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On a good day, the government scares people as hell. On a bad day it should.
Our sober arguments about the state of health care – in Georgia and the United States – revolve around two conflicting fears about the government; that it does too little or too much.
When we talk about mental health, this tension comes in abundance, especially when considering involuntary treatment for a psychiatric disorder. Too much to do looks like the days a husband might admit his wife to a mental hospital for “an unclean ghost” or some other kind of talk. Too little looks like … well, the corner of Peachtree and Marietta on a Tuesday afternoon.
The Georgia General Assembly will be considering a bill to amend the Mental Health Act in a few weeks’ time. I’ve seen a draft. And in general I like it. I know there will be an argument about the treatment changes. And I want to counter this argument now to set a marker.
People go to war to prevent the atrocities seen daily on a street corner in Georgia. No longer.
Georgia scratches bottom of the U.S. mental health rankings. Mental Health America placed Georgia in the middle of the ranking this year only because of its newly included “prevalence” data – which, frankly, doesn’t capture any unreported cases in a state no other than 48that for all other indicators. Georgia was dead last year. And it should.
The proposed law would change the standard for a police officer to take someone to hospital against their will. Currently, the law requires the threat of “immediate harm” to yourself or someone else. In effect, this required a police officer to witness or threaten an act of violence – an identifiable crime. The law would change to allow a police officer to seek medical treatment against his will if that officer “has a reasonable expectation that a life-threatening crisis or significant psychiatric deterioration will occur in the near future”.
This does not mean that people are permanently interred in hospitals without recourse. Specifically, this means that the People’s Police, which decay in front of their eyes every day, don’t have to stop just because they know the day of the week and the name of the President and don’t want to leave.
The draft law also calls for involuntary outpatient involvement. The law would allow a probate court to visit someone for treatment in a clinic from time to time, and provide alternatives to arrest for those who skip a session or stop taking their medication.
In the past, families could and did buy a bed in an institution to send away an unwanted family member. In 1953, 559,000 Americans were admitted to an institution against their will – about one in 285 people. (I note, by the way, the percentage of Americans who were incarcerated or institutionalized at lower because today almost 2 million people live behind bars. Fewer than 100,000 people were imprisoned in 1953.)
Our involuntary engagement laws changed because the abuses became apparent. O’Connor v. Donaldson, a 1975 case that established new conditions under which someone might be committed, met One flew over the cuckoo’s nest, the 1975 Oscar-winning film is set in an insane asylum. And the laws crashed. Meanwhile, the development of antipsychotic drugs matched Reagan’s zeal for a smaller government. And the institutions collapsed too.
But after that, something went very wrong. The promised community care never materialized, and our streets and prisons were slowly filling up with people who needed a doctor and a safe place.
The proposed legislation strikes a middle ground between Jack Nicholson’s lobotomy and freezing people from not getting in on a cold night.
I literally chased people down the streets of Atlanta trying to keep an eye on them long enough to get in touch with an agent and get them treatment and shelter. The conditions today are as absurd and confusing as One flew over the cuckoo’s nest. It just happens outside.
Out of these concerns, Georgia’s Behavioral Reform and Innovation Commission emerged, which has drafted a law to address major problems with the Georgian system. Mary Margaret Oliver, DeKalb County’s own state rep, was a key commissioner and discussion leader. Despite being a Democrat, she is relied on by the Republican legislature for legislative expertise on mental health issues. And she is satisfied with the results so far.
“I am impressed with the many efforts the Behavioral Health Commission has made since the end of the 2021 session to draft a comprehensive bill to reform mental health,” she said. “The current draft continues to be scrutinized by many groups and political leaders. Spokesperson (David) Ralston has been instrumental in perfecting the design and has spoken publicly about his interest and support, which gives me hope of passing a strong bill. “
Part of the bill harmonizes Georgia insurance laws with federal law and requires insurance companies not to neglect mental health care. Even with insurance in Georgia, many services are not covered. It would also offer educational debt repayment for mental health workers. Georgia ranks at the bottom end of the mental health employment-to-population ratio. It takes a momentum to get more adolescent mental health treatments.
The bill creates a state funding mechanism for law courts and a committee to coordinate technical assistance and data sharing between these courts, prisons and other providers. The goal seems to be to promote universal mental health screening in county prisons and prevent people from migrating in and out of treatment as they walk from prison to local community service … and unfortunately back again.
It doesn’t fix anything. Some big, obvious problems are outside the scope of the legislation.
Georgia didn’t expand Medicaid. That leaves many people uninsured and adds to our dire state of access to psychiatric treatment. The bill avoids this problem, but does not solve it.
Nor does it directly affect the housing problem. Residential instability worsens mental health problems. It is why We find people on the street. The recipe for this problem is permanently supportive living. But the bill does not fund new PSH units.
The bill does as much as possible without spending any money. Money seems to be a separate negotiation. And … okay. I accept that. Because I want to This, regardless that. This is how adult politics works.
Most of the people who might object to this bill were in the room while it was being written. The only part that worries me is the language of involuntary engagement. But I am not afraid. I don’t have to be.
– George Chidi is a political columnist, public order advocate, and veteran. He also writes for The Intercept.
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