Last fall, one of us received a panicked call about a friend. Jenn struggled with mental health issues for some time, but that day things had escalated. She was hearing and responding to voices. Even worse, the voices were telling her to harm people, including one of us and her family. Action was needed quickly.
When the police officers showed up, they simply asked Jenn if she was OK, to which she replied “yes”. They proceeded to leave the home, despite pleas to stay and further evaluate the homicidal ideations she was experiencing. They declined to do so and left the residence. Was that it? Was that all they could do? Were we really supposed to wait until someone was hurt before we could get the help she needed?
As it turns out, there was more they could have done to help. Georgia House Bill 1013 passed in 2022, requiring parity for insurance companies to cover mental health and substance abuse. Another part of the bill laid out a standardized way for peace officers and mental health workers to respond to people having a mental health crisis in the community. This was partly due to the large amount of those suffering from mental health crises who end up incarcerated or fatally injured by police officers.
Per HB 1013, the state intends that, for a 911 emergency call involving a behavioral health crisis, a co-response team should be implemented to de-escalate the crisis, refer to community-based treatment, or transport the individual to an emergency receiving facility (ERF) when necessary. A co-response team is comprised of at least one peace officer (any public servant who has the authority to enforce the law) and one trained behavioral health professional (such as a social worker, psychiatric nurse, psychologist, or peer specialist).
In Cobb County, there are currently more than 750,000 residents and only two co-response teams. Although House Bill 1013 provides a framework for improving mental health care in Georgia, three pillars to ensuring its success remain unaddressed: providing an adequate workforce, implementing proper training and securing stable funding.
The first major barrier is that the current workforce does not exist to handle the volume of people that the bill is hoping to aid. Georgia ranks 48th in access to mental health care, according to Mental Health America’s report. The COVID-19 pandemic has further strained an already overtaxed workforce. Without addressing staffing for mental health professionals, it will be difficult to meet the demand.
A second problem relates to crisis training. Training exists, but is not mandatory for all police officers. New police officers get minimal training to assist people with mental illness during their time in Basic Academy. The Georgia Public Safety Training Center, along with support of the National Alliance on Mental Illness of Georgia, created a 5-day course in 2006 with the mission to “equip Georgia law enforcement officers with the skills to assist those with mental illnesses and other brain disorders in crisis, thereby advancing public safety and reducing stigma.”
Thousands of police officers have completed the training to be deemed “Crisis Intervention Team officers”; however, if not all officers receive this training, it will be difficult for law enforcement to carry out the law as intended.
Lastly, training mental health professionals and law enforcement will be impossible without adequate funding. HB 1013 states that implementing a co-response team-based approach is based on funding availability. It is clear from the above case that more co-response teams should be available to provide the proper triage and help for a person in crisis. People’s access to mental health treatment should not depend on the limited dollars attributed to this cause.
If these three pillars are not addressed properly and interconnectedly, Georgia will continue to suffer from the impact of mental illness. Unless we act quickly to supply the care this population needs, the mental health epidemic will continue to intensify.
Sadly, in Jenn’s case, there was no co-response team when 911 was first called that morning. The officers did not contact a peace officer/co-response team or recommend such next steps. A careful questionnaire performed by a professional with proper training would have revealed the homicidal ideations she was having and led to a swift response. They instead chose to abandon Jenn and her family, leaving them in a more dangerous situation than before.
This case is a tragic reminder that Georgia is not implementing the co-response team approach as recommended by House Bill 1013. Without substantial and predictable funding and support, we will continue to grapple with cases such as this, with even worse outcomes.
ABOUT THE AUTHORS
All work at Emory University School of Medicine. The views here are their own.
Janelle Williams Holder, M.D., is is an assistant professor in the Department of Family and Preventative Medicine and Division of Palliative and Hospice Medicine.
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Digvijaya Navalkele, M.D., is an assistant professor, Department of Neurology.
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Elizabeth McCord, M.D., is an assistant professor, Department of Psychiatry.
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Vaishali Rathee, M.D., is an assistant professor, Department of Family and Preventive Medicine and Division of Palliative Medicine.
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Kimberly Curseen, M.D., is an associate professor in the Department of Family and Preventative Medicine and director of outpatient supportive care.
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Katilia Harden, DrPH, LCSW, is associate director - programs/behavioral health consultant with PARTNERS for Equity in Child and Adolescent Health, Department of Pediatrics.
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