Georgia ranks among the worst in the nation when it comes to helping people struggling with mental illness. A forthcoming bill in the state House aims to change that.
The expansive legislation could, among other things, attack chronic staffing shortages in the mental health field; compel insurance companies to provide comparable coverage for mental health as they do physical; and create a system of involuntary outpatient treatment for people who struggle to care for themselves.
The bill is still being drafted by a large study committee and expected to be filed in the state House around the start the next legislative session, beginning Jan. 11. The Atlanta Journal-Constitution obtained the latest version Thursday.
With Gov. Brian Kemp’s office and House Speaker David Ralston both engaged in the discussion, mental health care reform is expected to be a key issue in the legislative session.
“We have a group of leaders very much on a bipartisan level who all recognize that we have to do better. And this is the time to do it,” said Kevin Tanner, the former state representative who in 2019 sponsored legislation that created a mental health study committee of officials, mental health workers and nonprofit leaders.
Georgia ranks low nationally on most measurements of mental health treatment while it ranks higher in the percentage of residents who face challenges, according to a 2021 report by Mental Health America, a century-old nonprofit advocacy group. It put Georgia dead last among states for the availability of mental health professionals. The American Academy of Child and Adolescent Psychiatry says Georgia has only eight psychiatrists per 100,000 children; the academy suggests a better ratio is 47 per 100,000.
Tanner’s 2019 legislation created the Georgia Behavioral Health Reform and Innovation Committee to review the patchwork of state agencies, nonprofits and for-profit providers that form the state’s system. A report by the committee found that only nine of Georgia’s 159 counties have enough mental health workers.
The new bill would encourage more Georgians to become mental health or substance use professionals by making them eligible for education loans that can be repaid by service, such as the state gives to members of the Georgia National Guard. Even a doctoral student could qualify, if they’re training to become a psychiatrist.
Georgia State University law professor Paul Lombardo, who’s published extensively on health law, said the loans could help draw people to the field. He reviewed a draft copy of the bill at the AJC’s request and said he was also encouraged by the the authors’ attempts to address insurance companies that aren’t following federal law. The draft language says state officials would watch insurers to ensure they provide as robust services for mental health care as they would for physical.
“It doesn’t address the bigger question,” added Lombardo, “which is, what if you don’t have any coverage at all?”
Thirteen percent of Georgians — 1.4 million people — are estimated to be uninsured. Still others have plans that scarcely cover mental health, though firm numbers are hard to come by on that group.
Tanner didn’t dispute that gap. “Will this bill be the end all, be all silver bullet for every problem? No, but I think what it will do is move us forward tremendously from where we are today.”
Credit: Ben Gray
Credit: Ben Gray
Lombardo also worried about language allowing police to take a person for a psychiatric evaluation, whether or not they’ve been charged with a crime. People facing mental illness are far more likely to die in encounters with police, often due to a lack of police training, the professor said.
Tanner, who’s worked in law enforcement, said police would rather help people in a crisis than charge them with a crime.
One of the largest portions of the bill seeks to use involuntary outpatient treatment to help people with severe psychiatric conditions who have been found by a court to be unable to care for themselves. Case managers would track patients to ensure they keep up with their treatment plan. This, the bill’s authors say, would help keep people from seeing their diseases lead them to jails and prisons.
Dozens of states have some version of the program, though debates often rage over whether each program strikes a balance between helping severely ill people while protecting their personal rights.
A significant amount of research suggests involuntary outpatient committal programs can work, Lombardo said. “But it’s got to be done in a way that commits resources.”
The House speaker has pledged to push for an additional $75 million for mental health needs in 2022, though the full cost of implementing the bill is unknown. This year, the Georgia Department of Behavioral Health and Developmental Disabilities, the state agency that runs programs and facilities across the state for people with mental illness or developmental disabilities, has a budget of $1.14 billion. Legislators allocated an extra $60 million to mental health programs in this year’s budget.
Improving how the state responds to people struggling with mental health is a high priority, Ralston has said.
“It’s just hard and those of us in government just don’t like to deal with hard stuff,” Ralston said recently. “But we’re going to have to deal with this.”
WHAT THE BILL COULD DO
- Compel insurers to cover mental health care expenses as generously as they would physical health
- Expand mental health services for children
- Encourage more people to enter mental health professions by offering education loans that can be canceled by working in the field
- Create a new involuntary outpatient commitment program
- Allow police to take a person appearing in psychiatric distress for an evaluation, whether the person has been charged with a crime or not
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