When Vaughn Calvert’s son was in the midst of a mental health crisis in 2017, there was only one place for him to turn: the local emergency room.
Calvert pleaded for help for his adult son, who has both a developmental disability and bipolar disorder, only to be turned away. There wasn’t a crisis bed available for him, so instead, his son sat in the ER for days.
“Everybody there was trying to help,” said Calvert, who is from Eatonton. “But when [there isn’t] a place to go, they don’t have a place to send you.”
Calvert’s son illustrates a long-standing problem with the state’s mental health care system. Meant to protect patients in crisis, it’s routinely overloaded, leaving patients sitting in emergency rooms or jail cells where they can’t get the care they need. A new study commissioned by the state shows that Georgia will need five more behavioral health crisis centers by 2025, and another three on top of that by 2032. That’s in addition to needing nearly 120 beds by 2025 for people who are ordered mental health treatment before they can stand trial.
State officials say they don’t have enough beds or mental health professionals to meet the existing demand. The state has 28 crisis centers with about 650 beds. But demand is far outpacing capacity, and many of these beds can’t be used due to a lack of staff.
The five crisis centers the study calls for by 2025 are in addition to creating and expanding three new facilities that are now underway: in Fulton County, Augusta, and Dublin.
The need for mental health and substance abuse services will likely rise in the coming years, as a new national three digit dialing code for mental health emergencies, 988, becomes more familiar to the public, and more patients could enter the system.
“It’s important for us to stay focused on the people that we’re here to serve, who are some of the most vulnerable individuals in the state,” Kevin Tanner, commissioner of the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD), said in an interview.
Tanner has put forth a plan that asks the governor for about $36 million in the next fiscal year, and a one-time $15 million payment this fiscal year to help start paying for this endeavor. The funds have been approved by the DBHDD board and now goes to the budget office to be considered in Kemp’s spending plan for next fiscal year.
If approved when the Legislature meets next year, the money would cover a number of things, including expansion of crisis centers’ capacity, as well as funds to boost wages for centers’ staff and psychologists who evaluate people within the criminal justice system. That money would come on top of $10.2 million Gov. Brian Kemp earmarked to boost the salaries of hospital staff, including behavioral health counselors, health aides, client support workers, social workers, and more.
The shortage of workers means that existing crisis beds are going unused across Georgia. In some parts of the state, as many as 20% to 50% of beds at a facility are unused, Tanner said.
Right now, Tanner said that there are about 550 people who have been deemed incompetent to stand trial and are court-ordered to a hospital. In recent years, the state has seen a surge in the number of psychiatric evaluations in the court system, with fewer psychologists working there.
The Dekalb Regional Crisis Center offers a peek into how the worker shortage and lack of bed space means fewer services for vulnerable Georgians. The facility has 36 crisis beds, but the struggle retaining workers has meant it can only staff 20 beds on average.
To remedy this, DeKalb is currently trying to secure funding for a new 30-bed mental health crisis center. The county is seeking voter approval of a sales tax that could raise $15 million for the facility, but will still need another $10 million to fully cover the remaining costs.
Credit: Jason.Getz@ajc.com
Credit: Jason.Getz@ajc.com
Fabio Van Der Merwe, CEO for the DeKalb Community Service Board, said he believes that stagnant Medicaid reimbursement rates, combined with a lack of additional state funding, has contributed to the workforce shortage. Van Der Merwe called the bed study an “important first step” but that he thinks it’s underestimating the need.
“The systems that were supposed to help support have been neglected. And now they’re getting to the point where the system is starting to break down,” he said.
Dr. Karen Kinsell of Clay County Medical Center agrees, and thinks the situation is far worse than the study describes. There are many patients who would benefit from hospitalization, she said, and moving them into treatment would take a tremendous load off law enforcement and social services.
Kinsell said that in her area, patients are sent to crisis centers that are further away, sometimes even in Alabama. Kinsell also said she’s never had an experience where responders from the crisis line actually intervene in a helpful way.
“Any time you call the crisis line, they say ‘Oh, we don’t have any beds, we will put you on a list,’” she said. “When you have a heart attack no one says ‘Oh, we will put you on a list.’”
Kinsell said she’s seen many families become destabilized by the lack of mental health care in her area. When a person experiences an acute mental health crisis, that then complicates things for the person’s family members, like their living situation, finances, or their own mental health.
Things have become better in the last year for Calvert’s son, who is now living in a crisis home. It’s not perfect: the drive to the crisis center is far, and Calvert recognizes that his son should be in a more permanent placement, like a psychiatric hospital, though there are simply not spaces for people like his son.
But, on a personal level, Calvert’s life is much easier knowing his son is safe.
“I don’t actually tense up when the phone rings anymore,” he said.
