Following is an editorial written by Dr. Barbara D'Orio, associate professor of psychiatry at Emory University School of Medicine and associate director of the Central Fulton Mental Health Center. It was published November 16, 2007, by the Atlanta Journal-Constitution.
MENTAL HEALTH: A Grady closure could turn ugly
By Barbara D'Orio
Much has been written about the impact Grady Hospital's closing would have on medical care, especially since Grady is the only level one trauma center for the region. Surprisingly little has been said about the impact that Grady's closing would have on mental health treatment.
Most Atlantans know that being brought to the 13th floor at Grady means a trip to Grady psychiatry. What most people don't know is that Grady is home to the largest and most comprehensive mental health center in the region with more than 80,000 outpatient visits and 1,100 inpatient hospitalizations each year.
The Grady psychiatric emergency service is one of the busiest in the country. Without it, local emergency rooms would be flooded with over 1,300 seriously mentally ill patients each month. Many of these patients would not be well served in standard emergency rooms that are not staffed or equipped to safely manage acutely agitated, confused and behaviorally disruptive patients.
Grady has two inpatient psychiatric units with 90 admissions per month. Closure of these units would place additional burden on the Georgia Regional Hospital/Atlanta, which is already reeling from the negative effects of patient overcrowding and limited resources. Additionally, many of the patients at Grady are too medically ill to safely treat in a state psychiatric facility.
Grady's adult outpatient clinics have 1,000 mental health visits and 2,200 substance abuse visits each month. Closure of these clinics would mean that the Fulton and DeKalb mental health centers would have to absorb Grady's patients at a time when they are already seeing more patients with fewer resources.
Grady serves 475 child and adolescent patients each month. Reaching troubled youth before they drop out of school is essential to help reduce subsequent unemployment, homelessness, legal problems and high utilization of psychiatric services.
Grady provides assertive community treatment and outreach services for more than 300 patients who are chronically noncompliant and homeless. Faced with our most challenging patients, care providers from these services go into the community to find patients under bridges and in shelters.
Grady also has an adult psychosocial day treatment program, a partial hospitalization day program and a peer day center that serves 80 patients. Patients attend these programs daily and learn about social and work skills. For many of these patients participation is the difference between successful integration into the community and a pattern of repeated inpatient psychiatric hospitalizations.
A large part of what makes Grady's mental health center successful is the collaboration between the dedicated Grady staff and the physicians and psychologists of Emory University and Morehouse schools of medicine. The expertise provided by the medical schools allows for the treatment of medically and psychiatrically complex cases that would be difficult to manage elsewhere.
Closure of the mental health center at Grady would greatly stress the public mental health system and there would certainly be an increase in psychiatric hospital utilization. Even so, it is reasonable to ask, why with all its financial difficulty should Grady also be a large mental health provider?
The psychiatric emergency room provides relief for Grady's medical emergency room, where it can be very challenging to manage mentally ill patients with medical problems. As soon as patients are stabilized medically, they are transferred to psychiatry.
Seriously mentally ill patients who are stabilized psychiatrically are more likely to comply with outpatient medical care, decreasing use of emergency services. Having mental health and medical treatment at Grady improves continuity of care, which is associated with better compliance, ultimately reducing cost of care.
When mentally ill patients are admitted to a medical or surgical unit, they are followed by a vibrant psychiatric consultation liaison service that works to facilitate patient care in the hospital and to coordinate aftercare, both of which can shorten length of stay.
What is the cost to Grady for providing mental health care? Due to state funding for indigent mental health care and Grady's role in assisting patients who apply for Medicaid, mental health has historically not been a financial burden to Grady.
Grady Hospital is much more than a trauma center. The public and those making decisions about Grady's future need to be informed as to the impact closing Grady or cutting its programs will have. A closed or dismantled Grady would not be easy to piece together. Mental health is just one small part of the picture, a picture that could turn ugly very quickly should Grady or its mental health services close.
