A Step in the Right Direction

By Amanda Newell

Legislation concerning mental health care in Georgia directly impacts people living with mental illness, their families, and mental health advocates and providers in this state.

The Friendship Center welcomes the reforms proposed in a bill (HB 520) passed by the Georgia House of Representatives on March 2, 2023. The Friendship Center’s vision includes clarifying complexities in new or proposed laws to help people experiencing mental health challenges understand and access resources these legislative developments offer.

Twice a month, we’ll provide updates on laws and policies affecting the mental health of Georgians, as well as share what we’ve learned from over 25 years of providing a supportive community to people living with mental health conditions.   

Lack of access to treatment for mental illness is a national issue impacting more than 28 million people in the U.S.1 According to Mental Health America, Georgia ranks 43 out of 51 in adult access to treatment for mental illness.2 (The rankings include the District of Columbia). By comparison Montana, Nebraska, and Massachusetts had the highest rates of adults accessing mental health services.3 The “access measures” the study utilized included “access to insurance, access to treatment, quality and cost of insurance, access to special education, and mental health workforce availability.”4 

Recent Legislation Aims to Address Shortages

Shortages of licensed mental health professionals and of inpatient beds for psychiatric care contribute to the difficulties Georgians face in obtaining treatment.5 If enacted, HB 520 would be a step towards addressing these shortages. With bipartisan support, HB 520 passed the House in a 163-3 vote and was formally introduced in the Senate on March 6, 2023.6 The cosponsors of the bill include Rep. Todd Jones (R-South Forsyth) and Rep. Mary Margaret Oliver (D-Decatur).7 

The proposed law adds to reforms introduced in last year’s Mental Health and Parity Act (HB 1013) also sponsored by Reps. Oliver and Jones as well as by the late House Speaker David Ralston.8 According to Rep. Oliver, “There is still much work to do, particularly in the area of workforce protection, development and expansion.”9 

Mental Health America reports that Georgia ranks 47 out of 51 in mental health workforce availability.10 This equates to 640 individuals for every one mental health care worker in the state.11 Rep. Jones noted that Georgia’s HB 520 “would both incentivize these workers to stay in Georgia and alleviate the educational costs of becoming qualified for this field.”12 The bill proposes to achieve this through the following:  

  • Providing student loan forgiveness for each year of service (up to 5 years) that a mental health or substance use disorder professional works in the state. To be eligible, applicants must be legal residents of, and licensed in, Georgia and must provide “services to underserved youth” or “in unserved geographic areas…that are disproportionately impacted by social determinants of health.”    

  • Creating a central data bank that gives the public access to geographical and demographic information on licensed mental health care professionals in Georgia.

  • Conducting a study to identify obstacles to licensure for behavioral health care professionals in the state. Specifically, the Office of Health Strategy and Coordination will examine ways to do the following: 

    • Modernize the licensing system.

    • Make it easier for mental health professionals trained in other states or countries to obtain licensure. 

    • Bring supervision and practicum requirements for licensing in line with those in other states.13   

HB 520 also calls upon the state’s Behavioral Health and Innovation Reform Commission to assemble a task force to study barriers to access, including the low number of inpatient beds dedicated to behavioral health care. The task force will determine the number of additional inpatient beds required to meet the needs of mental health consumers in Georgia. It will also evaluate Georgia’s continuum of crisis services to identify other points along the continuum that, if strengthened, could reduce the demand for inpatient beds. Under HB 520, the study must also assess non-crisis resources that help people stabilize within the community and thus reduce their need for crisis care.14 

As part of this proposed study, we urge the task force to give adequate attention to the role supportive community plays in reducing mental health crises. Since its inception, the Friendship Center has offered a supportive environment that connects participants to holistic care for their mental health needs. For example, members of Grady’s Assertive Community Treatment (ACT) teams visit the Friendship Center regularly to meet with participants one-on-one. ACT teams are multi-disciplinary and assist with “medication management, therapy, substance use treatment, and vocational and recovery support.”15 According to the Friendship Center’s Executive Director Tameka Baker, “We’ve also discovered that access to regular monitoring of chronic physical conditions, like diabetes, adds to the mental stability our participants experience. We’ve partnered with the Georgia State School of Nursing to meet this need.” Future legislation should fund investment in non-crisis models that have proven effective in helping consumers access outpatient health care with a frequency sufficient to manage mental distress before it reaches the crisis level.    

Mental Health Parity Act 

One way to achieve greater access to both inpatient and outpatient mental health care is to ensure parity between insurance coverage for physical and behavioral health conditions. The Mental Health and Parity Act (HB 1013), which the Georgia General Assembly passed unanimously, and Gov. Brian P. Kemp signed it into law on April 4, 2022, requires that health insurers in the state comply with federal parity provisions.16 A federal law, the Mental Health Parity and Addiction Equity Act of 2008, ordered that group health plans (with some exceptions) offer mental health and substance use disorder coverage at the same level as benefits for medical or surgical care.17 HB 1013 strengthens the state’s enforcement of federal and state parity requirements through the following:

  • Directing the Commissioner to request data from health insurers by May 15th of this year and to utilize the data to identify any possible violations of parity laws. 

  • Streamlining the process for mental health care providers and consumers to file complaints against insurers.  

  • Appointing a mental health parity officer. 

  • Authorizing the Commissioner to impose penalties of up to $2,000 per violation (or $5,000 per violation if the insurer knew or reasonably should have known it was not in compliance). 

  • Requiring that insurers use “generally accepted standards of mental health or substance use disorder care” in medical necessity and prior authorization determinations.18   

Increased compliance with parity provisions among insurers should help mental health consumers continue to receive treatment that in the past insurers might have cut off pursuant to coverage exclusions or limitations. However, even when the state ramps up its enforcement of parity rules, the systemic shortages of behavioral health workers and inpatient beds still function to exclude mental health consumers from receiving adequate crisis care.  

For this reason, HB 1013 and HB 520 represent only a start to long overdue reform of mental health care delivery in this state. HB 520’s potential to help reverse the critical shortages in Georgia’s mental health care work force does offer hope that the state will get on track to provide comprehensive, consistent care to persons experiencing mental illness. However, we must hold lawmakers to an end goal of not only stabilization but also thriving for persons living with mental health challenges. 

Start today to advocate with and for the mental health community! Contact your legislators in the Senate and urge them to support HB 520 (https://www.legis.ga.gov/members/senate). Thank your House legislators who supported the bill (https://www.legis.ga.gov/members/house?sortBy=districtNumber). If you have encountered barriers to access, make sure to share your story. And stay tuned for our next edition later this month where we’ll feature more about the Friendship Center’s care approach and continue to provide up-to-date news to help you stay in the know.

Resources:  

For more information on the state of mental health care in Georgia, check out:  Mental Health America State of Mental Health in America (includes statistics assessing Georgia’s mental health care delivery) - https://www.mhanational.org/sites/default/files/2023-State-of-Mental-Health-in-America-Report.pdf

For the full text of HB 520, go to https://www.legis.ga.gov/legislation/64634

To track the progress of HB 520 through the General Assembly, visit https://legiscan.com/GA/bill/HB520/2023

If you need immediate help for a mental health crisis, contact the GA Crisis & Access Hotline (available 24/7) at 1-800-715-4225 or dial 988 for the national 988 Suicide & Crisis Lifeline.  

For ongoing support check out the National Alliance on Mental Illness (NAMI) Support Groups:  https://namiga.org/calendar-2/

NAMI Georgia offers a non-crisis HelpLine that can provide information about resources for persons with mental illnesses and their family members in Georgia.

We can provide information on NAMI programs, community services, education, support groups, and peer support. Our operators are not trained to provide counseling, nor emergency services for those in crisis. We are not a suicide hotline. If you are in a crisis situation, please call 911 to receive emergency support. Request that a CIT officer be sent, if one is available.

HelpLine Number: 770-408-0625

HelpLine is available Monday-Friday, 9am to 5pm. Please leave a message if a resource specialist is not available and you will receive a callback as soon as possible. You may also reach the HelpLine by email at helpline@namiga.org. Please leave a phone number if you would like to be contacted by telephone.

Sources:

1 Maddy Reinert, Danielle Fritze, and Theresa Nguyen (October 2022). “The State of Mental Health in America 2023” Mental Health America, Alexandria VA, pg. 21 accessed at

https://www.mhanational.org/sites/default/files/2023-State-of-Mental-Health-in-America-Report.pdf

2 Reinert, Fritze, and Nguyen, “The State of Mental Health in America 2023” pg. 21.

3 Reinert, Fritze, and Nguyen, “The State of Mental Health in America 2023” pg. 21.

4 Reinert, Fritze, and Nguyen, “The State of Mental Health in America 2023” pg. 21.

5 Betsy Theroux, “Reps. Todd Jones, Mary Margaret Oliver Introduce Legislation to Continue Mental Health

Reform Efforts” (February 21, 2023) accessed at https://www.legis.ga.gov/house/press-releases

6 LegiScan, “Georgia House Bill 520” accessed at https://legiscan.com/GA/bill/HB520/2023

7 Sponsors of HB 520 also include House Majority Leader Chuck Efstration (R-Dacula), House Minority Leader James Beverly (D-Macon), Rep. Sharon Cooper (R-Marietta), and Rep. Butch Parrish (R-Swainsboro).

8 Sponsors of HB 1013 also included Reps. Don Hogan, Sharon Cooper, and James Beverly.

9 Betsy Theroux, “Reps. Todd Jones, Mary Margaret Oliver Introduce Legislation to Continue Mental Health

Reform Efforts”

10 Reinert, Fritze, and Nguyen, “The State of Mental Health in America 2023” pg. 29.

11 Reinert, Fritze, and Nguyen, “The State of Mental Health in America 2023” pg. 29.

12 Betsy Theroux, “Reps. Todd Jones, Mary Margaret Oliver Introduce Legislation to Continue Mental Health Reform Efforts”

13 Georgia General Assembly, House Bill 520 accessed at https://www.legis.ga.gov/legislation/64634

14 Georgia General Assembly, House Bill 520

15 Grady Behavioral Health Center, “Grady Gets It: A Vital Part of Healthcare accessed at

https://www.gradyhealth.org/care-treatment/behavioral-health-center/

16 Georgia General Assembly, HB 1013, Mental Health Parity Act, accessed at

https://www.legis.ga.gov/legislation/61365

17 Centers for Medicare and Medicaid Services, “The Mental Health Parity and Addiction Equity Act” accessed at

https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet

18 Georgia General Assembly, HB 1013, Mental Health Parity Act

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