Over the last two decades, several commissions have tried to figure out how to finance much-needed improvements in Georgia's mental health system and better coordinate services to the chronically ill. While those efforts have met with some small successes, the system continues to be profoundly flawed, as evidenced most tragically by 136 suspicious deaths over the last five years in the state's mental hospitals.

Problems persist because state leaders have wasted valuable time trying to structure a mental health system that "saves" the state money. That's simply not going to happen. Mental health care is costly and intense. For most patients it is never-ending. State spending on it will constantly need to rise.

That's bad news for taxpayers, but it's even worse news for those trying to deal with mental illness. There is no cure for the insidious disease, only control through vigorously coordinated care.

Because Georgia has failed to protect the civil rights of citizens under its care for mental illness, the state could face a U.S. Justice Department lawsuit that might put state mental health services under control of a federal judge. If Georgia hopes to avoid that pitfall, state officials can no longer afford to flat-line budgets for mental health care while tinkering with Medicaid reimbursement, case management and other programs in a vain attempt to save money.

Protecting the 15,000 patients within the state system demands a huge, immediate spending increase, more than likely doubling the nearly $500 million a year now being appropriated. The best the state can hope for — indeed the goal of all states struggling with the issue — is to create a system that wisely uses public funds while improving the lives of the severely mentally ill who have no other place to go.

As it stands now, Georgia ranks 42nd among the states and District of Columbia in per-person spending on community-based care, which is considered the most effective means of dealing with chronic mental illness. On average, other states spend 2.5 times more than Georgia on treating and managing mental illness outside of hospitals, according to an Atlanta Journal-Constitution analysis of spending figures provided by the National Association of State Mental Health Program Directors.

The state does somewhat better — 35th in spending — on hospital care, yet that is where the most severe problems exist. When community mental health services are inadequate, as they are in Georgia, state hospitals get overrun with patients.

Moreover, local taxpayers foot an additional bill for county jail beds filled by mentally ill inmates charged with nuisance crimes, and charity groups and homeless shelters have to take in others who have bottomed out. This vicious cycle has been allowed to play out for far too long.

Seriously ill patients who can afford private mental health therapy routinely need institutional care, often for only a few days at a time, to stabilize medication regimens or straighten out their living arrangements. That's even more the case for patients who have exhausted their private insurance coverage or have never had coverage. Their social network is constantly under siege.

The state should consider more formal contract arrangements with local public hospitals to set aside emergency psychiatric beds for these patients so they can be treated closer to home and avoid lengthy stays at one of the state's seven psychiatric hospitals. While the state would have to pay more in the form of increased reimbursement for services provided by local hospitals, it would still be less expensive than committing patients to longer-term stays in the state's seven hospitals. It would also relieve pressure on the state institutions and allow them to concentrate services on the most seriously ill.

Additionally, the coordination of care between hospitals and outpatient community mental health centers needs much more attention. Justice Department investigators looking into the state hospitals last year found that some discharged patients were given bus tokens and sent on their way, while others were taken to homeless shelters.

That kind of discharge planning was unacceptable decades ago. That it still happens is an embarrassment to Georgia.

One lesson learned from other states is that mentally ill patients need strong case managers to monitor their lives — making sure they are taking their medications, monitoring their living arrangements and, in the best of conditions, checking in with their employers.

The expense in new personnel will be high, but the benefit of a patient-centered system coordinated by readily available psychiatric social workers and nurses will lead to better health and give the state a chance to control the overall costs of the system.

So what's the final bill?

Given the crisis the state faces, that's not the first question to be asking. What we know for certain is that it is more than we are spending now, significantly more.

— Mike King, for the editorial board