Policing Mental Health: A Historical and Geographical Analysis of Mental Health Policy in Atlanta Georgia Restricted; Files Only

Abstract

Recently, the Georgia state House of Representatives passed House Bill 1013, also called The Mental Health Parity Act. The bill sought to address access to and insurance coverage for mental health services, first identified in a Department of Behavioral Health and Developmental Disability report in 2020. The budget for mental health services was reduced by $8m in 2020, when demand was at an all-time high. In contrast, law enforcement budgets have grown every year, despite changing public perceptions of mental health and police violence, including $80m towards "Cop City." Meanwhile, Georgia is ranked 37^th in the country for access to quality mental health care (Mental Health America, 2021), half counties in the state have no psychiatrist, and the projected mental health workforce will be able to meet 12% of consumer demand by 2025. In this dissertation, I will demonstrate how the history of Georgia’s provision of psychiatric services after deinstitutionalization has led to current problems, echoing a history of ideals that prioritize punishment and surveillance based on ideas of deviancy and crime based in white supremacy. I designed a methodology for evaluating mental health policy and developed a theoretical framework based on the work of psychiatrist Jonathan Metzl, sociologists Tressie McMillan Cottom and Karen E. Fields, and historians Barbara J. Fields and Achille Mbembe. Using archival materials, interviews with stakeholders, geographical information systems software, and records from the Georgia Department of Corrections, I demonstrate that a disproportionate number of people who are arrested are incarcerated due to the criminalization of mental health disorders. Based on analysis of redlining maps, arrest data, I found that approximately 40% of “quality of life” arrests are in approximately 8% Atlanta’s acreage, which are historically redlined areas.

While the State has decried the shrinking mental health workforce, the contributions of psychiatric nurses and nurse practitioners are continuously overlooked in community mental health. Psychiatric nurse practitioners are a recognized upstream solution to reduce the need for forensic services, but current policy fails to adequately support or recognize nurses as mental health first responders. Meanwhile, a significant proportion of mental health services are provided through jails and prisons, an extremely expensive and inefficient solution with poor outcomes and high likelihood of recidivism.

Table of Contents

Ch. 1 Introduction 1

Ch. 2 Historical Factors in Race, Policing, and Psychiatry 41

Ch. 3 Contextualizing Policy Through Multiple Methods 68

Ch. 4 Analyzing Redlining, Policing, and Mental Health Service Provision In Atlanta 84

Ch. 5 Conclusion and Implications for Policy and Practice 120

References 132

Appendix I Interview Guide 162

About this Dissertation

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School	Laney Graduate School
Department	Nursing
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Geography Health Sciences, Nursing Health Sciences, Mental Health
Keyword	Redlining, critical geography, history of psychiatry, mental health, resources, race and psychiatry
Committee Chair / Thesis Advisor	Kylie Smith, PhD, Emory University
Committee Members	Shaquita Starks, PhD APRN, FNP-BC, PMHNP-BC, Emory University Benjamin Druss, MD, Emory University Whitney L. Wharton, PhD, Emory University

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