How lawmakers plan to overhaul the behavioral health care system in Georgia

Georgia’s psychiatric system is set to receive a revolutionary upgrade with a massive bill set to go into effect. It only needs the signature of the governor after the unanimous final passage on Wednesday.

Why it matters: The state consistently ranks lowest in the country for mental health and substance abuse treatment.

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

The big picture: Kevin Tanner, chairman of the Behavioral Health Reform and Innovation Commission, said it will mark the biggest improvement in Georgia’s healthcare system to date. He estimates that more than 50 people worked on the legislation.

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

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

  • It will create a credit forgiveness program for mental health and substance abuse treatment professionals.
  • And it gives police the ability to refer people with a mental health crisis to medical care instead of arresting them. “These people don’t deserve to be in prison. They need treatment,” Tanner said.
  • Republican Rep. Todd Jones, a major sponsor of the bill, recalled being told the best way for his son, who is living with substance abuse, to get help was if he was arrested.

“We saved lives with this law. We’ve helped families break out of debt, and we’ve forever changed the way Georgia approaches mental health and addiction treatment. This is a big deal for Georgia families.” — Jeff Breedlove, Head of Policy and Communications, Georgia Council on Substance Abuse

Remarkable: The bill does not change the penal code. If someone commits a crime, they can still be charged. But where it’s more appropriate, they can soon find treatment instead of jail.

Proponents have fought hard to keep insurance parity provisions in the bill. Tanner tells Axios, “One thing we’ve heard over the past two years is that parity is the key to repairing the mental health system. If we don’t get this right, the rest of the mental health system will remain broken.”

  • Kim Jones, director of NAMI Georgia, tells Axios that it took two months to find insurance coverage for her son’s mental illness. “And for those who suffer from psychosis, this time is brain damaging,” Jones said. “When we say it saves lives, we mean it. Then it can lead to suicides.”

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

Here are some of the main issues with the Georgian 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 as physical health. But Georgia hasn’t enforced that yet.

  • This means that families go into debt to pay for the treatment of their loved ones or that people forgo treatment for financial reasons.
  • Additionally, insurance companies have not directly allocated the required amount of government funding they receive for behavioral therapy to the treatment known as medical at-loss. It is estimated that this keeps half a billion dollars on the table annually.

Solution: Once this law goes into effect, the state will begin enforcing parity. And insurance companies are required to spend at least 85% of premium dollars on treatment rather than administrative costs.

workforce

Georgia does not have enough doctors, nurses, therapists and other licensed behavioral health professionals to meet its needs, particularly in rural, underserved areas. 59 districts have none.

Solution: The legislation provides for a loan forgiveness program to encourage people to choose this profession.

  • It is also creating a database to track these professionals so the state can better assess its gaps.
Law Enforcement Response

When a Georgia police officer encounters someone who is clearly going through a mental health crisis, their only option is to arrest them for a crime. This can set off a cycle of problems for someone stuck in the criminal justice system when that person needs treatment most.

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

  • It creates a blueprint for “co-responder programs,” in which law enforcement and behavioral health professionals respond to those calls together, treating people instead of jailing them.
Assisted outpatient treatment

The most vulnerable patients living with mental health or substance abuse often fail to complete their treatment. The state has an ambulatory civil liability law to try to support them, but attorneys and family members report that the status quo is “a disaster and an embarrassment,” according to Breedlove.

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

There is much more. You can read the full legislation here.