Mental health crisis: Georgia ranks 47th in mental health care access

MILLEDGEVILLE — A son stabbed his mother to death then lived with her for two days before anyone else discovered it.

It's a shocking example, but one Baldwin County Commissioner Henry Craig makes to underscore a problem he sees in his community, the state and the nation.

“Every community in our state has the same problem — mental health and opioid issues — it’s become a crisis in our communities, and I would like to address that crisis in three ways. It’s a public safety crisis,” Craig said.

While mental health and mental wellness pose challenges for the nation and the world, it is arguably a more serious challenge in Georgia and the SunLight Project region, which encompasses six newspapers including the Daily Citizen-News in various parts of the state.

According to the nonprofit Mental Health America of Georgia, the state ranks 47 out of 50 for access to mental health care, resources and insurance.

In Georgia, 1 in 5 people with a serious mental illness has a better chance of ending up in a prison than getting adequate treatment at a mental health facility, according to officials.

The SunLight coverage area of Dalton, Milledgeville, Moultrie, Thomasville, Tifton and Valdosta recently explored mental health processes and how law enforcement, county officials and medical staff deal with the people affected by mental illness.

Craig is a mental-health advocate. He serves as the Sixth District representative on the Association County Commissioners of Georgia board of managers. He communicates across county lines and shares ideas with other commissioners across the state.

Craig said counties and governments face several problems when it comes to handling mental health issues. Problems on multiple levels — moral, fiscal, public safety.

Craig said there is a moral component to mental health. He said the criminal justice system is too often used as an outlet for the mentally ill.

“We have a moral issue,” Craig said. “If a person has heart disease, we will give that person compassion and move them into a hospital. If a person has cancer, we will help that person. We will have compassion for that person. When a person is mentally ill, too often, he goes to jail and the criminal justice system provides the help that the community, the families, the government did not provide. Our judicial system and law enforcement know that it’s morally wrong. Everyone here probably agrees that it’s morally wrong. We need to find a different solution for those that are ill with a mental illness — keyword, ill.”

Craig addressed the fiscal issue of mental health for counties.

“In Baldwin County, a small county, we spend out of the general funds of the county, $150,000 to $200,000 a year just on psychotropic drugs for those who are mentally ill,” Craig said. “The cost of housing those persons who are mentally ill in the county is very expensive, and in Baldwin County alone, 60 to 65 percent of all of our prisoners in the jail are mentally ill. We must do something different. ... The largest mental institution right now in the country is the Los Angeles County Jail, the second largest mental institution right now is the Dade County Jail in Miami. And in Baldwin County, the largest mental institution is the county jail.”

Baldwin County is not alone.

Mental health in jail

“The jails have become the primary provider for those that are mentally in the state of Georgia,” Craig said.

In Thomasville, the Thomas County Sheriff's Office spends hundreds of man-hours transporting mentally ill people to out-of-town mental-health facilities. To date this year, the sheriff's office has transported 267 people, driving 8,515 miles requiring more than 53 hours. Last year, transports totaled 986, with 83,884 miles driven in more than 849 hours.

"10% of our jail population is diagnosed mental patients," said Capt. Steven Jones, Thomas County Sheriff's Office public information officer.

Some mentally ill inmates must be taken to mental health appointments. Some are on medication.

"Then you have to ensure they take their medication," Jones said, adding that one nurse looks after the entire jail population and sees that inmates take their medication.

If an inmate's attorney says his client is incompetent to stand trial, the individual must be taken to a mental-health facility for evaluation that can take 10 days to six months.

Southwestern State Hospital, a former Thomasville state mental hospital, closed in 2012 and 2013. The Thomas County Jail immediately saw a dramatic increase in mentally ill inmates, Jones said.

When a mentally ill person commits a crime, he or she is expected to go through the criminal justice system like anyone else, he said.

"It doesn't work out well," Jones said.

In Whitfield County, Sheriff's Office Capt. Wesley Lynch said the jail does not track how many inmates are diagnosed with mental health issues.

"One of the problems with this is defining what counts as a mental-health issue," Lynch said. "Mental-health issues can range from personality disorders, such as substance abuse disorder or antisocial personality disorder, to serious psychoses such as schizophrenia. While it is impossible to tell how many of the 7,000-plus arrests that we receive every year are persons with any type of mental disorder, it does seem to be a trend here and across the state that we are receiving increasing numbers of inmates with serious mental disorders."

Lynch said jail personnel are trained to report any potential issues to medical staff.

"We provide medication for serious medical needs to all inmates in the facility," Lynch said. "This includes medication for inmates with mental disorders. This is done regardless of an inmate's ability to pay. We do not have specific information on the (number) of costs for only mental-health issues. We verify mental-health records in the same manner of other illnesses. That is, we contact prior treatment locations and physicians, and confirm this data with pharmacies."

Lynch said jail staff also make the courts and the district attorney's office aware of any inmates with special needs.

"We have dealt with inmates with serious mental-health issues such as manic depression/bipolar disorder and various types of disorders in the schizophrenia spectrum," Lynch said. "While these are not the most common, they are serious and use up a great deal of our resources and are difficult to treat. State resources such as mental hospitals are not as available as they have been in the past and the process of treatment and release seems to be creating a system where critical issues are resolved (short term) and the patient is released as soon as they can care for themselves.

"Longterm, this creates a process where many individuals who have difficulty functioning on their own and seem to reoffend, only to be housed in the correctional systems instead of mental-health systems."

But Lynch said millions of Americans suffer from mental illness.

"That does not mean that they should be considered violent or dangerous," Lynch said. "It might better be said that some mentally ill individuals engage in criminal behaviors, while many who are mentally ill do not. The same could be said of the public at large.”

In Moultrie, for 2018 alone, sheriff’s deputies provided 368 mental transports — an average of more than one a day — which led to 357 admissions to inpatient facilities. Thirty-seven of the admissions were by court order; 320 were by physician certificates.

In all, Colquitt County deputies drove 28,246 miles and logged 678.78 hours carrying patients as far as the other side of Atlanta. Most transports involve only one deputy, sheriff’s Capt. Julius Cox said, but if a male deputy is the only one available to drive a female patient, he must be accompanied by a female, non-certified officer, such as a jailer.

So far this year, the Colquitt County Sheriff’s Office has provided approximately 200 mental transports.

Jails across the state are clearly dealing with mental health issues day in and day out. However, in many counties, treatment centers are available.

Centers of treatment

For example, in Lowndes County, some mental-health services are provided by Legacy Behavioral Health Services, which covers 10 of the surrounding counties.

Legacy is governed by a community service board (CSB) appointed by the county commissioners of each of the 10 counties in the coverage area. There are a total of 25 CSBs in the state. The board then hires a chief executive officer to manage the CSB, which is funded by the state and other entities inside the county.

Pamela Cartwright, chief executive officer of Legacy, said a CSB is part of Georgia’s public system of care for behavioral health. She said it acts as the state’s safety net for individuals suffering from behavioral issues.

The net is there to catch anyone suffering from a mental-health-related issue with limited to no resources.

Cartwright said Legacy is authorized to provide services anywhere in the state, and unlike single-purpose providers, Legacy offers consumers a range of integrated services designed to address the needs of adults with severe and persistent mental illness, children and adolescents with serious emotional disturbance, persons with intellectual and developmental disabilities and those addicted to alcohol or other drugs.

“Anybody can come in whether they are insured or not,” Cartwright said. “We’re not going to put anybody out because of a lack of money.”

She said Legacy sees about 7,800 people a year.

Stories everybody knows

Craig, the Baldwin County commissioner, said everyone claims to know someone is mentally ill but too few people do anything about it, or even know what to do about it.

Talking about the man who killed his mother, he said, "at the hind end of the event, everybody knew he was mentally ill — his neighbors knew it, his family knew it and the criminal justice system knew it, but there was nothing we could do about it.

"Another story in my community, and these stories are the same in every community, it just has a different variation to it, a grandmother and her grandchildren were walking out of a convenience store and a man stood up behind the ice machine at the entrance and killed the woman by shooting her in the back of the head.

"Everybody knew he was mentally ill. ... There are stories like this all throughout our state, our counties, all throughout the country.”

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