Georgia lawmakers aim to tackle spike in suicides, overdoses

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Facing a surge in overdose deaths and rural suicides, Georgia lawmakers want to bolster the state’s dismal mental health care system by pressuring private insurers to improve coverage and increasing state funding for treatment and crisis services.

Members of the state Legislature are scheduled to unveil a policy package for mental health and substance abuse on Wednesday. Efforts to ensure private insurers provide the same level of benefits for depression, anxiety and other mental disorders as they do for medical conditions are expected to be a central part of the legislation.

The package is also expected to contain incentives for people to get trained as mental health workers. Separately, Georgia House Speaker David Ralston has said he anticipates budget proposals that will increase spending on treatment and bed space.

Gov. Brian Kemp’s proposed budget for next year includes millions of dollars in additional funding for the state Department of Behavioral Health and Developmental Disabilities to treat adults with substance abuse and mental health problems and add hospital beds for people experiencing mental health crises.

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"What I’ve seen is a sea change in terms of recognition of what a significant challenge behavioral health care, or the lack of behavioral health care, is for many Georgians," said Roland Behm, a member of the board of directors at the Georgia chapter of the American Foundation for Suicide Prevention. "We have very clear indicators that there are many Georgians who are struggling but who aren’t getting the access to care that they need."

From 2019 to 2020, suicides in rural parts of Georgia increased by more than 8 percent to 428, according to a presentation last week by Department of Behavioral Health Commissioner Judy Fitzgerald. Fitzgerald told state lawmakers preliminary data indicates 2021 was even worse.

The state also experienced a surge in substance abuse. From April 2020 to 2021, overdose deaths in Georgia climbed by 36 percent to 2,086, Fitzgerald said.

"Isolation, stress, limited access and the strain of the pandemic is having devastating consequences in our communities, our cities and our families," she said.

The nonprofit group, Mental Health America, has consistently ranked Georgia among the worst states for access to mental health care. Of the state’s 159 counties, 77 had no psychiatrists working fulltime and 76 did not have a licensed psychologist, according to a January 2021 report by a state commission.

The Department of Behavioral Health’s five hospitals have lost more than 1,000 employees since 2020 — a shortage that has forced officials to take 185 beds offline in order to meet required staffing ratios, according to Fitzgerald.

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"We were already behind before the COVID-19 pandemic when it came to addressing issues of mental health and substance abuse disorders," said state Sen. Kim Jackson, D-Stone Mountain, co-chair of a mental health caucus at the Capitol. "COVID-19 has exacerbated that."

Behl said private insurers are failing to meet requirements for parity between mental health and substance abuse coverage and medical coverage.

Federal law generally bans insurers from charging higher co-pays or deductibles, requiring pre-authorization or imposing other restrictions on mental health and substance abuse treatment that they don’t require for medical or surgical coverage. Insurers must also use comparable processes to determine reimbursements for mental health and medical providers.

Behl said insurers are shortchanging mental health providers in Georgia, reducing their incentive to become part of insurance networks. The result is that many people, particularly in rural parts of the state, have few options for mental health treatment and are forced to go outside their insurance networks and pay themselves.

Jesse Weathington, president and CEO of the Georgia Association of Health Plans, an insurance group, said in a statement that "parity does not mean that a psychologist must be paid the same amount as a surgeon." Insurers are facing a provider shortage that has been exacerbated by the pandemic and "has at its root the failure of Georgia to adequately invest in mental health delivery," he added.

"Access won’t meaningfully increase without increasing the number or providers or expanding the use of telehealth," he said.

A parity bill in Georgia’s House of Representatives would require insurers to submit a report each year that includes data on how often they required pre-authorization for treatment of mental health and substance abuse problems and the rates at which they denied claims for those services. It would also authorize state officials to examine reimbursement rates and other factors for compliance with parity requirements.

Jackson said the measures that will be unveiled Wednesday are not a silver bullet. Democrats in Georgia have pushed for years for a full expansion of Medicaid and say that would greatly improve access to mental health services. But Republicans are opposed to that plan.

Jackson anticipates lawmakers this session will consider a separate measure she supports to have social workers respond to 911 calls involving people with mental health problems. But she said more will need to be done in the years ahead.

"Hopefully, this is a good start to continuing the conversation," she said.

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