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Georgia's Mental Health Parity Bill Part 2: Changes in Involuntary Inpatient Law

While the expansion of opportunity in the existing statutory framework for involuntary outpatient treatment is extensive, the changes the Bill makes with respect to involuntary inpatient care are more subtle, but in one case in particular, potentially beneficial in keeping those facing acute mental health challenges out of the jails.

I'll start by noting that earlier versions of the Bill had made changes to the definition of involuntary "inpatient," as currently defined by O.C.G.A. §37-3-1(9.1), that would have been potentially broad-reaching and disastrous. The existing language defines it as a person who "present a substantial risk of imminent harm to that person or other, as manifested by recent overt acts of violence or threats of violence which present a probability of physical injury...". These earlier versions would have eliminated the word "imminent" from the current language. Not a big deal, right? It's only one word, after all. As in many other cases when it comes to the law, eliminating that one word would have drastically changed the liberty considerations of those who are involuntarily committed, broadening the powers of hospitals to deny discharge or to accept a patient in the first place, as the bar for what qualifies as involuntary inpatient presentation would have been dramatically watered down. What's more, that specific statutory section serves as the basis for commitment in criminal cases of commitment due to lack of Competency to Stand Trial and Insanity cases. It would have completely changed the criteria for release into the community and potentially changed the trajectory of hundreds of existing cases of commitment in the criminal justice system.

Thankfully, those changes didn't make it to the final Bill, so we don't have to consider those dire consequences.

The significant change was language that would be added to O.C.G.A. §37-3-42, which addresses the interaction between law enforcement and citizens struggling with acute mental health challenges. As I mentioned in Part 1(b) of this post, law enforcement has been more or less handcuffed by the law as far as what they can do when they encounter someone facing these challenges in the community. As the law previously existed, hospitalization was only an option for law enforcement when they observed a person committing a crime, leaving them with the choice of taking the person to a hospital or booking them at the jail. This left a large gap for individuals who posed continuous challenges to their respective communities (in the form of calls from businesses or passersby reporting individuals who presented with concerning symptoms) but who weren't necessarily committing any criminal offenses at the time. So, the officers would have little choice but to do nothing, which inevitably led to further escalation of problems and eventually an arrest of some kind.

The new law provides options for law enforcement in cases where a crime isn't necessarily being committed, while also safeguarding against arbitrary or malicious hospitalization of "nuisance" cases. Subsection a(2) of the above-mentioned statute allows officers to transport someone to the hospital for inpatient evaluation where they feel the person meets those criteria, AND they have consulted via telehealth or other method with a mental health professional who signs off on their assessment. This opens up a path for many officers who have expressed frustrations with not only having no options for these individuals, but also having their other duties regularly interrupted by incidents for which they had no solution.

By itself, this addition wouldn't mean much, as the inpatient system is a revolving door in most cases. But, the changes the Bill made to outpatient care, as discussed in Parts 1(a) and (b) of this post, mean that a real path for sustained recovery and treatment might now exist that can put these individuals on a positive road. The success or failure of these changes will depend on the professionals involved, their commitment to change, and their willingness to see mental health challenges as more than just medication management. But, at the very least, the new Bill brings us to a promising place to which we've never been in Georgia. Now, the real work begins.

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