Probate Judge Sherri Friday holds commitment hearings every week inside a small group therapy room at UAB’s Center for Psychiatric Medicine.
On a recent Thursday, one of the patients folded and unfolded a stack of papers and bounced her knee up and down. She had been diagnosed with schizophrenia, and had been responding to treatment. There was just one problem, her psychiatrist said. She didn’t always take her pills.
Judge Friday postponed the hearing for two weeks, giving the patient more time to prove she is not a danger to herself or others and avoid longer involuntary commitment.
If the patient does not improve, then Friday will have to determine where to continue the treatment. The last remaining state psychiatric hospital, Bryce Hospital in Tuscaloosa, only accepts about two to three patients from Jefferson County every week. The rest are treated closer to home in beds rented from local psychiatric treatment facilities.
Friday is worried that the funding for those additional beds could be threatened if legislators cut the budget for mental health services.
“I don’t know what we’d do without those beds,” Friday said.
Those rented psychiatric beds have become part of the system that has sprung up to replace state psychiatric facilities – which have been disappearing faster in Alabama than almost anywhere else in the country. Since 2012, the state has closed three psychiatric hospitals – Greil in Montgomery, Searcy in Mobile and North Alabama Regional Hospital in Decatur. The number of state-owned psychiatric beds decreased from 740 to 268.
The last psychiatric hospital outside of Tuscaloosa, North Alabama Regional Hospital, closed in June.
The state operates just three remaining facilities: Bryce Hospital, Mary Starke Harper Geriatric Psychiatry Center and Taylor Hardin Secure Medical Facility – which serves the criminally mentally ill.
Communities have adapted differently to the changes. In Birmingham, the mental health authority rents beds from Hill Crest and other psychiatric facilities. Friday said the county can only send two to four patients to Bryce in any given week.
In Mobile, East Pointe Hospital, operated by AltaPointe, handles many of the patients who would previously have been sent to Searcy Hospital.
In northern Alabama, the mental health authority replaced the hospital with four 16-bed crisis stabilization units, which are designed to serve the majority of mental health patients who can be treated and released within 90 days.
The law allows for up to five months of involuntary commitment, and issues remain for the most complex patients, who may need months of treatment before they can be safely released into the community. Those patients may need treatment at Bryce instead of a crisis stabilization unit designed for shorter stays.
“There are some people who need long-term hospitalization to resolve their symptoms,” said Dr. Richard Craig, executive director of Jefferson-Blount-St. Clair Mental Health Authority, which serves the area around Birmingham. “People with more severe illnesses are waiting longer.”
The process of closing state hospitals began as many as 30 years ago, but then accelerated in 2008, when the state cut funding for mental health by more than $30 million. Since then, the Department of Mental Health has received level funding, which does not account for inflation in medical costs.
Jim Dill, president of the Alabama Council of Community Mental Health Boards, said the state has saved a lot of money by closing the hospitals. Many mental health advocates want to see more of those savings put back into community based services, which could then be expanded to serve more people. Dill said the state never invested enough money in mental health to serve all the people who need it.
“The amount of money that has been shifted from the state to the communities has been adequate to serve the people who were being served by state hospitals,” Dill said. “There never was enough money in the system to take care of everyone.”
Jim Perdue became the commissioner of mental health this summer. His first objective is to protect the department’s budget during the next special session. At least one proposed budget could cut mental health services by five percent. With the addition of federal matching funds, the total amount lost could be as high as $17 million, Perdue said.
“I’m worried about how much funding we’re going to have on Oct. 1,” Perdue said. “When it comes to mental health, in just this small part of Alabama, we have a duty to do this.”
It is unlikely the state could cut funding to the three remaining facilities, Perdue said. That means any cuts would affect community-based services. That is exactly what worried Friday, who was concerned about beds for Jefferson County.
If the department cut outpatient services, that could affect as many as 3,000 people in Alabama, Perdue said. Ending services to patients receiving outpatient treatment could cause some of them to become sicker, Perdue said.
“If just 10 percent of them had to be committed, that would be 300 people,” he said. “That’s already more beds than we have in Bryce Hospital.”
Dr. Craig said additional cuts could threaten public safety. Earlier this year, a police officer shot a man in Lawrence County just days after he was turned away from a mental health facility, according to his family.
Events like that one, and the recent shooting in a Lafayette, La. movie theater committed by a mentally ill Alabama man, raise awareness of the need for mental health funding, Perdue said.
The difference between a schizophrenic patient who ends up in Taylor Hardin after committing a violent crime, and one who lives successfully in the community, may depend on mental health funding, Perdue said.
“How much money would it take to continue level services?'” Perdue asked. “It would only take about two or three percent. That means you’re happy staying the way you are, and I’m not. I want to continue to be more progressive. It would take probably a twenty percent increase, but we don’t even want to go there right now. What we’re trying to get through is at least level funding, maybe funding to continue level services. But the biggest thing is, tell me something.”
By Amy Yurkanin – Published on Al.Com on 8.23.15