Atlanta Progressive News

(APN) ATLANTA — At least three local community health centers have stopped offering mental health services for working poor and homeless people in Fulton County, Atlanta Progressive News has learned after a two-month investigation.

APN has found there is much confusion and lack of communication between social service agencies, clinic staff, service providers, and management, regarding exactly what is going on.

APN first obtained a copy of a discharge letter from one Fulton County clinic to an anonymous patient.

“Effective April 1, 2010, Behavioral Services at South Central Mental Health will relocate to the Neighborhood Union Health Center. Based on your medical and clinical needs, the treatment team has recommended that you:” the letter stated. However, the next section was left entirely blank.

“You have the option of receiving services at multiple locations,” the letter said, listing two: Neighborhood Union Health Center and Center for Health & Rehabilitation.

Roger Miller, who has served as a homeless outreach case manager for a local organization for several years, sent an email to APN stating: “I am hoping that you will expose the loss of Outpatient Mental Health Services in Fulton County… If you need outpatient mental health service in Fulton County, if you have insurance, Medicaid, Medicare etc they will refer you to a clinic. If you are not insured, you can no longer go to your local Mental Health Center–they have closed for adult mental health, you will be discharged from your local Mental Health Center.”

Patrice Harris, MD in Psychiatry, Director of Health Services for Fulton County, initially did not respond to several phone calls seeking comment. Then, APN called Fulton County Commission Chairman John Eaves, who referred APN to Alice Johnson; Johnson instructed Harris to respond.

Dr. Harris explained to APN that the County is in the process of relocating the delivery of mental health services, from the local mental health centers, to what she referred to as One Stop Shop centers.

This explains in part why Miller could no longer make referrals as usual for his homeless clients. These clinics were not accepting new appointments.

“We are moving, we have not closed any services,” Dr. Harris said.

Three local mental health centers are now closed for referrals–Central Behavioral Health Center, South Fulton Mental Health Center, and West Center Mental Health Center–and their patients are serviced by Neighborhood Union Health Center, Dr. Harris said.

Miller described the three clinics in South Fulton as “having been there for decades.”

There are plans to establish three more of the one stop shop centers, closing more local mental health centers, Dr. Harris said.

A so-called One Stop Shop would handle teaching employment skills, treating mental and physical problems, as well as offering services for low-income individuals and families such as those provided by Georgia Department of Family and Children Services.

“I think there has been a lot of misinformation out there,” Dr. Harris said. “We have not closed any center, we moved locations in order to enhance services. South Central Mental Health Services to the Neighborhood Union Health Center, the first integrated care one stop for all care.”

The ten year plan appears to be that central facilities will be built for many needs. The three listed are on Roswell Road, Adamsville, and the one in mid-Atlanta, Neighborhood Union. Dr. Harris claims this will be an orderly transition without loss of services.

Fulton County is in a unique situation in terms of funding mental health services for indigent people.

“Years ago Fulton County told the State to keep their money; we will do it on our own,” Alan Harris [no relation to Dr. Harris], director of the Coalition for the Homeless and Mentally Ill, told APN.

Alan Harris has been an advocate for homeless people in Atlanta for 27 years and believes that many homeless people, particularly the chronically homeless, require mental health services in order to successfully transition off the streets.

“Fulton County is responsible for its own funding. A decade or more when it was set up it was different,” Tom Wilson, Press Secretary for the State’s Department of Behavioral Medicine, told APN. “All other counties in Georgia are funded by money distributed from state grants and Medicaid.”

“Fulton County does make a greater budget allocation than other Georgia counties. Fulton County provides a greater percentage of funds from the County versus state funds. Fulton County is part of the City of Atlanta, and the other counties can’t do what they do,” Jessica Corbitt, Public Affairs Manager for Fulton County Government, told APN.

These neighborhood centers have served their surrounding community for past decades, Miller said, noting that they came out of what used to be the community health center movement.

Miller said he received a memo stating that the neighborhood centers had met their financial obligation to Fulton County, and would no longer accept new patients without insurance.

Alan Harris told APN the One Stop Shop program sounds good in theory but in reality there was only one facility to treat profound addiction problems–the Center for Health and Rehabilitation, on Boulevard Avenue–and that they have stopped providing those services.

In general the whole State of Georgia is getting out of the treatment of mental illness, he said, as they are closing residential facilities and they are providing no treatment for the severely addicted.

“The Neighborhood Union facility said they would provide one hour of group meetings per week for addiction. Where do the addicted go? In addition, how do indigent people get to these centers?” Alan Harris asked.

Miller says he believes that Fulton County’s unique funding structure is related to the problem of the closing of neighborhood clinic services.

“In Dekalb County there is oversight by a community services board allocating services for the county. They oversee all their clinics and services and make sure that funding from a general pot is distributed. Fulton County has a different structure. Instead of general funding, each facility gets individual funding from the state. There is no central funding source that can provide for every center, and those that cannot get funding are trying to make do,” Miller said.

“Fulton County is the only county not part of the regional community resource board,” Alice Johnson, Eaves’s liaison, confirmed.

Miller also says that in his experience, none of his clients have been referred to the Neighborhood Union facility. He states that there are in fact only two locations in Fulton–Northside Hospital and Grady Hospital–open as options for low-income, uninsured people with no Medicaid.

He said the problem with Northside Hospital is that it is difficult for low-income people in South Fulton to get there and that clients report back the perception that the Northside staff are not used to dealing with poor or homeless clients from South Fulton and that they are treated rudely.

He sent one of his clients to Genesis, a health center in Dekalb County also servicing some Fulton clients. The client got a prescription from Genesis and was told to fill it at Grady. But Grady would not fill the prescription unless they made it themselves, so it was a useless prescription.

APN attempted to call several clinics and inquire what services they provide for low-income people with no Medicaid or health insurance, to see what they would say.

APN attempted to call Grady Recovery- Florida Hall, but there was neither an answer nor a voice mail.

APN attempted to call Northside, and they confirmed that they were willing to make an appointment for someone in those circumstances.

APN attempted to call the three neighborhood clinics that have stopped offering services in Fulton County and each of them answered the phone and were willing to make an appointment. When APN inquired why they were answering the phones when in fact Dr. Harris said they were no longer offering those services, the clinics stated that the calls were automatically being forwarded to the Neighborhood Union.

However, when APN attempted to call the Georgia Crisis Line at 1-800-715-4225, they told APN that the only Fulton County clinics offering indigent services for mental health were Grady and Northside. When APN asked about why the Neighborhood Union was not being offered, APN was told that they were not on the list.

The Georgia Crisis Line was also willing to make referrals in Dekalb County, and advised that appointments were available sooner in Dekalb than in Fulton.

It is not clear why, if Neighborhood Union was allegedly available after the closure of the three neighborhood clinics, the Georgia Crisis Line was not offering it as an option.

It is also not clear why the three neighborhood clinics were not being transparent about the fact that they were allegedly forwarding phone calls.

All in all, the simple transition being described by top officials with the closure of the neighborhood health centers, is not consistent with the experience of those on the front lines.

Where there is supposed to be continuity of services, many do not know where to refer clients and there appears to be a deterioration in the level of available services. Workers like Miller are concerned that many poor and working people in Fulton County will fall through the cracks.

(END/2010)

About the author:

Alice Gordon is a Staff Writer for The Atlanta Progressive News and is reachable at alice@atlantaprogressivenews.com.

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