A New Mindset for Prison Operator
GEO Group's move into mental health has some lessons for future privatization efforts.
Those who look to South Florida State Hospital for a model in how privatized mental health services can work, however, should pay close attention to a key factor: Both the company and the state credit the improvement in the hospital’s operations in some part to an accountability plan that spelled out goals and desired outcomes clearly and established ways to monitor performance carefully as the contract proceeded.
At the south Florida hospital, the transition from state control wasn’t smooth. The hospital’s unionized staff reacted angrily to the takeover, and Atlantic Shores encountered picket lines, protests, thefts and vandalism as it replaced state workers with its own. Even some newly hired employees had their doubts: “I went into it being fairly skeptical, as I had been a state employee for seven years and believed the general myth that privatization meant generally ‘take the money and run,’ ” recalls Kevin Huckshorn, whom Atlantic Shores hired as the assistant administrator of the hospital’s clinical programs.
But as Atlantic Shores whacked away at inefficiencies, the hospital’s operations began to improve. The state employed four people to procure supplies and equipment. Atlantic found it could get by with one. Also on the payroll were more than a dozen psychologists who spent most of their time conducting psychiatric assessments of patients — a somewhat pointless task since the hospital never established programs to address the disorders it documented.
In all, the company cut about 200 jobs from the hospital’s 700-employee staff, including many of the psychologists. Some of the savings went for higher salaries to hire top talent in the mental health field and to create treatment plans oriented toward preparing patients for lives outside the hospital. Atlantic Shores implemented programs to engage patients in art, music and other therapies and skill-building courses. Instead of sitting in their hospital units, some 90% of the hospital’s patients today participate in programs in the Town Center, a building in the center of the hospital campus.
While the average stay at South Florida State Hospital was 8½ years when Atlantic Shores took over, today the average stay is less than a year. Readmissions to the hospital have dropped to around 2% annually. The company bases its approach to treatment on the concepts of William A. Anthony, a Boston University professor and one of the founders of the modern movement in psychiatric rehabilitation.
In 2000, Atlantic Shores issued tax-exempt bonds to replace the old hospital facility with a new building that helped it streamline operations further and improve security. Instances of patients walking away from the facility fell from 30 or 40 per year to two or three. Atlantic Shores also assigned employees to track patients after their release and coordinate further care with local community mental health centers.
“The project worked better than any of us could have ever dreamed,” says Huckshorn. Other observers, including Gayle Bluebird, a registered nurse and independent consultant on patient rights issues who served as a resident advocate at the state hospital during the transition, validate Huckshorn’s view: “I think the privatization has allowed for more creativity, a more focused approach to treatment.”