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Explanation of How America’s Mental Hospitals Were Gutted and How to Fix the Problem

President Kennedy’s Community Mental Health Centers plan failed due to racial and labor tensions, a failure which has left this country with a legacy of heartbreak and shame.

The bill was the work of an Alabama Senator whose daughter suffered from mental illness. Sen. Hill crossed political lines to craft and champion Kennedy’s CMHC bill of 1963. But Northern senators upended the bill, claiming that funding for staff should be withheld until desegregation of mental hospitals in the South could be verified. This stance ignored many cultural nuances, among them that black families often did not want their loved ones in the care of white-majority hospitals for fear of neglect and abuse. This was not a sentiment that blacks at the time felt safe in voicing, so a crucial component of public discourse on the matter was missed.

To complicate matters, Northern lawmakers who were heavily supported by organized labor demanded that all personnel funding for the centers be withheld unless their Southern counterparts agreed to hire only union labor. Given the climate of the time, one can’t help but think that they had to know this would be the death knell of the bill. And it was.

While construction of the first 400 Community Mental Health Centers was funded, the staffing part of the legislation failed, so no payroll was provided.

The States, which were the primary source of care for the mentally ill—the vast majority of mental hospitals were state-owned, funded and run—took passage of the construction bill as an opportunity to evict thousands of patients and to begin phasing out their hospitals. This act on the part of the States had enormous consequences.

With no Congressional approval for paying staffers, the Federal government scrambled to find some way to take care of the hordes of sick people the States were dumping. What they came up with was a mish-mash of Medicaid, Medicare, and SSDI funding passed as part of the DHHS budget in 1965.

The States then transferred their patients to nursing homes where the Federal Medicaid, Medicare and SSDI checks were sent to the patients individually, but in many cases, the patients never got them. Many mentally ill people, some of them young, died in nursing homes of neglect and abuse over the next several decades as the nursing home operators took their federal checks.

Others–an exact number is hard to come by as records were thrown into chaos–went home to their families who were in some instances ill-equipped to care for them despite the desire to do so or, sadly, didn’t want them, ultimately ending up out on the street or in jail due to minor offenses or “compassionate arrests,” which means that law enforcement locked them up to give them shelter.

This sorry state of affairs didn’t happen over night. As legislators and administrators across the nation fought State budget cuts to hospitals and programs, it took decades to reduce our mental hospital system to the inadequate thing it is today.

Click on the following link to view the slideshow I prepared for my Public Policy masters program at Georgia Tech.

Ramage Slideshow Mental Health legislation proposal


The Ramage Report has learned that a member of the Atlanta Police Department’s motorcycle unit, who was injured in an accident while on duty last night, was admitted to the intensive care unit at Grady Hospital with a “bruise” on his brain. The term bruise, according to medical sources, likely means a hematoma in this case. The hematoma will be monitored daily to make sure it isn’t spreading. The injury is usually not life-threatening, according to my sources, and the outlook for recovery from that kind of injury is generally good.

He also has a chipped pelvis.  In answer to some inquiries: The Ramage Report has not been informed of any leg injury.


The Atlanta Police Department has chosen a name for the unit formerly known as Red Dog: APEX, the acronym for Atlanta Proactive Enforcement & Interdiction. True, there is no “X,” but the unit hasn’t been obsessed with details in recent years and APEI doesn’t have the same ring to it.

The 36-person unit is scheduled for training March 28 through April 1. It will be under the command of Lt. J.D. Patterson.


In 2010, the Atlanta Police Department responded to more than 73,000 commercial and residential alarms. A staggering majority, 54,700, were false, eating up hundreds of personnel hours and dragging officers away from fighting real crime.

With the APD stretched thin already, false alarms present a dangerous waste of police resources, a problem Atlanta shares with other cities.

North of Atlanta, at the Sandy Springs Police Department, Lt. Steve Rose says suburban traffic ensures an alarm call takes about 45 minutes for each officer who responds, and sometimes longer. The SSPD gets between 800 and 1,200 calls for alarms each month. Most, he says, are false, which creates hazards that go beyond mere inefficiency.

DeKalb County Police received 74,452 alarm calls in 2009 (the most recent numbers available), of which 73,136, or 98 percent, were false.

“Nationally, we know that about 99 percent of all alarms are false,” says Marietta Police Chief Dan Flynn, chair of the alarm management committee for the Georgia Association of Chiefs of Police (GACP). “It is an enormous problem for police.”

Alarms, he says, both false and valid combined, account for about 10 percent of the demand on police across the country.

Read more of my story on false alarms and what they cost us at The Buckhead Reporter, where I’m currently helping out a little:


Atlanta Mayor Kasim Reed asked members of the Atlanta City Council today to consider cutting the pensions of existing city employees, a move that unions say is illegal and would set a precedent allowing other cities to alter the retirement of their current employees.

Chief Operating Officer Peter Aman said the mayor would like to see the council come to a decision on the matter by July 1.

Each of two plans put forward by the mayor  to the council’s finance executive committee would shift more of the cost burden of retirement from the taxpayers onto the employees themselves and would slightly reduce retirement benefits.

Both plans call for “closing” the amortization of pensions—meaning the obligation to pay off the funds would be spread over a set period of 30 years. “Option 1” would move all employees from a defined benefit plan in which they know how much money they will draw in retirement to a defined contribution plan similar to a 401 K that fluctuates according to financial market performance. It would require a 6 percent contribution from employee paychecks. The mayor claims it would save the city between $27 million and $31 million in the first five years.

Option 1, according to the mayor’s office, has been the plan in place for all higher ranking employees hired since 2001.

“Option 2”would shift employees at pay grade 18 or below—sergeant and below in the police department—to an 8 percent defined contribution plan and would also allow them to participate in Social Security, which the city opted out of in the 1970s to avoid the funds matching required by the federal government. Reed says this option would save the city between $12 million and $18 million in the first five years.

The changes would affect a majority of employees. Those with less than about 27 years with the city would see an increase in the amount of money withheld each pay period in order to achieve slightly less than present projected retirement earnings.   Continue reading ATLANTA MAYOR MOVES TO CUT CURRENT EMPLOYEE PENSIONS


The Atlanta Police Department and the U.S. Marshals Service made 46 gang-related arrests this week in what marshals describe as a “surgical operation.” The arrests were carried out in the Mechanicsville, Pittsburgh and Cleveland Avenue areas of Atlanta.

“Operation Zero Deep” was quickly organized after a “violent attack on a witness from the Jonathan Redding trial,” according to the USMS. Redding, who is affiliated with the 30 Deep gang, is being tried for the January 2009 murder of John Henderson, a bartender in Grant Park.

The arrests were announced today at a 10 a.m. press conference at the USMS offices in Clayton County.

James Ergas, a supervisory inspector with the USMS said the operation was “surgical” because the individuals arrested were specifically named in warrants. Officials took pains to say the arrests of 37 associates of 30 Deep, and nine others for violent crimes and drug trafficking, was not a “round up.”

But the real problem, as illustrated by the shooting of Eddie Pugh, the star witness in the case against Jonathan Redding, is how to keep witnesses safe so that violent gang members can be effectively prosecuted and put behind bars. Continue reading ATLANTA POLICE AND U.S. MARSHALS MAKE 46 GANG-RELATED ARRESTS, BUT CAN THE DISTRICT ATTORNEY KEEP WITNESSES SAFE?


When about 200 protesters gathered outside Georgia’s Gold Dome last week to support or oppose the passage of a law devised to crack down on the state’s illegal immigrant population, there were the usual signs and shouts that go with public debate over citizenship.

In the midst of the anger and passion, it was almost impossible to remember the common ground shared by even the most fringe characters of the two sides, those who vehemently oppose giving any kind of legal status to illegal immigrants, and those who want open borders.

What common ground? The recognition of the fact that the federal government, under Clinton, Bush and now Obama, has taken a shameful pass on a problem that is squarely its own to solve.

In Georgia, the two sides of the national debate are most clearly represented by D.A. King, often described by Jerry Gonzalez as an anti-immigration activist (and sometimes as a convicted felon), and Jerry Gonzalez, who is often described by King as any number of not very flattering things the most mild of which is an open-borders supporter. King is the head of the Dustin Inman Society, and Gonzalez, his nemesis, is the head of the Georgia Association of Latino Elected Officials. The talk between the two often gets ugly, but any hope for a sane approach to immigration issues relies upon them, and others like them, coming together to force the federal government to do its job. Continue reading OPPOSING SIDES OF GEORGIA’S IMMIGRATION DEBATE SHOULD UNITE TO FORCE CONGRESS TO DO ITS JOB


Last week, the Atlanta Police Department began collecting citizen input for its zone and beat redesign. Town hall meetings on the matter will continue through March (see below).

The redesign is based on “calls for service,” essentially calls to 911 that require police response. The goal is to use the recent influx of recruits to shrink each beat—the area patrolled by an officer—and add some beats, so that police can respond to calls more quickly.

In offering up a draft of the redesign last month, APD included the total number of calls for each of its six zones. But, the kinds of calls cops are responding to is every bit as important as the number of calls. Some calls take longer than others. The calls are so varied, from checking on elderly residents to trees falling, to rapes, robberies, and “disorderly children,” that simply slapping a total number on a zone when determining its manpower needs doesn’t make much sense. And maybe that’s not what APD will ultimately do, but recent events suggest that those in charge may not be matching manpower to the type of calls the zones are getting. Continue reading MAKING THE MOST OF ATLANTA POLICE


“Pro & Con: Should Legislature allow Atlanta to raise liquor taxes?” In today’s Atlanta Journal-Constitution, Mayor Kasim Reed’s policy advisor David Bennett says yes, it’s only pennies on a drink. I say no, small businesses will suffer.

There is no place for comments on the AJC site, so we can hash it out here, if you like. I’ll be very frank, this “it’s only pennies” stuff is silly. Taxes are always “only pennies,” but have the rest of you noticed how those pennies have added up? That new proposed tax on personal services that I wrote about last night is “only pennies” too–but at 7 percent or 8 percent on the dollar it adds up. Yes, we’re only talking about drinks, beer, etc., but clearly Bennett doesn’t know how a restaurant works if he thinks diners aren’t going to notice the increased tab and head home a little earlier or at least try to counter-balance the cost of the mojito tab by not ordering dessert or coffee. Maybe he hasn’t worked at one. I have.


A proposal currently being reviewed by the Georgia General Assembly to tax services like haircuts, car repair, shoe repair, auto detailing, dry cleaning, veterinary care, tire installation and a host of others, is part of a sprawling tax reform package recommended by the 11-member Special Council on Tax Reform and Fairness.

That particular aspect of the package is causing anxiety among Georgia’s small businesses which are represented, theoretically at least, on the council by the National Federation of Independent Business (NFIB).

According to the legislation that established the council, the chair of the Georgia chapter of the NFIB serves on the council, which puts the small business advocacy group in an interesting position. Continue reading SMALL BUSINESS GROUP IN AWKWARD POSITION ON TAX REFORM, ATLANTA HIT HARDEST