Kevin Tanner, commissioner of the state Department of Behavioral Health and Developmental Disabilities, presents his budget proposal to the agency’s board during a hybrid meeting held Thursday. Jill Nolin/Georgia Recorder
This story was updated at 1:20 p.m. Friday, Sept. 1, 2023, with additional information.
Georgia will need to build five more behavioral health crisis centers and free up about 120 additional beds in the state hospital network for people in the criminal justice system – all by 2025.
But the state must also shore up its workforce so the existing crisis beds and other resources can be fully used, especially as the new national three digit dialing code – 988 – increases demand for state services.
These were some of the key take-aways from a capacity study the state Department of Behavioral Health and Developmental Disabilities commissioned management consultants Alvarez and Marsal to do this year.
The study’s preliminary findings were presented to the agency’s board Thursday as part of a discussion on the department’s budget request, which seeks funding to act on some of the study’s recommendations.
The board members also heard the draft conclusions from a second study, this one done by Deloitte, focused on how best to address the agency’s nagging workforce challenges.
Lawmakers had granted some funding boosts for agency staff wages earlier this year, but those increases were part of Gov. Brian Kemp’s long list of spending “disregards” in May when the state’s budget writers were bracing for a potential economic slowdown.
Now, for the first time in years, state agency heads have been told they can request a 3% increase in spending – so long as they also offer up ideas for a 1% cut.
Kevin Tanner, commissioner of the state agency, says he is eager to defend his agency’s budget proposal as it goes through the process, which is just getting started. The governor will present his overall budget proposal in January, when lawmakers return to Atlanta.
Tanner’s budget proposals, which the board unanimously approved Thursday, include $9.5 million for a new behavioral health crisis center in north Georgia, $15 million in one-time funding for crisis center staff wages, and $10 million to boost the salaries of forensic psychologists and others, as outlined in the workforce study.
“The pattern is the items we’re asking for go to address two major things: workforce and our forensic backlog that we have. Those are two of the key issues that we feel like are in crisis in Georgia, and we’re focused like a laser on trying to solve those and all of these go directly to that,” Tanner said.
Tanner presented troubling statistics in remarks Thursday about the agency’s forensic backlog.
Georgia experienced a 40% increase in court orders for pretrial evaluations since 2006, yet the state has fewer forensic psychologists to do the work. That means people are waiting in jails across the state to be evaluated to determine whether they are competent to stand trial.
“We have over 1,200 individuals today waiting on an evaluation from one of our staff. That is unacceptable to us, and I know it’s unacceptable to sheriffs and others in the state who have these individuals sitting in their jails waiting on a forensic psychologist. But it is just the state that we find ourselves in,” Tanner said.
About 64% of those evaluated in a recent two-year period were found competent to go to trial, Tanner said.
There is a much different kind of backlog for those who are found incompetent and ordered to go to a state hospital. Last month, 523 people were waiting for a spot. The average wait time in Georgia is 275 days.
In addition to funding for staffing, Tanner’s budget includes money for improvements to existing facilities, like East Central Regional Hospital in Augusta, community- and jail-based restoration services and a renovation project at a Savannah state hospital that would house a transition program where people can receive vocational training and live once they find a job.
The Savannah project is being called “Project Hope” – a nod to comments the late House Speaker David Ralston said last year when a major mental health bill overcame opposition from far-right activists. “Hope won,” he said at the time.
More on behavioral health crisis centers
The five behavioral health crisis centers called for in the capacity study are in addition to the three facilities that are currently in the works this year. State and local officials in Fulton County partnered to build the county’s first publicly funded crisis center, and two more are planned for Augusta and Dublin.
Over the next decade, a total of eight additional crisis centers are needed, the study found.
But the study also concluded that if the centers are not at about 85% occupancy, then more facilities will be needed – which ties back to the workforce issue.
The impact of 988 on the state’s safety net also remains an open question. The hotline went live more than a year ago, but the federal government has held off on vigorously promoting it while states adjust.
A dramatic increase in demand for services would change the state’s projected need. For example, if more calls for help to 988 translate into a 50% increase in demand, then the state would be short 27 crisis centers by 2025, the study found.
The state paid Alvarez and Marsal about $785,000 for its work on the capacity study, and it paid Deloitte $640,000 to do the workforce study. Both firms presented their preliminary findings Thursday.
Tanner said he hopes the $15 million in one-time funding in this year’s budget for crisis center staff wages will bring more crisis beds back online – a move he is banking on saving the state $1 million as it reduces the need for state-contracted beds for adults and children.
Last year, the state spent $40 million on these private contracts. About 13% of adult crisis beds were offline due to workforce shortages as of last month, as were 13.5% of spaces for children and adolescents.
Tanner’s goal, he said, is to create “a carrot and a stick” for the community service boards across the state that run the behavioral health crisis centers.
No funding requested to implement wage increase for caregivers
Tanner’s budget proposal does not include funding for provider rate increases to give direct-support professionals, who assist people with disabilities, a $6-per-hour pay bump.
Earlier this year, lawmakers put language – but no funding – in the budget to pay for the $107 million proposal, but the governor later wiped away that gesture as part of the extensive list of spending “disregards.”
The average pay for direct-support professionals today is $10.63 per hour. Increasing their wages is seen as an essential step toward reducing the number of people with disabilities waiting for services. Tanner’s budget proposal includes funding for 100 new waivers. There are more than 7,000 people on the waiting list.
But Tanner said he is asking Kemp to include $14.7 million in the budget to help providers in the meantime, and he said talks with the governor’s budget writers about moving forward with the pay increase continue.
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