“It’s such a sense of hopelessness,” Ellis told The Atlanta Journal-Constitution. “It’s worse when you do know the system. You know there’s no genuine help out there.”
State lawmakers this year passed a mental health parity law designed to improve access to a range of behavioral health services. Advocates tagged the last legislative session the “Year of Mental Health Reform.” But even the lawmakers who passed the legislation say this was just a first step.
“Now we’re going to make this the decade of mental health reform,” said Kevin Tanner, chairman of the state’s Behavioral Health Reform and Innovation Commission, at a June meeting.
To build a truly functional behavioral health system for Georgia’s children and teens, the state may need to take a hard look at itself.
State health plans cover about half of the state’s children and teens through the Medicaid and PeachCare programs, giving the state government enormous influence over the entire pediatric care system. Plus, the state has a Department of Behavioral Health and Developmental Disabilities that is supposed to operate a comprehensive safety net.
But the state of Georgia has yet to take essential steps that could prop up a comprehensive system and fill gaps for children in crisis, The Atlanta Journal-Constitution has found. That means any family, whether they are privately insured or reliant on state plans, may have trouble getting care for a child.
Crisis psychiatric care for children who also have autism or developmental disabilities is one of the biggest gaps. Yet, Georgia has created just 10 safety-net beds for crisis care that can handle children with autism — to serve the entire state. And those beds were closed for months due to staffing issues, the AJC learned.
“It's such a sense of hopelessness. It's worse when you do know the system. You know there's no genuine help out there."
- Dr. Michael Ellis, child psychiatrist
The AJC also found that children on the state health plans who need longer-term psychiatric treatment routinely wait for services or have care cut short. State documents show that for-profit Care Management Organizations paid to administer Medicaid plans in Georgia frequently reject requests for care in psychiatric residential treatment facilities for children and teens.
Georgia’s low reimbursement rates for care may also block access to services, advocates say, because providers will take other patients first, whose plans pay more. Due in part to Georgia’s low reimbursement rates, nearly 40% of the psychiatric residential treatment beds in Georgia were occupied by children from other states, a snapshot from 2021 shows.
Problems are compounded, say doctors and hospitals, because the Care Management Organizations may limit access by approving fewer days of treatment than needed.
Advocates say they also block access by failing to have enough health providers available in their networks.
“You’ve got a ticket that says, I’ve got insurance. But who do you give that ticket to? Can you find somebody? In many instances, you cannot find the necessary care because the managed care organizations, the CMOs, have such sparse networks, especially as it relates to mental health care or behavioral health care for children,” said Roland Behm, a board member for the Georgia Chapter of the American Foundation for Suicide Prevention.
Behm recently presented findings about inadequate provider networks to a committee of the Georgia Behavioral Health Reform and Innovation Commission. Georgia needs more oversight of the Medicaid CMOs to monitor the adequacy of payment rates and networks, he said.
“The state has to double down on its oversight of CMOs and their contractual obligations to the children they cover,” said Melissa Haberlen DeWolf, research and policy director at Voices for Georgia’s Children, a statewide advocacy organization.
Test of state commitment
It’s urgent that the state addresses these problems, say those on the front lines of the mental health crisis.
Pediatricians say children coming in with depression and anxiety are now just part of the daily routine. “Between runny noses and well checks and coughs— there is this as well,” said Dr. Angela Highbaugh-Battle, a pediatrician from St. Mary’s who is president of the Georgia Chapter of the American Academy of Pediatrics.
She said screening for depression is a part of every check-up. “Sometimes during a well-check, you get to that point in the visit and for a second there is silence, and then sometimes there are tears immediately,” Highbaugh-Battle said. “It’s like whoa, what did I just uncover? What landmine did I just step in? And sometimes, it’s a very big landmine and that becomes a focus. OK, we need to address this.”
But addressing it quickly through a specialist usually isn’t possible, she said. “Before it would be a few weeks; now it can be several months,” she said.
Primary care pediatricians, she said, try to do whatever they can to treat the kids while they wait to see counselors or psychiatrists.
Tanner said the state will likely need to increase its payment rates for mental and behavioral health providers. Part of the new mental health parity law was a requirement for state agencies to collect reams of data that the experts on the commission needed to make recommendations. That includes information about how Georgia’s rates compare with those of other states.
“I would anticipate once that study comes back, we will see the commission push for increases in those reimbursement rates that can benefit everyone in the system,” Tanner told the AJC in a recent interview.
That will be a big budget item that may test the state’s commitment to comprehensive reforms.
But Tanner, a former state representative from Forsyth County, said he’s optimistic because he’s seen a sea change. “People who had kind of ignored the problem now are taking an interest in it, and we’re starting to see everyone get on board with, ‘We have to fix this system.’ It’s not just a Georgia problem. It’s a national problem.”
Ellis, the child psychiatrist, was finally able to find inpatient treatment for his daughter in crisis. But she had to leave Georgia to get it. Soon, she will be back, and Ellis is already encountering barriers as he tries to arrange the continuing care she’ll need when she returns. He told the committee of experts that Georgia simply isn’t doing enough.
“People are desperate,” he said, “and they are waiting.”