1. DRAFT Department of Human Resources Division of Mental Health, Developmental Disabilities and Addictive Diseases BEHAVIORAL HEALTH GAME PLAN December 9, 2008

2. GEORGIA’S REALITY
No resources for state to build new hospital infrastructure
7 hospitals ranging from 40 to 150 years in age
$70M has been spent in the last 6 years to maintain the facilities (projected an additional $30M in next 3 years---$100M in 9 years)
Buildings were not designed for today’s active treatment requirements
Community system requires new resources that are not available in current budget environment
Front door for MHDDAD is the hospital system and should be the community system

3. STRATEGIES Consolidation of hospital populations
Shift the front door from the hospitals to the community
Privatization to construct new facilities
Closure of some hospitals and open community crisis stabilization programs in those areas

4. WHY THIS GAME PLAN?
Provides new hospital infrastructure to replace outdated and inefficient facilities
Expands and enhances treatment alternatives in the community
Positions state hospitals to be used only after community options have been exhausted

5. GAME PLAN: SFY 2009 Privatize Establish community as front door
Use SFY 2009 new fund to add community services (CSP’s, social detox, mobile crisis, transportation and ACT teams) in Columbus and Savannah areas
Increase capacity for outpatient (in jail) forensic evaluators
Consolidate
Savannah forensics consolidated to West Central and Southwest
Savannah and West Central long-term adult MH clients into other hospitals or the community (IRTFs)
Privatize
Cook building for Central State forensics-close deteriorating Freeman and Binion buildings
Begin refurbishment/expansion of Kidd building to house forensics

6. GAME PLAN: SFY 2009 Privatize (continued) Close
Issue RFP to privatize, design and construct new Atlanta Regional Hospital to replace hospitals in Atlanta and Rome
Issue RFP to privatize, design and construct a new hospital in south-central Georgia to replace hospitals in Milledgeville, Augusta and Thomasville
Close
C&A units at Atlanta and Central State hospitals (56 beds)
263 DD beds
Savannah hospital and convert facility to adult CSP program
Open
Adult enhanced CSP program at Savannah
Private Sector beds for C& A

7. GAME PLAN: SFY 2010 Establish community as front door Privatize Close
Use funds from Savannah hospital conversion to add community services (enhanced CSP’s, social detox, mobile crisis, transportation and ACT teams) in Fulton, Clayton and Rome areas
Privatize
Atlanta Regional Hospital
Continue construction of new hospital for metro Atlanta
Finish refurbishment/expansion of Kidd building
Finalize RFP and begin construction of new hospital in south-central Georgia
Initiate RFP for Skilled Nursing Facility at Milledgeville
Close
150 DD beds

8. GAME PLAN: SFY2011 Consolidate Close
Forensic clients from Rome, Augusta, Southwest, West Central and Atlanta at Milledgeville in privatized Kidd building
Close
West Central hospital
117 DD beds
POTENTIAL NEED FOR APPROXIMATELY $5M IN STATE FUNDS

9. GAME PLAN: SFY2012 Establish community as front door Privatize Close
Use funds from closing of Rome, Southwest, East Central and Central State to add community services (i.e. enhanced CSP’s, social detox, mobile crisis, transportation and ACT teams) in Augusta, Athens, Thomasville, Warner Robins and Macon areas
Privatize
Skilled Nursing Facility at Milledgeville
Close
Rome, Southwest, East Central (with exception of 250 DD consumers) and Central State hospitals and open adult CSP programs
149 DD beds
Open
Metro Atlanta new hospital (early SFY 2012)
South-Central new hospital (mid SFY 2012)

10. GEORGIA’S PUBLIC BEHAVIORAL HEALTH SYSTEM IN 2012
Privatized inpatient forensic services consolidated in Milledgeville
Significantly increased number and timeliness of outpatient (in jail) evaluations
Inpatient child and adolescent (C&A) programs operated by community providers
SNF (nursing home) operated by private provider
Privatized inpatient adult mental health services in two new, state-of-the-art hospitals (Atlanta and South Central Georgia)
All regions have enhanced community mental health and addictive disease services serving as alternates to hospitalization using private providers, CSBs or MHDDAD

11. Projected Hospital Bed Capacity in 2012
Bed Type
2008
2009
2010
2011
2012
AMH
573
464
450
Forensic
590
600 DD
929
650
516
364
250
C&A 56
SNF
205
180 **
Total
2,353
1,909
1,775
1,619
1,480*
* 679 beds replaced by DD waivers (Olmstead)
** Current utilization of Craig Nursing Home (SNF)

12. Projected New Community Capacity in 2012
2009
2010
TOTAL
% increase from 2008
Enhanced CSP
44 beds ($6.6M)
40 beds ($6.9M)
88 beds ($11.9M)
172 beds ($25.4M)
48%
Social Detox
2 programs ($1.0M)
6 programs ($3M)
New Program
Mobile Crisis
16 counties ($1.5M)
20 counties ($2.3M)
32 counties ($2.3M)
68 counties ($6M)
154%
ACT
(team caseload = 70)
2 teams ($1.7M)
4 teams ($3.5M)
8 teams ($6.9M)
114%
Transportation
$200K
$300K
$700K
21%
Total Community Investment
$11.0M
$13.8M
$17.2M
$42.0M
15%
Communities Served
Columbus, Savannah
Fulton, Clayton, Rome
Augusta, Athens, Thomasville, Warner Robbins, Macon
Source of Revenue
FY09 Approp
Savannah closure
Rome, SWSH, ECRH and CSH closure 12

13. Projected Hospitals in Service at Beginning of Each Fiscal Year
2009
2010
2011
2012
Savannah
Closed
West Central
Closed (1/1/2011)
Atlanta
Privatized
New Hospital*
Rome
Southwest
Central State
New Hospital**
East Central
* 250 adult mental health beds – metro Atlanta
** 200 adult mental health beds – south central Georgia