States Supporting Familiar Faces Case Study: Georgia

The experience and lessons learned in Georgia can be valuable for other states and local communities working on similar challenges. The most critical elements that allowed Georgia to move swiftly and effectively in policy areas with high complexity are as follows:

• Identifying effective champions within state agency leadership and engaged, multidisciplinary local teams

• Building a broad coalition of support to drive policy action

• Pinpointing locally informed policy and funding strategies that are impactful and technically and politically feasible

Behavioral Health and Justice Involvement in Georgia

Across the country, people with behavioral health needs often fall through the cracks of community support services and are overrepresented in local criminal justice systems. Nationally, approximately 20 percent of people in jails have a serious mental illness¹ compared to about 4 percent of the general population.² Georgia is no different. In one Georgia county, a 5-year study revealed that people with mental illness stayed in jail over 3 times as long as the jail population without mental illness, though further research is needed to understand why.³

These challenges are exacerbated by behavioral health workforce and supportive housing shortages. In 2021, Georgia ranked third for prevalence of mental illness in the population and 48th for access to care.⁴ Additionally, Georgia lost more than 28 percent of its affordable housing stock from 2011 to 2019, leading to a gap of more than 200,000 affordable units needed for extremely low-income renters.⁵ When people don’t get the care they need in the community or can’t find a stable, affordable place to live, they come to the attention of law enforcement and often wind up in jails and courthouses.

But there is immense opportunity in Georgia. The state’s expansive network of peer support specialists reaches even the most rural areas, and its system of crisis services is nationally recognized. Individual counties have been touted as national leaders at the intersection of criminal justice and behavioral health through initiatives like the Stepping Up initiative, the National Association of Counties’ Familiar Faces Initiative, and the MacArthur Foundation’s Safety and Justice Challenge. Indeed, there are many examples in Georgia of local policies and programs ripe for scaling at a state level or piloting in additional sites.

Georgia has 159 counties, including urban centers like Atlanta and Savannah and some of the most rural areas in America. There are 151 jails and 25 state-run regional behavioral health providers. Across this large, diverse system, state and local leaders are finding common ground in the ethical, financial, and practical need to improve responses for people living with serious mental illness in the state.

Familiar Faces in Georgia

Local data from across the state supports the need for policy and program changes to improve outcomes for people who are familiar faces in Georgia.

• Fulton County (Atlanta) used housing, behavioral health, and jail data matching to identify and analyze a pilot cohort of 100 people with high use of multiple systems. They found that people who are familiar faces are booked into local jails 10 times more frequently and use 20 times the number of jail bed days as the general jail population, costing $1.3 million annually in jail bed days alone.⁶

• Another study conducted by the Georgia Criminal Justice Coordinating Council looked at the people who had the most felony bookings (top 1 percent) across 9 diverse county jails in Georgia and found that people who are familiar faces were booked into jail, on average, 15 times over the 5-year period, or 3 times annually.⁷

With legislative and executive branch support, Georgia Supreme Court Chief Justice Michael Boggs requested technical assistance from the CSG Justice Center to support the efforts of Georgia’s Behavioral Health Reform and Innovation Commission in developing strategies to better serve people with behavioral health needs in Georgia, with a focus on familiar faces. In spring 2022, Georgia officially joined SSFF, committing to an 18-month long effort to create state and local policy strategies to address the needs of the state’s familiar faces.

Chief Justice Boggs chairs the Mental Health Courts and Corrections Subcommittee, which was created in statute under the Behavioral Health Reform and Innovation Commission. In 2022, the Familiar Faces Advisory Committee was created to advise the Mental Health Courts and Corrections Subcommittee on identifying state-level legislative and administrative interventions to improve outcomes for familiar faces. Chief Justice Boggs recruited champions from the legislature; Governor Brian Kemp’s Office; the judiciary; lead state agencies, including the Department of Behavioral Health and Developmental Disabilities (DBHDD) and the Department of Community Affairs; other key Georgia organizations such as the Association of County Commissioners of Georgia; the Georgia Mental Health Consumer Network, a large convenor of certified peer specialists in the state; as well as local leaders from counties engaged in this work.

Coalition of Counties

Twelve counties in Georgia volunteered to work with their state counterparts to develop policy strategies. County representatives attended Familiar Faces Advisory Committee meetings to share information between local teams and the committee throughout the project. The CSG Justice Center hosted three virtual convenings over the course of the project with the county teams and held numerous meetings with individual county representatives to build the project’s state and local communication, planning, and collaboration infrastructure. The cohort of participating counties includes rural, suburban, and urban, as well as well-resourced and under-resourced communities from regions across the state.

Georgia States Supporting Familiar Faces Counties

Promising Practices that Came from Local Communities

Here are some examples of promising practices and programming that counties in Georgia are implementing. These practices informed the recommendations of the Familiar Faces Advisory Committee.

• Validated behavioral health screening in jails is essential for identifying who should be connected or reconnected to services and treatment. Georgia counties that have implemented best practice models include Chatham County, Fulton County, and Screven County.

• Jail in-reach programs, like the Gwinnett Reentry Intervention Project (GRIP), focus on people who are familiar faces by connecting the highest-need individuals leaving jail with community-based services. Between 2012 and 2017, recidivism rates for GRIP participants declined by 30 percent.⁸

• Georgia’s 26 state-funded crisis stabilization units (CSUs) provide 24/7 behavioral health services and evaluation to help divert people experiencing a mental health crisis from jail or hospital care and reduce public safety risk with early and effective services. Georgia’s CSUs show promising results. For example, in Chatham County, jail admissions for people with mental illness decreased by 33 percent following the opening of the CSU.⁹

• Another strategy in Georgia that has extremely strong evidence of effectiveness is drawing on the expertise of people with behavioral health and criminal justice services who are trained and certified as peer support specialists. These skilled professionals can relate to people who are returning home from jail while experiencing psychiatric symptoms and trying to seek out care, and they can help people with this often difficult transition. The state’s robust network of peer support specialists can intervene at critical points with people who are familiar faces to help them avoid hospitalization or arrest. In a study from Forsyth County, individuals who engaged with a peer support specialist had significantly fewer jail bookings following the connection than those who were not connected to peer support specialists, and those who did go to jail stayed for 26 percent fewer days than individuals who were not connected to peer support specialists (35 days vs. 26 days).¹⁰

Seeking Out Advisement from People with Lived Experience

The project drew on the expertise of Georgia’s well-established community of peer support practitioners and leaders for their advisement about policy priorities, barriers, and opportunities. A focus group composed of a geographically diverse group of peers, including people with direct experience in both behavioral health and corrections systems, met with CSG Justice Center staff in October 2023. Some of the findings from the focus group are as follows:

• While peers in Georgia have extensive experience working with local decision-makers to expand their reach within local jails and across systems, they identified expanding jail in-reach and coordination as a priority as people return to their communities.

• Peers can provide continuity of care at reentry when people return to geographically distant communities outside the service catchment area of jail reentry programs.

• Although there is extremely strong evidence for the effectiveness of peer supports¹¹ and they are a vital part of a community behavioral health workforce, there are barriers to expanding peer support in the state, such as low wages and resistance to peer support workers by correctional staff and other key partners.

Identifying Policy and Funding Strategies to Improve Responses to Familiar Faces

Priorities Articulated by the Familiar Faces Advisory Committee

The Familiar Faces Advisory Committee met monthly between June 2022 and November 2022 to hear from the local teams and synthesize the information and data provided by state agency staff, focus groups, local best practices, and subject matter experts. The Advisory Committee prioritized the policies to include in its final recommendations based on their potential impact and their technical, political, and fiscal feasibility.

The Familiar Faces Advisory Committee prioritized the following challenges for policy action, including legislative, budgetary, or administrative action, because they saw opportunities for improvement with strategic state action:

• Severe behavioral health workforce shortages

• Behavioral health bed shortages (crisis, state hospital, supportive housing)

• Lack of capacity across systems and jurisdictions to share information between criminal justice and behavioral health providers

• Long wait times for evaluation and restoration of competency to stand trial

• Lack of access to housing for people who are familiar faces

• The need for best practice information for practitioners, such as a best practice clearinghouse

• The lack of a statewide definition of serious mental illness (SMI)

• The need for standardized metrics to collect, report on, and measure the impact of policy strategies selected for implementation

• Poor linkages between local jails and community services providers

This list of issues and challenges informed policy recommendations that the Advisory Committee developed and considered to improve outcomes for people who are familiar faces and local communities. Over the course of 3 meetings, the Advisory Committee prioritized 16 policies to include in its final set of recommendations. The Behavioral Health Reform and Innovation Commission received the Advisory Committee recommendations when it convened on November 16, 2022, and accepted them in full.

Supporting Implementation of Reforms and Scaling Successful Approaches

Nearly all the familiar faces policy recommendations moved quickly to implementation through legislation and administrative action in 2023; in some cases, implementation will extend into the 2024 legislative session. This rapid implementation relied on strong leadership in the DBHDD and the Department of Community Affairs as well as strategic use of multiyear initiatives.

The table below shows each policy recommendation and its implementation status as of the publication of this case study.

Writing: Amy Button, Marilyn Leake, CSG Justice Center

Research: Marilyn Leake, CSG Justice Center, Stefanie Lopez-Howard, Georgia Department of Behavioral Health and Developmental Disabilities

Advising: Hallie Fader-Towe, CSG Justice Center

Editing: Leslie Griffin, CSG Justice Center

Design: Michael Bierman

Web Development: Yewande Ojo, CSG Justice Center

Public Affairs: Kevin Dugan, CSG Justice Center