Taking Georgia to Court

.....can a new lawsuit finally fix Georgia's broken child mental health system?

After brewing for years, a class-action lawsuit on behalf of Georgia children with severe mental illnesses and emotional disturbances was finally filed today. The individual plaintiffs are children who have been in and out of psychiatric facilities and hospital emergency rooms dozens of times due to their behavioral health needs. Some have been abandoned to DFCS because parents and guardians could not get appropriate intensive and coordinated community-based services to allow them to live safely at home.

Recognizing that no single agency can solve this complex problem, the litigation names three key players: The Department of Community Health (DCH), which is the State’s Medicaid agency; the Department of Behavioral Health and Developmental Disabilities (DBHDD), which has responsibility for coordinating and providing mental health services; and the state’s child welfare agency, DFCS.

The allegations of the complaint are all too familiar to those of us who have been working with traumatized, emotionally disturbed, and developmentally disabled children over the years. But a few data points from the federal court complaint stand out:

• In 2022, 475 children were abandoned to foster care due to their parents’ or guardians’ inability to obtain sufficient behavioral health services that would allow the children to remain in their own homes with their families. In many situations, these children’s behaviors endangered their families, including other children in the home. Even when they were able to obtain short-term psychiatric hospital services, the children were often discharged home with little or no discharge planning, no in-home services, and no way to keep the family safe in the event of another behavioral health crisis.

• The State Medicaid Plan covers an intensive community-based service called Intensive Care Coordination (or “High-Fidelity Wraparound”), which has been demonstrated to keep children out of psychiatric hospitals and other deep-end facilities. But only 225 children statewide were receiving that service as of November, 2022. That’s a tiny fraction of the approximately 8,000 youth admitted to psychiatric institutions each year. It’s a drop in the bucket when one considers that approximately 85,000 children with Serious Emotional Disturbance were enrolled in Medicaid in 2022.

• The lack of these intensive services appears related to bureaucracy. Although DCH contracts with “care management organizations” to provide health care to children on Medicaid and Peachcare, approval for a service such as Intensive Care Coordination must come through DBHDD. Another DBHDD rule allows its contracted community-based providers to decline to provide some intensive services for children who have both a mental health diagnosis and a developmental disability such as autism spectrum disorder.

• The suit also brings into question the effectiveness of GCAL, Georgia’s Crisis Access Line, which has been touted as a 24/7/365 mobile service for those suffering a severe emotional or mental health crisis. The advocates determined that between 2019 and 2023, in almost 80% of the calls for assistance involving children in crisis, GCAL did not send anyone to check on the child. Even when GCAL did respond, families had to wait for hours.

Litigation is and should be a last resort for solving problems. Let’s hope this action produces real solutions.

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In other news (briefly):

• Here’s an update on Illinois’ child welfare system. Progress?

• Changes afoot in Massachusetts’ child welfare system.