Fulton County to outsource mental health care

Fulton County will stop providing mental health services to residents, commissioners decided Wednesday.

About 1,500 people go to county facilities for help with addictions, diagnosis or therapy. But at a cost of $3,200 per person to provide the services, Fulton leaders think more people can be helped if they fund treatment elsewhere. Other programs spend closer to $1,200 per person for similar services. The county estimates there are about 34,000 uninsured Fulton County residents who could use mental health care.

“Once we looked at the numbers, we became underwhelmed with the impact we were making,” said Anna Roach, the county’s chief strategy officer. “We have to do something about the way Behavioral Health is structured.”

Under the current system, the county gets about $750,000 from the state Department of Behavioral Health and Developmental Disabilities and budgets about $10 million in county funds for mental health services. Roach said the state gives about $21 million to a total of 20 behavioral health providers in the county. But Fulton wants the state to give it the money instead, so it can coordinate care by distributing the funds to those local agencies.

If the county is able to direct the state money, she said, officials will have a better idea of the kind of care that is being provided. In other counties, the distribution is performed by a community service board, but Fulton decided more than 20 years ago not to create its own. That means there are no shared medical records among service providers, and little understanding of whether or where patients are getting help.

Controlling the distribution of the state’s money is still just an idea. But if the change is implemented, Roach said, it could have a significant impact — including at the jail. Improved mental health care could decrease recidivism, she said.

Having an integrated system, Roach said, could allow for continuous mental health care both in and outside the jail. Now, people can’t be tracked once they leave the county facility, and there is no way to know if they continue to receive help. About 40 percent of the jail population receives some kind of mental health care.

“Change is needed,” Commission Chairman John Eaves said. “The part that’s exciting is that I think Fulton County can be a leader.”

Eaves said the county has to be “more aggressive, more innovative” with its plans for the administration of behavioral health.

Regardless of what happens with the state, Roach said, the county model was flawed. There are frequently unfilled vacancies in the county department responsible for providing care, including for psychiatrists, who are hard to keep on staff due to the county’s relatively low pay rate. The department currently has 57 employees. The county will help them find other jobs, including elsewhere in the county or at the community organizations they intend to send patients to. The transition will take several months.

Developmental disabilities programs will not be affected by the change.

County manager Dick Anderson said he hopes the end result will be expanded services for residents. By spending its money more wisely, he said, the county can have a greater impact on more people.

In approving the plan earlier this week, Commissioner Bob Ellis said the county’s system was “fairly broken.” Vice Chairman Liz Hausmann said the employee shortfalls meant the county was already resorting to outsourcing. The proposal passed by a 5-1 vote.

“I think this is the right direction to go in,” she said.

Support real journalism. Support local journalism. Subscribe to The Atlanta Journal-Constitution today. See offers.

Your subscription to the Atlanta Journal-Constitution funds in-depth reporting and investigations that keep you informed. Thank you for supporting real journalism.