As a wide-ranging bill aimed at increasing Georgians' access to mental health care and addiction treatment has made it through both the state House and Senate and is awaiting the governor's signature, advocates in Northwest Georgia said the legislation is much-needed and would greatly benefit people in the Peach State.
House Bill 1013 passed the House with three no votes on March 8. On Wednesday, it passed the Senate unanimously with amendments, then the amended bill passed the House unanimously.
The bill would provide loan forgiveness to keep more health care professionals in Georgia and also enforce parity - a federal law that requires insurance companies to treat mental health like all other medical issues.
"The No. 1 issue in the bill that really brought us to the table is parity. Parity is a 14-year-old federal law that simply has never been enforced by state of Georgia," Jeff Breedlove, chief of communications and policy for the Georgia Council on Substance Abuse, said in a phone interview.
Breedlove said the bill is the product of a two-year process by a broad coalition of mental health organizations, recovery organizations, Georgia Medical Association, sheriffs, police chiefs, hospitals and nurses. The bill was sponsored by House Speaker David Ralston, R-Blue Ridge.
Breedlove said Georgia consistently ranks poorly for mental health services, and this is a foundational bill for transformational change. If the state of Georgia enforces federal law, Breedlove said, $200 to $300 million would be made available by insurance companies to help pay for new mental health and substance abuse services.
Many final details were worked out at the Senate Health and Human Services Committee last week after four meetings and much emotional testimony. The Senate committee added medical professionals to the list that would qualify for a program to cancel loans for working in under-served areas.
Proponents wanted more resources given to the state's mental health care system, which is consistently ranked as one of the worst in the country, while the limited opposition feared more government intervention into health care and threats to civil liberties.
"There are counties up in Northwest Georgia that don't have access to services," mental health care advocate Bonnie Moore said in a phone interview. "They have to go to another county because, again, it has to do with funding because community service boards can't put a [mental health care] center in every county."
The state's 23 community service boards provide mental health, addictive disease and developmental disability services for uninsured Georgians. Moore said there aren't enough nurse practitioners and psychiatrists in rural Georgia.
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Moore is president of the Rome chapter of the National Alliance on Mental Illness, which provides support, education and advocacy to those struggling with mental health and substance abuse disorders, although she said she was not speaking for the organization.
At the committee hearing, Sen. Michelle Au, D-Johns Creek, was concerned language in the bill would allow private insurance companies to determine what treatment was a medical necessity. Committee Chairman Sen. Ben Watson, R-Savannah, said that could be strengthened by new legislation later if necessary.
Mental health care advocates were concerned the updated bill added exemptions to the parity mandate for some policies and also no longer required insurers to provide mental health and substance abuse benefits if they didn't already offer them.
The new Senate version of the bill added primary care physicians to the health care professionals who could qualify to have their student loans canceled in exchange for working in under-served areas. That part of the bill was expected to cost $10.3 million annually, said Sen. Greg Dolezal, R-Cumming, in the hearing, but that figure didn't include adding primary care physicians to that list.
"In my mind, the workforce is the critical issue here that we've got to address, and if that's $10 million a year that we need to put towards that for adequate coverage, I'm willing to recommend that," said Vice Chairman Sen. Dean Burke, R-Savannah, adding the bill should be updated with the additional costs.
The Senate committee also added a provision that would provide mental health training to law enforcement officers. The bill gives officers the power to refer people for a mental health evaluation, but that's separate from a hearing before a probate judge that could lead to restricted gun rights, committee members pointed out.
After the committee vote, Rep. Philip Singleton, R-Sharpsburg, an outspoken critic of the bill, described the changes to a crowd at the Capitol in an online video. He's one of three House members who voted against the bill before it reached the Senate.
Northwest Georgia Reps. Mike Cameron, R-Rossville, Dewayne Hill, R-Ringgold, Steven Tarvin, R-Chickamauga, Jason Ridley, R-Chatsworth, and Kasey Carpenter, R-Dalton, all voted for the bill.
Singleton said he is against mandates and doesn't think the government should get involved in health care at all but believes "serious improvements" in the bill were made. The civil liberties piece of the bill - what Singleton said he was most worried about - was removed in the Senate updates, he said.
Later on social media, he wrote that in the previous version of the bill someone could be "locked up against their will with nothing more than a reasonable belief that they might need mental health treatment in the near future."
The bill still allows law enforcement to take people to an emergency receiving facility if officers have probable cause to think the individual is mentally ill and in need of involuntary treatment. This can only be done, the bill says, after consulting with a physician in person or through a telehealth portal, and the involuntary hold is up to three days. A judge must determine a longer hold. As is the case now, law enforcement officers can detain people who pose a threat to themselves or others.
Moore, the mental health advocate from Rome, leads crisis intervention training for police, teaching officers how to identify and manage mental illness when they respond to calls. She said this is a tool law enforcement needs and believes it won't be abused.
Breedlove, with the substance abuse council, said this bill is the first step in a multi-bill process to reform mental health care treatment in Georgia, including giving law enforcement officers more options rather than simply taking people to jail.
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"The largest mental health provider in any county or state, practically speaking, is the jails. And that's a tragic shame," Breedlove said.
About 800,ooo Georgians are in recovery from substance abuse, he said, and more than 1 million Georgians have diagnosed mental health issues, he said.
More funding for mental health courts is also provided in the bill, but Moore said advocates want a program that will provide support and guidance before a crime is committed. Moore said the bill would fund a study in multiple jurisdictions to determine whether assisted outpatient treatment is effective. A similar program is in place, but Moore said she is advocating for a standardized system.
Right now, Moore said, if law enforcement determines someone in Northwest Georgia is threatening violence or self-harm, the closest emergency receiving facility is in Rome. The bill should provide funds for new facilities and more training for law enforcement when encountering people in crisis, Moore said.
Breedlove said he thinks a good balance has been found in the bill.
"The important point is there's a cultural shift within law enforcement across our state that they now want to be peer-supported partners. They don't want to send peers to jail if the peer needs medical help and hasn't committed a serious offense," he said.
Don Benson of Rome said he got involved with Georgia's mental health care system after he was assaulted by his son, who was schizophrenic. In a phone interview, Benson said he knew his son had to be held accountable even if he had mental illness, but the elder Benson also said he thinks the system failed the family because his son was already on probation and should have been receiving mental health care services.
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"The head Superior Court judge, Judge [Frank C.] Mills, heard my case, and he allowed for rehabilitation versus incarceration," Benson said. "And it was that point in time that I got seriously involved with our state's mental health care system, and I also studied his mental illness to see if I could contribute in any way, shape or form to solving or helping people with the severe mental illness of schizophrenia."
As a former IBM systems engineer, Benson said he is familiar with business management and customer service, and he said it was difficult learning to navigate the state's administrative system governing mental health care. In the beginning, Benson said he had to learn the mental health care system on his own.
What helped his son stay on track, Benson said, wasn't just clinical treatment or therapy, but also peer support - help getting through the process from someone who has been through it.
In Northwest Georgia, the group in Rome hosts the only National Alliance on Mental Illness support group for people living with mental illness and family members supporting them. Moore said people can join the meeting by teleconference rather than make the drive.
Contact Andrew Wilkins at awilkins@timesfreepress.com or 423-757-6659. Follow him on Twitter @tweetatwilkins.