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

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

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

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 Provides new hospital infrastructure to replace outdated and inefficient facilities Expands and enhances treatment alternatives in the community Positions state hospitals to be used only after community options have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

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

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

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

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

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)

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

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)

Projected New Community Capacity in 2012 2009 2010 2011-2012 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

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