LaKlieshia Izzard, a mental health therapist, poses for a portrait at her home in Oxford. TNS

Michelle Baruchman, Tribune News Service

During the COVID-19 pandemic, more than 1,200 state psychiatric hospital employees left their positions, and just over half that number have been replaced, according to state officials. Meanwhile, courts, aided by a COVID stimulus package, began quickly moving through cases among people suspected of mental illness who had been charged with a crime. That resulted in more orders for mental evaluations to determine whether they were competent to stand trial. “It’s kind of been the perfect storm,” said Kevin Tanner, commissioner of the state’s Department of Behavioral Health and Developmental Disabilities. In the past two years, lawmakers in Georgia passed a slate of legislation targeting the mental and behavioural health crisis in the state, which has grown in size and severity since the COVID pandemic began. Those efforts have included a parity bill that requires insurance companies to provide coverage for mental health care and substance-use disorders at levels comparable to physical health care, reaffirming federal requirements, and the development of the 988 system for emergency mental health crisis calls.

Republicans and Democrats agree support for the mental health workforce is the largest issue that remains. Low pay — the result of stagnant wages and out-of-date reimbursement rates for Medicaid — has beleaguered care providers. Meanwhile, licensure obstacles delay out-of-state therapists from practicing in Georgia. These staffing shortages create challenges for people in need of timely care; Georgia ranked 49th in access to care, according to Mental Health America’s 2023 report. People often wait months before getting an appointment, causing some mental health problems to escalate into crisis.

This year, lawmakers are seeking to build on the previous efforts by budgeting for increases in salaries for state employees and raising reimbursement rates, pending an agreement with the federal government. Several bills are also aiming to encourage more mental health counselors in private practice to work in the state by aligning Georgia’s licensure requirements with other states and enabling people to take credentialing exams earlier.

How they get there is still being worked out.

A massive departure of state employees meant that there were fewer people available to treat those with mental illness and get them through the mental health system. For example, more than 30 of the positions for psychologists, including those who conduct the evaluations, were vacant as of February, Tanner said. Of the state’s roughly 4,500 behavioural health and developmental disability employees, most work in state psychiatric hospitals. In Gov. Brian Kemp’s proposal for the budget year beginning July 1, all state workers would get a 4% cost-of-living raise, in addition to the one-time $1,000 bonus sent out in December.

For private health care workers, such as doctors, psychiatrists, clinicians and anyone billing Medicaid, the state has requested an increase in federal reimbursement rates for providers. If the Centers for Medicare & Medicaid Services approve, providers serving people with intellectual and developmental disabilities could receive about a 45% increase in payment for their services, and behavioral health providers would get about a 30% increase, said Kaleb McMichen, a spokesperson for the DBHDD. These rate increases could have made life-changing differences in pay for LaKlieshia Izzard, who worked for several years at community-based behavioral health and developmental disabilities services organizations. Ultimately, low pay as well as a desire to grow her skill set caused her to leave those workplaces and branch out on her own as a telehealth mental health counselor. When she entered into this field, she knew she was doing so to help people in need — not to rake in money. “You learn how to adapt to living with a salary that may be a little lower because you really want to help the individuals who are in difficult settings,” she said. Now, she said, it’s critical that state legislators increase salaries for state behavioral health workers to allow them to stay in the field and provide services to the most vulnerable people in Georgia.

Georgia has some of the lowest reimbursement rates for Medicaid in the Southeast, which concerns Rep. Todd Jones, who co-sponsored a package of mental health legislation last year. Mental health professionals could be enticed to leave the state and seek better rates. “Talent can transition when they see they have a better opportunity,” he said. “We’ve got to keep them here.” Another barrier to entry for behavioral health workers is the high cost of education for degrees often required to work in the field.

Senate Bill 480, sponsored by Republican Sen. Mike Hodges, one of Kemp’s floor leaders, would allow health care professionals working in mental health and substance abuse to apply to the Georgia Board of Health Care Workforce to get money to pay off student loans if they are caring for “underserved youth” or practicing in underserved geographic areas.

One of the challenges slowing down the pipeline of new behavioral workers into the state is licensing. It can take months for therapists to get credentialed in Georgia, and sometimes they have to repeat courses or meet additional requirements, even if they’ve been practicing for several years. Several bills moving through the Legislature were crafted to expedite licensing for marriage and family therapists, mental health counselors and social workers who have worked professionally in other states to practice in Georgia. Senate Bill 373, sponsored by Republican Sen. Larry Walker, would allow marriage and family therapists who are coming to Georgia from other states to get licensed in the state so long as they hold a valid license in another state, are in good standing, satisfy a criminal background check, complete an application and pay required fees.

House Bill 1344, sponsored by Republican Rep. Katie Dempsey, would allow the Georgia Composite Medical Board, which licenses many health care workers, to waive requirements for licensed professional counselors, licensed clinical social workers and licensed marriage and family therapists to obtain supervisory hours if they have completed two years of work in another state. A similar version, Senate Bill 336, did not pass out of its chamber. “I’m optimistic that we’re actually going to get the key pieces of mental health legislation passed,” said Republican Sen. Kay Kirkpatrick, who sponsored SB 336.

Similar to the agreement among states to recognise each others driver’s licenses, House Bill 839, also sponsored by Dempsey, would create an agreement between Georgia and other member states that would enable bachelor’s and master’s level clinical social workers to practice in those states, without having to get individually licensed in each state. “There’s no doubt that one of the lessons we learned during COVID was a shortage of social workers that are needed throughout our state,” Dempsey said in a committee hearing. The bill, which would allow counselors in member states to practice in Georgia and Georgia counselors to practice in other states, passed the House chamber last week. Trenese Johnson, a clinical social worker and therapist, said in the hearing that she began working in Louisiana and is now licensed and lives in Georgia, where she operates an online telehealth business.