George on Georgia – General Assembly will consider bill to change mental health lawGeorge Chidi. Photo by Dean Hesse
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The government scares the hell out of people on a good day. On a bad day, it should.
Our benighted arguments about the state of health care – in Georgia and in the United States – revolve around two countervailing fears about government; that it will do too little or too much.
We get this tension in spades when talking about mental health, particularly when considering involuntary treatment for a psychiatric disorder. Doing too much looks like the days when a husband could commit his wife to a mental hospital for “an unclean spirit” or similar claptrap. Doing too little looks like … well, the corner of Peachtree Street and Marietta on a Tuesday afternoon.
The Georgia General Assembly is going to consider a bill to change mental health law in a few weeks. I’ve seen a draft. And generally, I like it. I know there’s going to be an argument about the treatment changes. And I want to get in front of that argument now to lay down a marker.
People go to war to prevent atrocities seen daily on a Georgia street corner. No more.
Georgia scrapes the bottom of the rankings for mental health in America. Mental Health America puts Georgia in the middle of the pack this year only because of the rankings newly incorporated “prevalence” data – which, frankly, don’t capture unreported cases in a state that is otherwise no higher than 48th in all the other indicators. Georgia ranked dead last the previous year. And it should.
The proposed law would change the standard for a police officer to take someone to a hospital against their will. Currently, the law requires the threat of “imminent harm” to oneself or another. As a practical matter, that required a police officer to witness an act of violence or the threat of it – an arrestable offense. The law would change to allow a police officer to take someone to medical care against their will if that officer had “a reasonable expectation that a life-endangering crisis or significant psychiatric deterioration will occur in the near future.”
It doesn’t mean people will be permanently interred in hospitals without recourse. As a practical matter, it means that the people police see who are deteriorating in front of their eyes day after day need not be left where they are simply because they know the day of the week and the name of the president and don’t want to go.
The bill also calls for involuntary outpatient civil commitment. The law would allow a probate court to require someone to show up at a clinic for treatment from time to time, and to provide for alternatives to arrest for people who skip a session or quit taking their medications.
Back in the day, families could and did buy a bed in an asylum to send an unwanted family member away. In 1953, 559,000 Americans had been committed to an institution against their will – about one out of 285 people. (I note in passing that the percentage of Americans who were incarcerated or institutionalized was lower then, because nearly 2 million people live behind bars today. Fewer than 100,000 people were imprisoned in 1953.)
Our laws for involuntary commitment changed because the abuses became obvious. O’Connor v. Donaldson, a 1975 case that established new terms under which someone could be committed, met One Flew Over the Cuckoo’s Nest, the 1975 Oscar-winning film set in an insane asylum. And the laws tumbled. Meanwhile, the development of antipsychotic medications met Reagan’s zeal for smaller government. And the asylums tumbled, too.
But something went very wrong after that. Promised community-level care never materialized, and our streets and our jails slowly filled with people who need a doctor and a safe space.
The proposed legislation is a middle ground between lobotomizing Jack Nicholson and letting people freeze to death because they won’t come inside on a cold night.
I have literally chased people through the streets of Atlanta, trying to keep an eye on them long enough to connect with a caseworker and get them treatment and housing. The conditions today are as absurd and confounding as One Flew Over the Cuckoo’s Nest. It just happens outdoors.
From these concerns was born Georgia’s Behavioral Health Reform and Innovation Commission, which has been building out a bill to address big problems with Georgia’s system. DeKalb County’s own State Rep. Mary Margaret Oliver has been a key member of the commission and a discussion leader. Though a Democrat, the legislature’s Republican leadership relies on her for legislative expertise on matters of mental health. And she’s happy with the results so far.
“I am impressed with the many efforts undertaken by the behavioral health commission to draft a comprehensive mental health reform bill since the end of the 2021 session,” she said. “The current draft continues to be vetted with many groups and political leaders. Speaker (David) Ralston is significantly involved in perfecting the draft, and has talked publicly about his interest and support which gives me hope of passing a strong bill.”
Some of the bill harmonizes Georgia’s insurance laws with the federal law, and requires insurance companies not to shortchange mental health care. Even with insurance in Georgia, a lot of services aren’t covered. It would also offer education debt repayment for mental health workers. Georgia is near the bottom in the ratio of mental health workers to population. It takes a swing at getting more treatment for adolescent mental health.
The bill creates a state funding mechanism for accountability courts, and a committee to coordinate technical assistance and data sharing between those courts, jails and other providers. The goal appears to be a push for universal mental health screening in county jails, and to keep people from drifting into and out of treatment as they pass from prison to the local community service board … and back again, sadly.
It doesn’t fix everything. Some big, obvious problems remain outside the scope of the legislation.
Georgia did not expand Medicaid. That leaves many people uninsured, contributing to our dismal state of access to mental health treatment. The bill works around this problem, but it doesn’t solve it.
Nor does it touch the housing problem directly. Housing instability exacerbates mental health problems. It’s why we find people in the street. The prescription for that problem is permanently-supportive housing. But the bill doesn’t fund new PSH units.
The bill does as much as possible without spending money. Money appears to be a separate negotiation. And … OK. I accept that. Because I want this, regardless of that. That’s how adult politics works.
Most of the people who might object to this bill were in the room while it was being written. The one part I’m worried about is the involuntary commitment language. But I’m not afraid. I don’t need to be.
– George Chidi is a political columnist, public policy advocate and a veteran. He also writes for The Intercept.
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