House Speaker David Ralston

House Speaker David Ralston speaks at the Capitol on Jan. 6. Ralston has noted addressing Georgia's mental health needs as a top priority of his this session.

ATLANTA — Lawmakers and advocates agree: the mental health system in Georgia has long been inadequate.

But in waiting to address the needs of Georgians who struggle with mental health and substance abuse disorders, those needs have become amplified throughout the pandemic.

Often referred to as a dual-crisis – COVID-19 has ravaged communities and the health care system while there has been an increased need for mental health and substance abuse counseling.

Last session, the General Assembly was forced to cut $2.2 billion from the 2020 budget to brace for the impending devastation of a shuttered economy; the state’s leading mental health agency, the Department of Behavioral Health and Developmental Disabilities, faced millions in cuts that led to hundreds of staff layoffs.

Now, health advocates say the state must step up before it is too late.

"Georgia needs to think about how we build and fund a mental health and substance use system that matches the needs of our population,” Laura Colbert, executive director of nonprofit Georgians for a Healthy Future, told CNHI. "To date, we haven't really done that.”

According to a 2020 report by nonprofit Mental Health America, Georgia ranks last out of all states for access to care for mentally ill residents — which includes access to insurance coverage and treatment. Providers have only been further strained since the pandemic upended health systems.

"Across ages, geographies and racial groups, there's been a really big spike in depression, anxiety, alcohol and drug use, and other kinds of mental health conditions,” Colbert said of increased prevalence during the pandemic. “... There's just this incredibly expanded need on top of kind of the constant need that we had before the pandemic. Because the need has expanded, we just need so many more resources to help handle it. There's a pandemic surge and there's also a mental health and substance use surge happening at the same time."

In both his pre-session presser and floor speech after his reelection as speaker, House Speaker David Ralston said mental health is one of his top priorities this session.

"I think that we have relegated our mental health system to being sort of a second-class citizen in our health care system for much too long,” the Republican said. "This is a disease that touches almost every family in Georgia and the treatment options are, quite frankly, really disappointingly limited — particularly in rural Georgia."

Lawmakers first face the challenge of amending the mid-year budget, which state agencies hope doesn't take additional cuts after last session. 

Last June, Department of Public Health Commissioner Dr. Kathleen Toomey sent a memo to agency partners that emergency departments were seeing an increase in suspected drug overdoses, leading officials to believe COVID-19 has been magnifying the state’s opioid epidemic. At the time, the red flag was just a hint at what was to come. 

Jeff Breedlove, an advocate for addiction recovery, said the memo sent from Georgia’s top health official confirmed the substance abuse community has been impacted by the pandemic unlike any other.

"Given the fact that there's been more increases in emergency room visits due to substance use disorder than any other medical issue during COVID. Given the fact that there's more admissions in treatment centers. Given the fact that there's been more arrests for people with issues related to substance use disorder," Breedlove said. "We hope that the General Assembly and Gov. (Brian) Kemp will work with the community and the appropriate agencies to expand funding to deal with this growing crisis impacting Georgia communities, up and down the state.

"It's really the epidemic within the pandemic," he said.

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