I live and work in Georgia. I am a Licensed Professional Counselor with 26+ years of experience in the field, most of it here in Atlanta Georgia. I have mostly specialized in children and family issues but a variety of issues conspired to send me to work with adults who have chronic mental illnesses, and that is what is happening with me these days.
And, unfortunately, I have had my eyes opened about the absolutely unacceptable state of mental health services here. Sometimes I am sarcastic and may tend to overstate a thing or two when frustrated. However, I have had my eyes opend, my mind blown, and find myself extremely angry about the situation for a number of reasons.
I suppose I could talk about this for days, but for the sake of brevity, I will try to remain right on the point: and there are but 2 main points. 1 is that mental health clients (I refuse to call them 'consumers') I work with are almost invariably poor, living with only an SSDI check of about $700 a month and they are herded like cattle into an ever-shifting array of shoddy houses packed 2 and 3 to a room, 8 - 10-15 or more to a house all at $600 a month each. (Some are only $500 but that seems rare). They are usually very poorly run and they actively contribute to client stresses that result in re-hospitalization. The second issue is that of Assertive Community Treatment at least in Atlanta.
Hellholes
First, I wrote Life on the bottom rung, that gives a lot of detail on the shoddiness of houses.
In A More Liberal Americaback in January was written because a 73 yo lady who was a client with us. She was residing with family and they were getting tired of her and they pressed to get her a new residence and pressed even harder to get her in there ASAP - which happened to translate into the family booting her out of the house on Christmas Eve.
There was a lady who came to the program I work with for several months. She was old, in her 70's, she was losing sight in one eye, was living with some family members and this wasn't going well. Efforts were made to get her a licenced care home placement, which occured. The family pressured the residence to take her as early as possible and they booted her out of the house on Christmas Eve.
The home she went to was, to all that I can gather, not treating her well.
I say was because the last time I saw this lady was Friday. She died on Monday [Jan 24 2011]. I learned about it Tuesday.
I have been livid ever since.
I am still livid, actually.
Every day I have my nose rubbed in the horrible conditions in which these vulnerable people are more or less forced to live - between the inabilities foisted upon them by their illness and a capitalistic society that won't help them because there's no money in it, to a lame rightwing political culture here in Georgia that despises mental health services, despises the mentally ill and simply won't help.
I do group treatment in a specialized mental health clinic and every day I hear tales of all the crap these people have to put up with: Their payee (the person their SSDI check is made payable to) often keeps the change from their paying rent. The clients go MONTHS without a friggin' penny in their pockets.
They have to pay $600 and 3 other people live in their room, 2 of them have sex while my client is trying to be in the room they paid $600 for.
They fuck up the client medication. I watch the Nurse Practitioners flay them daily about not fucking up the meds for people but they are just not interested in the well-being of these people. "Meds = chemicals that help them stay in my house so I can take their whole check".
The house owners are most usually (but not always) slumlords: they open a house they bought for cheap (one was sinking into the ground with sewage coming up in the basement and they STILL moved people in there) and fill them with people; buy another one then take some of the people from the established house and put them in the new house.
Then buy another crappy home, disrupt some more clients from another established home and send them to the place. Take the client's money, pocket it, and let the house go into foreclosure; move people again.
As I pointed out in Life on the Bottom Rung, stable housing is a prerequisite for basic stability and these people do not get any of it. They are herded like cattle into different unlicensed houses, ripped off, told to be out of the house in the daytime (often, not pervasive) and bilked for $600 a month to live poverty-stricken for months at a time.
Assertive Community Treatment
I am not going to go into the history of this endeavor as it has been used successfully in other states - all that really matters for this article is that Medicaid authorizes ACT on people who meet the criteria and then the ACT agencies are sup[posed to provide some clearly defined services.
Which, of course, seldom happen correctly much of the time.
I have worked for one lame agency for over a year, trying to keep up the good attitude and spin all the inequities in a way that encouraged me to keep trusting them.
Let me state here, as obnoxious as this is going to sound: when I delivered ACT services, I did a very good job. I supervised the teams who went and did the treatment, I did the assessments, wrote up care plans and completed the managed care prior authorizations, as well as endured the audits. My work is fine and I sign my name to it.
But, overall, the agency that I worked for was well-beyond lame. They were not professionally educated - I looked past that - they seemed to mean well and they seemed to have financial sense. Just a couple months after I began working for them - busting my ass - the paydays started to travel. Apparently in Georgia an employer must pay you withinj 10 days of the stated date or face consequences. This translated into this agency frequently changing paydates so that one never knew when one would get paid again.
Yes, I endured that for many months. working 12-14-16 hour days.
They fucked up my pay in July 2009. They fucked it up in August. Didn't pay me at all in September. I finally quit in Nov 2009 because I just refused to take it any more. I returned to pizza delivery and had another job inside of 40 days.
That was at ANOTHER ACT program. Much better than the first one, but still just too slack given the client acuity. I had run across others as well - none of them function right. A couple, which I assume to be the worst, run ads constantly seeking LPC's, of which there are not but maybe 3000 in this city and MOST of them expect to be paid for their services on time. I have talked to person after person after person who has worked and worked and worked and then been stiffed for their paycheck by the little agency. Not jsut the one I was talking about: LOTS of them get by not paying people.
No.... I do not know how they keep their doors open. The one I worked for had whole TEAMS of professionals walk out due to the inequities they had to endure.
Summary
So when these agencies cannot retain their professional staff, the clients in the community cannot maintain a stable relationship with a therapist and they are again victimized.
The ACT agencies are 'policed' by American Psychological systems to ensure they are not 'taking money from Medicaid via fraud'. As far as I know, no government agency has any clout to really review these companies and check into their business practices.
The group homes aren't policed unless they are licensed and there appears to be little incentive for them to get licensed since they can do whatever the hell they want unlicensed.
And the community-based treatment they are supposed to be getting and which Medicaid is billed out the...nose for, the treatment these folks get should be far better.