitals, according to documents obtained by The Atlanta Journal-Constitution. The last of the old facilities would close by 2012.

The move would end 150 years of state-provided psychiatric care in Georgia, marked by frequent revelations of horrid conditions, reforms, more revelations and more reforms. Now the state confronts a confluence of challenges: up to 10 percent budget cuts and an investigation of the hospitals by the U.S. Justice Department.

No other state has privatized its entire psychiatric hospital network. Only a few have turned over pieces of their mental health systems to the private sector, to mixed reviews.

Proponents say the private sector can perform many government functions at less cost and with greater efficiency. That would be good news for Georgia sheriffs, who say they are overwhelmed providing medicines and services to mentally ill prisoners awaiting transfer to state hospitals.

“It looks good on paper,” Oliver Hunter, the deputy general counsel of the Georgia Sheriffs’ Association, said of Walker’s plan. “You don’t know if it’s going to work. If it doesn’t work, we’re looking at dire consequences.”

As with the notion that private companies could run prisons or provide probation services "cheaper" than the state, the idea that Georgia, which already ranks near the bottom in per capita expenditures on mental health care, could further "save money" by privatizing psychiatric care is indeed a dire proposal. And the contention that it could actually help the correctional system alleviate its problems dealing with mentally ill inmates on the local jail/sheriff's level is equally astounding.

For those with short memories, the entire explosion in homelessness, jail and prison populations beginning in the 1980's was the direct result of twenty years of deinstitutionalization, when states began shuttering their psychiatric hospitals in the 50's and 60's and dumped their patients into local communities with the fondest hope they would receive care at that level.

And similar to this move underfoot now, deinstitutionalization began after a series of both budget cuts and exposes in the media which showed the inhumane conditions existing in many state "loony bins" at that time (see also: Ken Kesey's "One Flew Over the Cuckoo's Nest").

While I applaud the AJC's series for unearthing the unfortunate deaths which occurred in Georgia hospitals from 2002-2007, the reaction we are seeing now (privatization) is similar to the deinstitutionalization sentiment we saw forty years ago: shutter these hospitals and everyone will be better off.

Except that in all probability, they probably won't.

Advocates withheld judgment, but several expressed what Ellyn Jeager of Mental Health America called “serious reservations.”

“Private companies are in the business to make money,” Jeager said. “I’m not sure it will improve the system.”

The profit-motive itself is suspect. As with prisons, probation and crime, there is simply no incentive to reduce (or cure) mental illness if millions are being made off psychiatric disorders. And as with privatizing corrections, the costs of overseeing and monitoring these facilities will erase (and in some cases add to) whatever proposed savings are being suggested.

I'll be happy to reserve final judgment until more of the plan becomes available, but when the Governor's own commission to study the conditions of Georgia's mental hospitals expresses a "lukewarm reaction" to the idea of privatization, we're in unchartered waters.

If this proposal were being floated simply in response to the AJC's investigation, I could understand, to a degree. But the fact that privatizing mental health care is seriously on the table because of further budget cuts, and a way to save a buck as we did in the 1950's, strikes me as shortsighted and potentially dangerous to both public safety and an already strapped correctional system.

Unlike private psychiatric hospitals, our system of jails and prisons can't say no.

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