Two years ago, state lawmakers rallied behind a landmark proposal that was touted as the first step in a multiyear effort to lift Georgia from the bottom of national rankings for access to mental health services.
That push hit a snag last year when a follow-up bill stalled in the Senate where it was met with opposition from far-right activists and then became ensnared in the end-of-session bartering between the two chambers.
Some provisions, like an in-depth look at service gaps in the state’s safety net, ended up being implemented administratively without legislative backing. But other pieces, like proposals to bolster the state’s porous behavioral health workforce, would have to wait a year.
This time around, lawmakers from both chambers were able to shepherd through several smaller bills with provisions designed to build on the 2022 law, sending them to the governor’s desk.
Instead of thick, sprawling bills like the last two measures – which clocked in at 77 and 51 pages – proponents of mental health reforms this year floated a flurry of bite-size proposals. That’s in addition to new funding for mental health put in the budget, including a boost for the state’s behavioral health crisis system.
The mental health-related proposals were so abundant and varied this session that they could at times be difficult to track.
“The momentum for mental health is continuing,” Kim Jones, executive director of NAMI Georgia, said at one point during the session. “I always tell people, ‘The great thing about this year is we have so many mental health bills. The hard thing about this year is we have so many mental health bills.’”
Many of the bills sailed through with bipartisan support. But a couple had a bumpier ride during an election-year session and were hijacked in the Senate to advance controversial proposals like a late-session proposal to ban puberty-blocking medication for transgender minors.
House lawmakers successfully used a legislative maneuver to revive one of the waylaid proposals. A proposal requiring opioid-reversing drugs to be kept in most state and local government buildings was tacked onto another bill allowing naloxone in K-12 schools.
Some measures still came up short. A bill designed to address mental health and suicide risks for student athletes never recovered from its conversion to a vehicle for culture war proposals in the Senate.
Another stalled bill would have allowed an alternative to discipline for nurses dealing with a substance use disorder or mental condition. Such a program already exists for physicians, pharmacists and dentists. This bill cleared the House easily but stalled in the Senate, and a last-gasp attempt in the House to graft it onto other legislation went nowhere.
“There’s a barrier, if you will, that might prevent a nurse from coming up and saying, ‘I’ve got a problem,’” said Savannah Republican Rep. Ron Stephens, a pharmacist who sponsored the bill. “And, of course, that is not what we want in the health care field at all. And this of course, I believe, will remove that barrier so that the person who has a problem will be more likely to step up to get help.”
Much of this year’s efforts surrounding mental health focused on boosting Georgia’s behavioral health workforce, whether through speeding up the licensing process for relocating marriage and family therapists who are in good standing in other states or offering loan forgiveness for mental health and substance use professionals working in underserved or hard-hit areas.
“The missing piece, I’m afraid, is workforce and mental health care providers,” said Sen. Larry Walker III, a Perry Republican who sponsored one of this year’s bills. “So, without access to qualified mental health professionals, all of these efforts that we’ve done really will be in vain.”
Another bill waiting for the governor’s attention – and a holdover from last year’s failed measure – would bolster the state’s efforts to provide jail-based competency restoration programs.
“I’ve heard people say time and time again that there are examples of people who may sit longer in jail waiting to be declared competent to go to trial than they would actually sit if they were found guilty of the offense they’re charged with,” said Sen. Brian Strickland, a McDonough Republican who sponsored the bill.
Other bills took steps intended to expand access to treatment.
A provision in a high-profile health care bill exempts new or expanded psychiatric facilities or inpatient substance abuse programs from regulations meant to limit the number of services in a geographic area.
Another bill sitting on the governor’s desk repeals a discriminatory zoning law. Today, when a provider wants to open a new treatment facility or halfway house in Georgia, the local zoning application is subjected to an additional six- to nine-month review period.
Critics of the provision say it is a discriminatory requirement that serves as a barrier for providers trying to offer treatment at a time when the state is working to increase services, partly in response to the opioid crisis. They also argue that the additional waiting period conflicts with federal law protecting the people served by these facilities.
They had no trouble convincing lawmakers that the law needed to be stripped from the books in Georgia.
“It’s the right thing to do. You don’t need extra time to get people to be opposed and to stir them up,” said Rep. Dale Washburn, a Macon Republican who sponsored the bill.
But efforts to provide health insurance to hundreds of thousands of low-income Georgians fell short again this year. Mental health advocates had joined others in pressing lawmakers to fully expand Medicaid in hopes of connecting more people with access to a doctor and care for their mental health. In the end, GOP leaders settled on a commission that will continue to look at Medicaid expansion this year.
Georgia is one of 10 states that have not fully expanded Medicaid expansion under the Affordable Care Act.
“We believe that closing the coverage gap would not only help the people we serve with mental health conditions but also keep people from experiencing mental health disorders,” Jones said.
Advocates say this year’s collection of mental health-related bills represented progress, even if the piecemeal approach meant narrower bills on multiple fronts.
“It’s almost like a LEGO wall,” said Roland Behm, board member of Georgia’s chapter of the American Foundation for Suicide Prevention and a co-founder of the Georgia Mental Health Policy Partnership. “In previous years, we tried to sell a LEGO wall, and in 2022, we were successful. And in 2023, let’s face it, we weren’t as successful as we would have liked to have been.
“So, what you saw (this year) was the effort of ‘OK, here’s the red brick. Here’s the yellow brick. Here’s the green button. Here’s the black brick.’”
Jeff Breedlove, advocacy strategist at the Georgia Council for Recovery, says he sees the 2022 law as the foundation for the work that is still underway.
“So, what we’ve done is take Georgia, who was basically in last place by any poll and survey, and put HB 1013 down and say, ‘Never again,’” Breedlove said in February, referring to the 2022 law.
“And now we will build methodically, holistically, and inclusively with diverse points of view over the next several years off the success of HB 1013, so that we have a workforce in place and we have reformed licensing, which will allow more services in more communities,” he said. “It does take time but that revolution, that transformation is happening in 2024 in Georgia.”
