Sat, Aug 26, 2017 at 05:00 AM

Alabama's struggle to treat its mentally ill

It’s a sad state of affairs for mental health in Alabama.

If you want to know just how bad things are for this fragile population and how our state got to the point of crisis, attend a presentation in Guntersville next month. 

Lake Guntersville Chamber of Commerce hosts a Healthcare Breakfast every year to keep residents informed with news about healthcare. Marshall Medical Centers sponsors the event. It’s an opportunity to gather with neighbors and friends for a free breakfast and learn something about healthcare. 

This year’s breakfast will be held on Wednesday, Sept. 13 at 7:30 am at Gunter’s Landing in Guntersville. Keynote speaker will be Dr. Jim Dill, who will discuss the current climate of mental health in Alabama. Dr. Dill is the executive director of the Alabama Council of Community Mental Health Boards, a position he has held since 1982.

A little background on the issue first. Dr. Dill said a movement began in Alabama when mental health boards were created by the legislature in 1967 to de-institutionalize large state mental hospitals. From the mid-1980s mental health professionals have been working to increase the number of community-based facilities in order to reduce the size of large mental hospitals. The national Right to Treatment lawsuit (Wyatt v. Stickney) fueled similar efforts all over the country. 

In 2004, Dr. Dill and his associates thought they had achieved the necessary amount of downsizing. Their efforts were sufficient to reach a settlement of a federal lawsuit.  

They feared, however, that once pressure from the federal lawsuit was gone, the state legislature would no longer fund the system at an adequate level. 

“That was exactly what happened,” Dr. Dill said. 

From 2004-09, the state legislature provided the department of mental health level funding, which was acceptable. But then in 2008-09, legislators cut the mental health budget by $35 million. It went from $140 million to $105 million. 

“We were faced with making the cuts in the community,” he said. 

But cuts to community services would send people through the court system to be committed to mental hospitals that had no available beds. 

“It becomes a domino effect,” Dr. Dill said. 

So rather than let the community facilities suffer the $35 million cut, the department of mental health proposed closing three hospitals: 

• Searcy Hospital in Mobile - a 250-bed facility
• Greil Memorial Psychiatric Hospital in Montgomery – a 75-80 bed facility 
• North Alabama Regional in Decatur - 75-80 beds.

Money saved by closing hospitals was re-invested to pay for more crisis centers. Acute care was contacted out to hospitals. But funding cuts and no increases have created a mental health system that is not adequate to move people through in a timely fashion like it was designed to do. 

“So we’ve just been backing up and stacking people,” he said. 

Bryce Hospital was slashed from a 5,000-bed hospital to a 269-bed hospital. Taylor Hardin Secure Medical Facility – the state hospital for those found guilty by reason of insanity - shrank to about 120 beds. 

“So Bryce is about half full of people who should be in Taylor Hardin and there are not that many beds for civil commitments available anymore,” Dr. Dill said. “So we’ve gone further into cutting hospitals than we ever intended and we have inadequate funding for the programs that are out there. That’s where we are today.“ 

Is it a crisis? That depends on whether you are mentally ill. 

“If you have a loved one who needs to get into a program because of a severe mental illness and you can’t gain timely access, it’s a crisis for those individuals.”

The state legislature was warned last year that services for the mentally ill were reaching a crisis situation and that Alabama was possibly headed back to federal court intervention. 

“We got no response. It’s been that way since the court order ended in 2004. And we don’t see relief coming.” 

Sign up for the Lake Guntersville Chamber of Commerce annual healthcare breakfast by calling (256)582-3612 to sign up. There is no cost and it is open to all residents of Marshall County.