How lawmakers plan to revamp Georgia’s behavioral health care system

Georgia’s mental health system will get a revolutionary upgrade with a massive bill set to become law. It just needs the governor’s signature after unanimous final passage Wednesday.

Why it matters: The state consistently ranks at the bottom nationally for mental health and substance abuse care.

• HB 1013, the product of years of work among dozens of lawmakers, organizations and a state commission, will finally put mental health on par with physical health in many ways.
• Nearly 20% of Georgia adults report living with a mental illness and more than 800,000 are in recovery from substance abuse.

The big picture: Kevin Tanner, chair of the Behavioral Health Reform and Innovation Commission, said this will amount to the biggest improvement to Georgia’s behavioral health system, ever. He estimated more than 50 people have worked on the legislation.

• House Speaker David Ralston, who called this his only legislative priority of 2022, estimated the bill will cost about $30 million.

Details: With this legislation, the state will begin enforcing what’s known as “parity,” to require insurance companies to cover behavioral health and substance abuse at the same level as physical health.

• It will create a loan forgiveness program for mental health and substance abuse treatment professionals.
• And it gives police an option to refer people experiencing a mental health crisis to medical care instead of arresting them. “Those people don’t deserve to be in jail. They need treatment,” Tanner said.
• Republican state Rep. Todd Jones, a lead sponsor of the bill, has recalled being told that the best way for his son living with substance abuse to get help was to be arrested.

“We saved lives with this bill. We helped families stay out of debt, and we have transformed forever the way that Georgia is going to address mental health and substance abuse disorder care. This is a big deal for Georgia families.”

— Jeff Breedlove, policy and communications chief, Georgia Council on Substance Abuse

Of note: The bill does not change criminal code. If someone commits a crime they can still be charged. But where it’s more appropriate, they may soon be able to find treatment instead of jail.

Advocates fought hard for the insurance parity provisions to remain in the bill. Tanner tells Axios: “One thing we’ve heard over the last two years is parity is key to fixing the mental health system. If we don’t get that right, the rest of the mental health system will remain broken.”

• Kim Jones, director of NAMI Georgia, tells Axios it took two months to find insurance coverage for her son’s mental health condition. “And for those who are in psychosis, that time damages the brain,” Jones said. “When we say this saves lives, that’s what we’re talking about. That’s when suicides can happen.”

What’s next: This is designed to be the first of a series of bills focused on mental health reform in Georgia.

Here are some of the major problems with Georgia’s system, and how the bill seeks to address them.

Insurance coverage

A 14-year-old federal law requires insurance companies to cover mental health and substance abuse at the same level they cover physical health. But Georgia hasn’t enforced that until now.

• That means families are going into debt to cover their loved ones’ treatments or people are forgoing treatment for financial reasons.
• Additionally, insurance companies have not been dedicating the required amount of state money they receive for behavioral health treatment directly to treatment, known as a medical loss ratio. It’s estimated half a billion dollars a year is being left on the table as a result.

Solution: As soon as this bill goes into effect, the state will begin enforcing parity. And it will require insurance companies to dedicate a minimum 85% of premium dollars to treatment instead of administrative costs.

Workforce

Georgia does not have enough doctors, nurses, therapists and other licensed behavioral health professionals to cover its needs, especially in rural, underserved areas. Fifty-nine counties don’t have any.

Solution: The legislation creates a loan forgiveness program to encourage people to choose this line of work.

• It also creates a database to track these professionals so the state can better assess its gaps.

Law enforcement response

As it stands, if a Georgia law enforcement officer encounters someone clearly experiencing a mental health crisis, they only have one option: to arrest them for a crime. That can set off a cycle of problems for someone stuck in the criminal justice system when that person is most in need of treatment.

Solution: The bill gives officers the ability to refer people directly to medical treatment without arresting them.

• It creates a blueprint for “co-responder programs,” in which law enforcement and behavioral health professionals respond to these calls together and get people treatment instead of jail.

Assisted outpatient treatment

The most vulnerable patients living with mental health or substance abuse often don’t follow through with their treatment. The state has an outpatient civil commitment law to try to support them, but advocates and family members report the status quo is “a disaster and an embarrassment,” according to Breedlove.

Solution: The bill creates a grant program to encourage trial programs between probate courts, sheriff’s offices, advocates and health care providers with the goal of testing and creating more effective court-managed diversion.

There’s much more. You can read the full legislation here.