Stateline Story

Ga. Hotline Aims to Cut Mental Health Costs

Even as the recession chips away at mental health services across the country, Georgia's around-the-clock psychiatric hotline is finding a way to weather the storm - and other states are watching closely.

The Peach State's Crisis and Access Line's philosophy is simple: By making it easier and faster for patients to get the psychiatric care they need, states can address problems before they potentially lead to expensive hospitalizations and even incarcerations.

Launched in July 2006, the hotline has long been a model nationally, but its success has held even wider implications lately as soaring unemployment rates take their toll, experts say.

"When people lose their jobs, when people lose their homes, those are huge life stressors, and anyone who is predisposed to a mental illness - the mental illness is normally triggered," said Sarah Schwartz, executive director of the support and advocacy organization Mental Health America of Georgia. Meanwhile, those who already suffer from an illness generally see their conditions deteriorate under such circumstances, she said.

Since starting in July 2006, the Georgia Crisis & Access Line has seen an increasing number of calls. During the first months of the recession in 2008, the call volume was higher and more steady than it had been in the first year-and-a-half.

But just as these demands for services accelerate, states have had to slash mental health budgets to close swelling deficits.

In this fiscal year, states have cut $1.5 billion from mental health programs, and that number is expected to double for fiscal year 2010, according to the National Association of State Mental Health Program Directors. State mental health agencies are saying it is becoming increasingly difficult to do more with less money.

"We're rolling on a crisis," said Marion Poirier, executive director of Hawaii's chapter of the National Alliance on Mental Illness (NAMI), a grassroots advocacy group based in Arlington, Va. "We are in a severe financial crunch."

For David Covington, who until recently ran the Crisis and Access Line, that is precisely why the Georgia model is so appealing in the current environment.

"State governments across the country are facing significant cuts," he said. "They're looking to prioritize and they're looking for effective and efficient ways to do better."

What distinguishes Georgia from mental health programs in other states is that its hotline serves the whole state, is open at all hours and gets callers immediate help or timely medical appointments at participating clinics without referring them elsewhere. Callers can generally get an appointment in about five business days, compared to weeks-long waits in other states.

The service is "innovative and maybe unique," said Dr. Kenneth Duckworth, NAMI's national medical director.

"In most of the states, the care is very fragmented," Duckworth said. "The idea of a statewide access (line) is not common at all."

In Georgia, for example, before the current line launched, there were 25 separate psychiatric hotlines. Many callers attempting to navigate the old system simply gave up and sometimes would resurface in emergency rooms or prisons.

By derailing this cycle, officials at Behavioral Health Link, the company that runs the Georgia hotline, estimate that their service avoided more than $1.7 million in costs to state mental health facilities last month alone, when 24,620 people called in.

While this compares favorably with the $4 million to $5 million the program costs the state annually, Gwen Skinner, the director of Georgia's Division of Mental Health, Developmental Disabilities and Addictive Diseases, noted that it is difficult to determine the actual financial impact of the program.

The hotline could save the state a significant amount of money, Skinner said, if it resulted in psychiatric hospitals lowering staffing levels. Until then, she said, sustained operating costs at these facilities will largely wipe out any savings to the state.

Covington, who recently left his job as CEO of Behavioral Health Link to do similar work in Arizona, disagreed, saying that the hotline has already paid for itself "many times over."

But even with the incentive of possible savings, states have struggled to replicate Georgia's model.

Colorado, Tennessee and Louisiana have expressed interest in the Crisis and Access Line, and just this month, a Kansas official requested information. But budget shortfalls have stalled progress in all instances.

In Louisiana, for example, the Office of Mental Health's budget will be chopped by $43 million for the fiscal year starting July 1, according to Lani Dupuis, program director at NAMI's Bayou State chapter.

"It's very troubling; it's horrible," she said. "We're all very concerned."

Meanwhile, mental health services in Tennessee are facing up to $37 million in cuts. And Kansas officials aren't sure they can afford the program either, according to Becky Rinehart, disaster coordinator for the mental health section of the state's Department of Social and Rehabilitation Services.

So far, Colorado has had the most luck, but efforts there have largely circumvented state agencies. Instead of relying on shrinking governmental allocations, organizers have set up a non-profit initiative in the seven-county metro Denver area, and their plans include the creation of a crisis and access line under the Metro Crisis Services program.

According to Heather Cameron, project director for Metro Crisis Services, the hotline is short some funding. All contributions to date have come from the private sector, but Cameron is hoping to secure state and federal money to close the gap.

"We were doing really well until we had the economic crisis hit, and then things slowed way down," she said. Still, Cameron expects the line to be up and running within three to six months.

Even in Georgia, the mental health budget is feeling the pinch. The state's mental health and addictive-diseases allocations are down by nearly $47 million for the upcoming fiscal year - a reduction of almost 9 percent from the current year. The crisis line will absorb only about $176,000 of these rollbacks.

"There are capacity deficits in almost every piece of the mental health puzzle," Duckworth, the medical director for NAMI, said. "And Georgia's certainly no exception to that."