Q. Tell me a little about your background and what brought you to this work?

A. Well, I guess in March, it will be 33 years since I started in some type of public service. I actually started my service career in law enforcement and worked for a good long time in a lot of different capacities, including running a law enforcement agency [in Dawson County]. And one of the things even back then that I became frustrated with on a regular basis was going on calls dealing with people who were suffering from behavioral health, mental health issues, and oftentimes not really having a good answer for the family that was there crying out. And you know, most folks when they have a need they call 911. And the police are supposed to solve all their problems, but so many times we just didn’t have a good answer.

[After college] I worked my way into county management, became a county manager and did that for a number of years. And enjoyed that. And then I had always been involved in some way [with] politics, not directly involved but had helped other people run for office and had been involved in the political party at the local and state level. Long story short, I ended up running, getting elected and I spent four terms in the General Assembly [as District 9 representative].

All the way back in 2013, I introduced legislation to create a study committee on mental health and didn’t have a lot of success, really, with that at the time. But as I developed my relationships in the General Assembly, in 2019 I revisited the issue. I’d heard several stories, but one in particular, where a gentleman I was renting a house to was in mental health court and things didn’t go well for him. And I just wanted to try to see if I could help make some positive changes to the system. So from there, I worked with Speaker David Ralston and in 2019, created and ultimately the governor signed and became codified into law, the Behavioral Health Reform and Innovation Commission [BHRIC]. So later that year, Governor Kemp named me the chair and I’ve been chairing that for the last three years. And our work resulted in speaker Ralston’s House Bill 1013 [Georgia Mental Health Parity Act], which passed last session. So I’m very proud of that. We just released the newest [Behavioral Health Commission] report for 2022.

Q. How can you leverage your position to accomplish some of the things that you’ve advocated for in the past, particularly in some of the areas where progress has been lacking?

A. Well, let me say this, I was not looking to be the commissioner of the Department of Behavioral Health and Developmental Disabilities. It’s not anything I had ever even thought about quite honestly. I was county manager in Forsyth County, I had 2,000 employees, I had a great operation. And I’d surrounded myself with some very bright people, and my job was fairly easy because I had built a great team of people and was running one of largest counties in the state and life was fairly good. When the governor approached me about this opportunity, I had to spend a little bit of time thinking about it. 

But it came down to the fact that so much of my life had been working toward understanding problems within the system, maybe some shortfalls, but also looking for solutions because … I don’t like to just stand on the sidelines and complain about things. And a lot of people like to point out what somebody else is doing wrong. That’s really not my personality. I want to be in the middle of trying to help find the solution. So I think what I hope to be able to bring to this position is I have, I think, a skill set. I know I don’t have all the answers. And I know I’m not the expert on all things mental health, or developmental disabilities. But just like we did with the Behavioral Health Commission, I know how important it is to bring the right people to the table, to get the right opinions, so that we can listen to those experts. And then from that formulate a process and a pathway to success. 

Q. One of the key elements of making the Mental Health Parity initiatives work is to expand and retain the mental health workforce in Georgia. What specifically are you focusing on this year to make that possible?

A. Yeah, that’s a very astute observation. Because I will tell you since I’ve been here in almost every meeting we’re in, whatever problem we’re talking about, the solution always goes back to the same thing, and that’s workforce. So many of the challenges we’re facing right now, of building out the crisis model that we need to be successful in Georgia, the barrier is workforce. And we’ve recognized that at Behavioral Health Reform Commission level … and we put some things in place and legislation around loan forgiveness [for people pursuing mental health education and training] and some other things. That is a step. But it’s definitely not going to fix the problem. And I think all of us have recognized there’s not a silver bullet to this issue. 

But one of the things that Representative Mary Margaret Oliver [D-Decatur] and Dr. Brenda Fitzgerald, who chairs the access subcommittee, one of the things they both jointly have talked about this past year, and it’s in the report, is the fact that reimbursements are so low in Georgia. There has not been a behavioral health provider reimbursement increase in I think it’s 17 years in Georgia. Our developmental disability provider rates are very low. The department has already released the results of that study and we’re taking public comments on the developmental disability piece of that now.

And that should result in a significant increase in providers. DCH [Department of Community Health] was directed under House Bill 1013 to do the same thing for Medicaid providers for behavioral health. They’ve gotten their initial results back and they’ve not released that yet. But I can tell you it will be a significant increase if we’re able to implement that. 

Q. Now, what’s the funding source and mechanism for that? What will make that happen?

A. Well, the way it would work, for instance, the one we’re doing public comment on now is, two-thirds of it would be paid for by the federal government and one-third would be state dollars. So it would require the state to commit money in the budget. And then in turn, once that happens, we send that up to the federal government, and they would ultimately approve it. Because obviously, we had to hire a reputable, recognized company [Accenture] that deals with this on a daily basis all across the country. And they’ve done a very independent professional study that the federal government would adopt. So really the biggest thing would be the General Assembly and appropriators have to appropriate funds.

Q. And what are you requesting as the budget allocation for the workforce increase?

A. We actually have not finalized those numbers. Because we know that on average it would increase the provider payments significantly. But there’s so many factors involved in it that we’re waiting on, we’re getting some data from DCH, and some other agencies. And then from that, we’re going to be able to run those numbers. We hope to have that within the next 45 days.

Q. And do you have a top-line total budget recommendation for the amended budget for this year for your department?

A. Well, the direction received from the governor’s office was it is a flat-line budget, so no increases.

Q. There is a big surplus that a number of agencies are looking at, in hopes of increasing budgets.

A. Yes. And obviously we’ll be having conversations with the governor’s office and others about the needs of the department. One of the things I also think is important that the department needs to do is to lay out a clear plan. We’re getting ready to undertake a bed study because as we build out our crisis network, we need to know so that I can tell the governor’s office and the appropriators that five years from now, I’m going to need this many beds — here’s where I need those beds, and here’s what type of bed I need.

Q. The Mental Health Parity bill is a landmark set of directives on paper but as you say, it must be implemented and it must be funded. What are the key areas that need to be funded at a higher level this year or in following years than they have been in the past for the bill to work as intended?

A. Well, I think it’s important, if you look back at Georgia, back to 2010, when the settlement agreement with the Department of Justice was entered into, Georgia has really had to, in a pretty short period of time, create a community-based system of behavioral health. So it’s a young system of delivery of services. So we’ve come so far, but I think we have to build out that crisis system and that network. So right now we’re reliant upon private beds to help offset our internal crisis system, and we’ve got to build that out, we obviously are going to need additional crisis beds across the state, we’re going to need some additional other types of beds, for our developmental disability population, and we need additional providers, and additional bed space for home-based care.

There’s a capital investment. There’s an ongoing provider investment. But it also goes back to the reimbursements. Because it’s very challenging for us as a department to get people to want to be a provider for us when our reimbursement rates have not been changed in so many years. So I always say it’s what comes first, the chicken or the egg, you’ve got to fix the reimbursement rates, so we can get our workforce addressed in order to really build out this crisis system. But I say all of that, to answer your question, to continue to adequately build out the crisis network system in Georgia is the number one thing we have to be able to look at.

Q. And for our readers, can you define what the crisis network is?

A. Yeah, and let me back up and give you an example. You have someone who’s reading your article, they themselves are in crisis, or a loved one is in crisis. And they pick up the phone and they call 988. And they access the Georgia Crisis System. They call our GCAL [Georgia Crisis & Action Line] center, and the person who answers the phone is a trained professional, to talk with them, to evaluate what their needs are. And then they can dispatch a crisis mobilization unit. So a trained professional will go out to that person, if that’s the need. We’re not talking about law enforcement, or an ambulance, we’re talking about trained mental health professionals, they go out, provide an assessment, and help get that person into whatever level of care they need at the time. So that’s one of the ways that people can come into the system. 

And then we have partners and we have community service boards all across Georgia; I think we have 23 boards currently. And many of those run crisis stabilization units. And those units are typically short-term, three-to-seven-day placements of individuals who are in crisis. They can go there, they can receive care and treatment, get regulated on medication, et cetera. And then from there, they’re discharged with a treatment plan that may involve follow-up with the right type of clinician with peer support and all the wraparound level of services they need to be successful. And our crisis process is coordinating all of that. 

Then there’s longer-term care with different types of beds that may be for 30 days. And then of course, we operate five state hospitals for people who need more significant longer-term care in our hospital settings. So that’s the crisis network that we have in Georgia and DBHDD is responsible for that. 

Q. Housing is such a big area that affects your ability to help people who are having a mental health crisis, including the homeless population. Can you speak to that?

A. Yeah, housing is an issue. And it’s specifically an issue for transitional housing, when we have someone that maybe comes out of a crisis center or comes out of a hospital, being able to make sure that we have the right place for that person to go. Good, stable housing is important. We also have community-based housing availability, whether it be a group home or another type of facility. And, again, it’s challenging to get those providers right now because of those reimbursement rates. So I sound like a broken record on that. But that’s on purpose. Because so many of our problems come back to reimbursements. But long-term housing needs are also obviously an issue. You mentioned the homeless population. There’s a pretty good percentage of our homeless population that suffer from behavioral health issues and being able to find ways to address that is important. And obviously, there’s a balance because we have a crisis system, but we’re not able to force someone to accept treatment and accept help. But all of those things you mentioned are real issues that we’ve got to find ways to solve. 

Q. Georgia Supreme Court Chief Justice Michael Boggs, who serves on the Behavioral Reform Commission’s Courts and Corrections subcommittee, mentioned recently, that before we can do anything else for people in the criminal justice system with behavioral health needs who are reentering society, they need to have a place to live and food to eat, and oftentimes they don’t.

A. Yeah, Maslow’s hierarchy of needs, right? Food, shelter, safety. And I’ll tell you that in Forsyth County, I was county manager there and one of the things they’re working on now, they have an RSAT [Residential Substance Abuse Treatment] program they run through the sheriff’s office. We funded it and they also had grant funding for that there, but they’re actually looking at meeting this week, with the city of Cumming, and trying to request some opioid funding for transitional housing to be built there in Forsyth. They’ve already identified a location to build that transitional housing, and part of it would be RSAT, for people who have substance abuse, addiction issues that need transitional housing. So there are examples of good things occurring there.

Q. So on a statewide level, how could that translate?

A. Well, we have to do something, right? We’ve talked a lot about these issues, but there has to be a stake put in the ground and we have to try something. And I think what’s happening in Forsyth is going to be a good test model to see if this can work, how does it work? And if it works well, those things need to be duplicated. That’s one of the things that I pushed for, and we received ARPA [American Rescue Plan Act] funds in Forsyth. And we used almost all of those funds to design — and they’re about to go out to bid on building a whole health facility. So it’s going to be a 64,000-square-foot, $35 million complex. It’s going to be a health department and a mental health facility in one building, and the mental health side is going to have 30 crisis beds. And it’s also going to have a 24-hour emergency room with a prescriber on duty 24 hours a day. So if someone’s in crisis, they can go there instead of the local ER, but also it helps with the stigma, because then if they may be going to get their physical health or their mental health they can go into the same facility. So there’s some pretty exciting things happening. And I think some of those things can be duplicated around the state.