People across Metro Atlanta need accurate data on dual diagnosis care, yet finding county-specific rates remains surprisingly difficult.
Georgia’s public hospital data systems cannot directly measure co-occurring mental health and substance use disorders because they track only principal diagnoses, leaving most dual diagnosis cases invisible in county-level reporting.
This article maps what we know about Metro Atlanta dual diagnosis rates across all 11 counties, explains the data gaps, and shows you where system improvements are happening now.
Metro Atlanta Dual Diagnosis Data Challenges
The 11 counties that make up the Atlanta Regional Commission region face a common problem when planning behavioral health services. They cannot access reliable, county-specific dual diagnosis statistics because the main public tool, Georgia’s OASIS system, was not designed to capture co-occurring conditions on the same hospital visit. The system uses principal diagnosis coding for most cases, which means when someone arrives at an emergency room with both a mental health crisis and a substance use issue, only one typically shows up in public query results.
This limitation affects all ARC counties: Cherokee, Clayton, Cobb, DeKalb, Douglas, Fayette, Forsyth, Fulton, Gwinnett, Henry, and Rockdale. Each county needs accurate dual diagnosis data to plan crisis services, allocate treatment resources, and measure whether residents can access integrated care. Without it, planners rely on indirect signals like separate mental health visit rates and drug overdose rates, then try to estimate where dual diagnosis services fall short.
The region added 64,400 residents in the past year, with the fastest growth in Forsyth and Cherokee counties at 2.4 percent each, followed by the City of Atlanta at 2.0 percent and Henry County at 1.75 percent, according to ARC population estimates. These growth patterns intensify the need for county-level dual diagnosis service mapping, especially in rapidly expanding suburban areas where behavioral health infrastructure may lag behind population increases.
Why Public Data Systems Miss Dual Diagnosis Cases
Georgia’s OASIS emergency room and inpatient discharge data follow a standard rule. They assign a cause based on the principal diagnosis, except for injury cases. Secondary diagnoses exist in hospital billing records, but the public web interface does not expose those fields to users. When a person receives treatment for depression and opioid use disorder during the same hospital stay, OASIS typically records only whichever condition the provider listed first.
The OASIS morbidity definitions confirm that inpatient discharges count Georgia residents treated in non-federal acute care hospitals, reported by discharge date, using principal diagnosis as the cause field. Emergency room visit counts follow parallel logic. People can appear multiple times if they have multiple visits, but each visit typically shows just one primary cause in standard public queries. This approach, while appropriate for many epidemiologic purposes, systematically undercounts co-occurring disorders because it treats mental health and substance use as separate categories rather than conditions that often appear together.
One exception exists within OASIS. The drug overdose mapping tool uses an “any mention” approach for poisoning codes T36 through T50, which captures overdose cases regardless of whether they were the principal diagnosis. This provides a more complete view of substance-related acute harm. Yet even with this tool, mental health conditions remain tied to principal diagnosis rules in the standard public query environment, preventing users from directly identifying which overdose cases also involve diagnosed mental health conditions.
Fulton County Dual Diagnosis Data
Fulton County anchors the region’s behavioral health system as the most populous county and home to the City of Atlanta. Like other counties, it lacks direct, publicly available dual diagnosis prevalence rates. Planners instead use proxy measures: Fulton shows high utilization in both mental health emergency visits and drug overdose emergency encounters, suggesting substantial co-occurring need even when exact dual diagnosis figures remain unavailable.
The county received funding to open a Behavioral Health Crisis Center in fiscal year 2025, adding 24/7 crisis stabilization capacity that links to the 988 Suicide and Crisis Lifeline through the Georgia Crisis & Access Line. This investment directly addresses gaps in crisis care for people with dual diagnoses, who often cycle through emergency rooms without accessing ongoing integrated treatment.
Fulton County also serves as the center of the Atlanta Eligible Metropolitan Area for HIV services. Roughly 60 percent of people with HIV in Fulton achieve viral suppression, according to AIDSVu county profiles. National data show that 34.1 percent of adults with diagnosed HIV had depression in 2021, with nearly half of those experiencing undiagnosed or ongoing symptoms despite diagnosis, per a Medical Monitoring Project study. The overlap between HIV care, mental health treatment, and substance use services makes dual diagnosis capability particularly important in Fulton County, where improving integrated care could raise viral suppression rates among disproportionately affected populations.
DeKalb County Dual Diagnosis Data
DeKalb County benefits from having Claratel Behavioral Health, formerly the DeKalb Community Service Board, which is implementing the Certified Community Behavioral Health Clinic model. CCBHCs deliver comprehensive mental health and substance use services with required 24/7 crisis access and robust care coordination. The CCBHC framework aligns well with dual diagnosis care because it mandates integration rather than treating mental health and addiction as separate service tracks.
However, even with this strong system anchor, DeKalb County does not have a published, county-specific dual diagnosis rate or facility capability inventory in the public domain reviewed for this analysis. The presence of a CCBHC indicates capacity to serve co-occurring conditions, but knowing how many residents need that care, where gaps persist, and whether outcomes improve over time still requires better county-level data collection and transparency.
DeKalb experienced less severe but still notable effects from a 2013 data anomaly in which mental and behavioral disorder hospital discharges were underreported across several counties. This means any trend analysis covering that year requires adjustment or annotation to avoid misinterpreting service patterns.
Cobb County Dual Diagnosis Data
Cobb County sits in the northern part of the metro region with a large and diverse population. Highland Rivers Behavioral Health, which serves multiple counties including Cherokee, has indicated CCBHC implementation plans that extend to its Cobb County service area. This suggests the county is on a path toward more integrated care infrastructure, though specific dual diagnosis capability metrics at the county level remain unpublished in the sources reviewed.
Like other ARC counties, Cobb has access to the statewide crisis system, including mobile crisis teams that provide face-to-face intervention 24/7/365. These teams can engage people experiencing dual diagnosis crises, but the absence of county-resolved data makes it difficult to know whether crisis encounters result in linkage to ongoing co-occurring treatment or whether people return to emergency rooms because outpatient dual diagnosis services are insufficient.
Cobb County’s moderate growth rate and suburban character mean its behavioral health needs differ somewhat from urban cores like Fulton and fast-growing exurban counties like Forsyth. Tailored dual diagnosis service planning requires county-specific information, which current public data systems cannot provide.
Gwinnett County Dual Diagnosis Data
Gwinnett County added 15,200 residents in the most recent reporting year, making it one of the highest numeric growth counties in the region. View Point Health, the Community Service Board serving Gwinnett and Rockdale counties, is a recognized CCBHC implementer. This positions Gwinnett relatively well in terms of access to integrated behavioral health services, including dual diagnosis care.
Still, the county lacks publicly available, granular dual diagnosis prevalence data or a facility-level capability inventory. Population growth at Gwinnett’s pace raises urgent questions about whether behavioral health infrastructure, including dual diagnosis treatment slots, is keeping up with demand. Without county-specific utilization and outcomes data, planners cannot confidently answer whether the system is adequately scaled.
Gwinnett also issued 5,607 residential building permits in 2024, second only to the City of Atlanta, reflecting ongoing suburban expansion that will continue to drive behavioral health service needs. The county’s diversity adds complexity, as effective dual diagnosis services must be culturally responsive and accessible across language and immigration status barriers.
Clayton County Dual Diagnosis Data
Clayton County presents a particularly acute data challenge. In 2013, it experienced the most severe underreporting of mental and behavioral disorder hospital discharges among Metro Atlanta counties, according to known data issues documented by Georgia’s health indicators office. Any historical trend analysis that includes 2013 must treat Clayton’s numbers with caution or exclude that year entirely to avoid misleading conclusions.
The county does not appear among the CSBs currently listed as CCBHC implementers in public state materials, though local providers certainly offer behavioral health services. In September 2025, the state announced a $19 million Behavioral Health Crisis Center for Clayton County, a 24-bed model designed to expand 24/7 crisis stabilization access, per a DBHDD press release. This investment will strengthen the crisis continuum for people with dual diagnoses, but the county still lacks a transparent, county-level dual diagnosis prevalence rate or service capability map in the public domain.
Clayton’s moderate population growth and its position south of Atlanta make it a critical county for regional equity. Any gaps in dual diagnosis care here affect vulnerable populations who may face transportation barriers to accessing services in neighboring counties.
Cherokee, Forsyth, and Henry Counties
These three counties share a common characteristic: rapid suburban growth that outpaces the regional average. Forsyth and Cherokee each grew by 2.4 percent in the past year, and Henry County expanded by 1.75 percent. Fast growth typically strains existing behavioral health infrastructure, and without county-specific dual diagnosis data, planners in these counties operate with significant uncertainty about current capacity and future needs.
Cherokee County has a system advantage through Highland Rivers Behavioral Health’s CCBHC implementation, which should improve access to integrated dual diagnosis care. However, Forsyth and Henry counties do not appear prominently in the public CCBHC materials reviewed, suggesting potential gaps in structured co-occurring care models.
All three counties benefit from statewide crisis infrastructure, including the Georgia Crisis & Access Line and mobile crisis teams. Yet crisis stabilization alone does not substitute for ongoing outpatient dual diagnosis treatment, and the absence of county-resolved service data makes it difficult to assess whether post-crisis linkages are working effectively.
These exurban counties also differ culturally and economically from the urban core, with different housing patterns, transportation networks, and stigma dynamics around mental health and substance use. Effective dual diagnosis service planning must account for these local factors, which requires granular county data that current systems do not provide.
Douglas, Fayette, and Rockdale Counties
Douglas and Fayette counties round out the ARC region with moderate population sizes and growth rates. Neither county appears among the named CCBHC implementers in the reviewed state documents, though both have access to regional crisis services. Like the other counties discussed, they lack publicly available dual diagnosis prevalence rates or facility capability inventories.
Rockdale County shares its Community Service Board, View Point Health, with Gwinnett County and benefits from that CSB’s CCBHC status. This gives Rockdale a structural advantage in dual diagnosis care delivery, assuming services are equitably distributed across the CSB’s catchment area. Still, county-specific data would clarify whether Rockdale residents face access barriers due to geography or other factors.
All three of these counties illustrate a key regional challenge. They are large enough to have distinct service needs and utilization patterns, yet they are often aggregated into regional or state-level data that masks local gaps. Improving dual diagnosis outcomes requires moving from regional averages to county-specific accountability.
Atlanta Dual Diagnosis Service Gaps
The data gaps documented across all 11 ARC counties create concrete risks for service planning and equity. Planners cannot confidently identify which counties have adequate dual diagnosis treatment capacity, which face critical shortages, or where investment would yield the greatest improvement in outcomes. They cannot benchmark counties against each other or track progress over time in a standardized way.
The absence of county-specific data also hinders equity analysis. Dual diagnosis affects all populations but disproportionately impacts people facing systemic barriers, including housing instability, poverty, justice involvement, and discrimination based on race, sexual orientation, or immigration status. Without granular data, it becomes nearly impossible to determine whether service gaps align with these social determinants of health or whether interventions are reaching the people who need them most.
Crisis system investments in Fulton and Clayton counties signal state recognition of gaps, but those investments happened without transparent, county-level dual diagnosis prevalence data to guide decisions. Future planning would benefit from a systematic approach that combines population need estimates, facility capability assessments, and utilization tracking at the county level.
Available Dual Diagnosis Resources by County in Atlanta
The following table summarizes system strengths and data gaps across the ARC region based on current public information:
| County | CCBHC Implementation | Crisis Center Investment | Public Dual Diagnosis Data | Primary Data Gap |
| Cherokee | Yes (Highland Rivers) | Regional access | No | Capability inventory needed |
| Clayton | Not named | BHCC opening 2025 | No | Prevalence rate plus 2013 data issue |
| Cobb | Planned (Highland Rivers) | Regional access | No | Facility capability map needed |
| DeKalb | Yes (Claratel) | Regional access | No | Prevalence rate needed |
| Douglas | Not named | Regional access | No | Full service inventory needed |
| Fayette | Not named | Regional access | No | Full service inventory needed |
| Forsyth | Not named | Regional access | No | High-growth area needs full data |
| Fulton | Regional providers | BHCC funded FY2025 | No | Prevalence rate and capability map |
| Gwinnett | Yes (View Point Health) | Regional access | No | Prevalence rate needed |
| Henry | Not named | Regional access | No | High-growth area needs full data |
| Rockdale | Yes (View Point Health) | Regional access | No | Capability inventory needed |
This table illustrates that while crisis system coverage is universal and several counties have CCBHC anchors, no county currently benefits from transparent, publicly available dual diagnosis prevalence data or comprehensive facility capability assessments.
Proposed Solutions and Measurement Approaches
National frameworks exist for measuring dual diagnosis capability. SAMHSA’s Dual Diagnosis Capability in Mental Health Treatment toolkit provides a structured approach for programs to assess and improve their ability to serve co-occurring conditions. However, even when facilities use this toolkit internally, the results typically do not flow into a public, county-tagged database that regional planners can access.
Georgia could address the county data gap through two parallel tracks. In the near term, the state could construct a Dual Diagnosis Proxy Rate using existing OASIS data by combining mental health emergency visit rates with drug overdose rates marked by any mention coding. This proxy would not equal a true co-occurring rate but would provide a standardized signal that counties could use for planning and benchmarking, with clear documentation of its limitations.
In the medium term, Georgia could pursue a data use agreement with hospitals to access full diagnosis fields, implementing the CDC’s hospital co-occurring disorders indicator that requires identifying cases with both a substance use diagnosis and a mental health diagnosis on the same encounter. This approach would yield defensible county-level dual diagnosis rates for emergency and inpatient care.
Beyond hospital data, the expanding CCBHC network offers an opportunity to capture community-based dual diagnosis engagement metrics. If CCBHCs and other contracted providers report standardized screening results, dual diagnosis caseloads, and care engagement rates by county of residence, the state and region would gain visibility into whether people access ongoing integrated treatment after crisis stabilization.
Why Dual Diagnosis Data Transparency Matters?
When counties lack dual diagnosis data, several harmful patterns can take hold. Resources may cluster in counties with strong advocacy or visible crises rather than flowing to areas with the greatest unmet need. Fast-growing counties like Forsyth and Henry may fall behind because their service gaps remain invisible in aggregate regional data. Populations facing the highest barriers to care, including people with HIV, unstably housed individuals, and justice-involved people, may experience disproportionate harm because equity analyses cannot identify where services are failing them most.
Transparent county-level data also supports accountability. When dual diagnosis rates, service capacity, and outcomes are public and comparable across counties, residents and policymakers can ask informed questions about whether investments are working and whether their county is keeping pace with neighbors. This kind of democratic accountability drives system improvement in ways that aggregated, state-level reporting cannot match.
The CCBHC model requires certification and ongoing quality monitoring, creating natural opportunities to build county-level dual diagnosis measurement into state oversight. Georgia’s quarterly updates to provider manuals and performance reporting systems demonstrate administrative capacity to support this kind of data standardization. The question is whether the state will prioritize making that information transparent at the county level.
Getting the Help You Need Now
While county-level dual diagnosis data gaps persist, individuals and families facing co-occurring mental health and substance use challenges should not wait for better statistics to seek care. The statewide Georgia Crisis & Access Line operates 24/7/365 and can connect you to immediate support, crisis stabilization, and treatment referrals regardless of which county you live in.
Community Service Boards across the metro region, including those implementing the CCBHC model, provide comprehensive assessments and can coordinate care across mental health and substance use needs. Many accept Medicaid and offer sliding scale fees for uninsured individuals. Crisis centers opening in Fulton and Clayton counties will add accessible stabilization options for people in acute dual diagnosis crises who need an alternative to emergency rooms.
If you or someone you care about is struggling with co-occurring mental health and addiction challenges, you deserve integrated treatment that addresses both conditions together. Reach out to Summit Mental Health Center for dual diagnosis treatment in a supportive environment where your whole health matters.
