Brett Bramble thinks of things that might have saved his sister’s life if she had them back in 2014. A trained recovery coach to meet her in the emergency room after her first overdose. A good Samaritan law so that during her final overdose, the guy with her might call 911.
Thanks in part to the state Department of Behavioral Health and Developmental Disabilities, those exist now. And it infuriates Bramble that as state leaders ramp up the Georgia legislative session, that department is facing budget cuts.
“It just doesn’t make sense to me,” Bramble said. “We need quadruple the amount of funding.”
Much of state government is facing cuts. But Behavioral Health — Georgia’s agency for people with mental illness, disabilities such as Down syndrome and autism, and addiction problems — has vaulted to prominence as legislative hearings detailed the possible impact on some of the state’s most vulnerable people.
The department is under federal supervision after it settled a lawsuit from the U.S. Department of Justice alleging inadequate treatment in the state’s mental health system, dangerous conditions and violence among patients.
An investigation by The Atlanta Journal-Constitution found 115 suspicious deaths in state mental hospitals even as the department was under federal investigation. The 2010 settlement called for improving the hospitals, but to also move patients out of hospitals and into supported community settings whenever possible.
State officials say the budget reductions are now tailored to do that as best they can.
Still, the cuts are raising fears. Legislators said the cuts would be “life-robbing.” An early budget document said the cuts would result in increases in suicides and addiction that the state would be unable to prevent, costing more money and lost productivity in the end. Concerned advocates agree and are gearing up to testify to legislators who are writing the budget.
Ellyn Jeager, a longtime mental health advocate, said, “The cuts they’re talking about that (they) said won’t hurt anybody — of course they’re going to hurt somebody.”
Aides to Gov. Brian Kemp, who has ordered spending cuts, say that’s not true. A spokeswoman for Kemp said the governor would not allow a significant disruption in service to Georgians.
Department Commissioner Judy Fitzgerald agreed.
She said state funding for mental health has been expanding in recent years and much of that will slow. But she the state had been “thoughtful and strategic” in making its proposals, strengthening crisis care while leaving other services in place.
“We did that because we agree with the long-term view,” she said. “But the crisis needs are a priority for every community in the state. And we cannot leave those unaddressed.”
212,000 served
With tax collections sluggish, Kemp ordered many state agencies in August to cut 4% of their budget this year and 6% next year to both prepare in case of an economic downturn and give him the money he needed to meet his priorities, including higher pay for teachers. He exempted some major programs, such as Medicaid.
Kemp asked the mental health agency to cut $34.3 million from its budget this fiscal year and $46 million next year. That’s a smaller slice than some other agencies faced. But it’s more than the department’s entire administrative budget of $38 million.
And while the department will have less money this year and next year than leaders originally budgeted, the cuts still leave the agency with an increase of $50 million more next year over this year, Kemp’s aides point out.
The $1.4 billion department oversees a dizzying array of services, including state-run mental hospitals, mobile crisis response teams and respite housing. But instead of doing all those jobs with state employees, the agency contracts with more than 700 community organizations.
Department officials emphasize their mission is not to solve all the state’s mental health needs, but to be a safety net. Its primary focus is those without insurance, without enough insurance or on Medicaid.
Its work served 212,000 Georgians last year.
The problems it faces are surging, from the opioid crisis to recognition of autism and mental health issues, experts say. The agency has long wait lists for its services.
Georgians’ access to mental health care still ranks worst in the nation, according to Mental Health America, a national advocacy group that promotes early intervention. Moreover, the department remains under federal supervision and is periodically evaluated by a court-designated official.
Fitzgerald and state leaders get high marks from advocates and legislators for improving the situation. Among additions to the agency’s services, she says, the budget is still funding an expansion of 40 hospital beds for court-ordered patients, and adding to the APEX school mental health program.
But even she admits the state doesn’t claim to meet all standards required by the federal settlement.
Balancing crisis, prevention
Under the 2010 settlement, Georgia committed to improve its mental hospitals and to move patients out into community-based care whenever possible. It’s been criticized for not doing that fast enough.
That’s the rub with the cuts. The budget prioritizes crisis services, preserving beds for those in the worst shape. But advocates say the agency is taking that money from intervention services, which will inevitably lead to more severe, future problems.
One example of the cuts was to “Core” services, which help patients with mental illness or addiction solve problems before they mushroom into a mental crisis — for instance, training and certifying peer specialists who work with patients to find housing or navigate the health system.
The agency worked for about seven years to win an increase of about $10 million in those services last year.
But the additional money hasn’t been spent yet; Fitzgerald said her agency is still designing the rollout of the program expansion. So the $10 million was moved to plug a gap in funding for private psychiatric beds.
An agency budget document called the Core program “essential to allow individuals to be served in the most effective and most economical means,” and it said redirecting the money raised fears of increased suicidality and addiction. Fitzgerald pointed out that that document’s been rewritten and said the less dire version more accurately reflects leaders’ sentiments.
“It’s the right thing to do,” Fitzgerald told legislators about the budget moves. “But when you hear from advocates and providers who say we can’t expand access, we can’t expand our reach, we can’t serve more people until you give us more money, they’re going to be correct. We’re stretched, they’re stretched.”
The reality
That shows a strategy behind the cuts: maintain current levels of service to existing patients most in need.
While no one likes cuts, Fitzgerald told the AJC: “It became critical to ensure we could meet the crisis needs. That’s back to our desire to ensure people currently in service still get service and the doors to our nationally recognized crisis system stay open.”
Critics of the cuts aren’t assuaged. In the years since the federal lawsuit, Georgia’s population has grown by 1 million and continues to grow.
The whole spectrum of services faces this growing need. There are 6,000 people on the waiting list for a “waiver” program that funds services to help a family move a patient with a disability to function more independently, according to the department.
Jennifer Brex and her son, Zachary, have been on that wait list for at least five years. If new slots don’t open up in the program due to attrition, another way that people on the wait list can get a slot is if funding increases every year. That’s not happening next year.
Zachary, 21, is a student at Tucker High School. He was born with a chromosome disorder and is on the autism spectrum; he can speak but is difficult to understand, and has slight hearing loss. Brex hopes the waiver will eventually put him in a day care program after school ends, for social interaction.
If the program worked as hoped, not only would Zachary move further toward independence, but Brex could suddenly be more independent and productive, too.
“Will Zachary be 40 before he gets help?” she asked. “How old will my son be before they get to him? This is terrible.”
A budget problem
Some activists say reducing mental health services to save money has the opposite effect. People need mental health services in order to keep their jobs. And when an economic downturn comes, more people will get depressed and stressed, triggering crises, experts say.
“We don’t have any fat in the budget. We have done a remarkable thing over the last 10 years in response to a DOJ lawsuit,” said Cynthia Wainscott, who served on the National Mental Health Association’s board of directors. But “when people walk into those providing agencies and they don’t get the help they need, bad stuff happens.”
Sue Smith, the director of the Georgia Parent Support Network and a former chairwoman of the National Federation of Families for Children’s Mental Health, has a different take.
She says the need is indeed rising. She recently held an event in Dublin for parents interested in mental health services for children. Organizers told her to bring 25 information packets, but 175 parents signed in. “I have never seen a response like this anywhere,” Smith said.
To her, that also meant that people were starting to hear that services exist and there is less of a stigma attached to seeking help.
Smith said she’s seen 30 years of Georgia budgets, and cuts come and go. She sees results from Fitzgerald’s leadership, especially in rural areas and schools, and she also respects Kemp’s efforts to minimize the harm from the cuts.
“I’m not nearly smart enough to know what the priorities should be in the state,” Smith added. “Eventually there will be harder times. So I certainly can’t criticize the governor who tries to put the state in a better position.”
However, she added: “I do think cuts will affect children and families. There is no doubt about that.”
About the Authors
