MONTGOMERY — Lawmakers this week began taking action on a package of bills and resolutions related to mental health in Alabama.
“The mental health problem in Alabama is an epidemic, not just a problem,” said Sen. Garlan Gudger, R-Cullman. “The Legislature before most of us got here had to cut the funding … because we were in the Great Recession in 2010.
“We’re feeling the repercussions of that now in today’s society from more and more people that are needing in-patient and out-patient (mental health care), there’s not enough on both sides,” he said.
Those cuts included the closures of three mental health hospitals in 2012 and 2015.
Gudger is a sponsor of a resolution to create the first crisis diversion centers in the state in the next fiscal year.
“There’s no place for (people in crisis) to go,” he said. “You’re sending them to jail or you send them to the hospital,” he said.
Resolutions aren’t laws but express the Legislature’s views or intentions. Many lawmakers and Gov. Kay Ivey have expressed support for the Alabama Department of Mental Health’s plan to create three 24-hour care centers that would provide immediate crisis treatment on a walk-in basis. Ivey’s proposed 2021 budget includes $18 million for the centers. Rep. Randall Shedd, R-Cullman, is sponsoring the House version of the resolution.
Senate Minority Leader Bobby Singleton, D-Greensboro, said the state’s mental health system has gone too long without attention, but federal court and U.S. Department of Justice attention on the state’s prison system has also renewed the focus on mental health care.
“Mental health is not just a corrections problem, but mental health is an Alabama community problem,” Singleton said.
This week, mental health advocates rallied at the State House advocating for more legislative action to improve care.
Jimmy Walsh, a former president of the Alabama chapter of the National Alliance on Mental Illness, said the overall state of the mental health care in Alabama “sucks.”
“The problem is, we’re not treating the crisis adequately – that’s why we need the centers. We don’t have enough beds because we closed down some of the hospitals, but the hospital situation was built to take care of what should be our average step. It was dependent upon building community mental health, but they didn’t fund it.”
While advocates praised the bills in the State House, some said more could be done.
Dr. Jackie Feldman, the director of the Division of Public Psychiatry at the University of Alabama at Birmingham Medicine, spoke at the rally.
“Expanding Medicaid would provide care and treatment,” Feldman said. “If you look at states who expand Medicaid, you increase family financial stabilization since they do not have to declare bankruptcy.”
Alabama’s GOP leaders aren’t talking about expanding Medicaid. But they are supporting several mental health initiatives now moving in the State House.
This week, the House Judiciary Committee approved House Bill 340, which would allow hospitals and law enforcement to put people in protective custody for 72 hours if they’re thought to be a risk to themselves or others. People will be transported to a hospital or other designated treatment facility for an evaluation and treatment.
Individuals don’t have to be charged with a crime and if they don’t consent to transport, officers may use reasonable force.
Bill sponsor Rep. Wes Allen, R-Troy, last year passed the same law specific to Pike County. Without it, there’s not much law enforcement can do for someone in crisis, unless they commit a crime, he said.
At the rally Thursday, some advocates had a few concerns about the bill.
“Seventy-two hours is too long,” said Thomas McCorkle, executive director of Wings Alabama, which works to improve guardianship and conservatorship practices in Alabama. “I think it doesn’t need to pertain to everybody, like for example, children shouldn’t be subject to that legislation the same way adults are.”
Allen on Thursday said changes will be made to the bill on the House floor to protect people’s due process rights. He said the bill would allow those who have been detained to make a phone call to whomever they choose and clarifies the definition of a “designated treatment facility.” The planned substitute bill also prevents anyone younger than the age of 14 from being detained.
Allen said this bill is about protecting individuals who are having an immediate mental health breakdown and is meant to address the most serious or dangerous cases in the state with immediate action.
“It’s about protecting them and getting them stabilized and evaluated and making sure we are meeting the needs of that mental health crisis at that particular time,” Allen said. “It’s another tool in the toolbox to address the mental health issues of our state.”
The bill got bi-partisan support in committee last week.
“In Alabama, we’re trying to fix our mental health, this is one of the ways,” Rep Phillip Pettus, R-Green Hill, said. “Instead of taking them to jail, we can get them to treatment.”
“Alabama is in the midst of a mental health crisis,” Rep. Chris England, D-Tuscaloosa, said. “So, I am excited and happy that the state itself is taking the initiative to begin addressing that, including making sure that people who are suffering from mental illness or are in the midst of a crisis end up in a facility to get treatment rather than being incarcerated.”
“I think it’s a good bill. I think it can probably use some work and we’ll be interested to see what’s in the substitute,” said Rep. Matt Fridy, R-Montevallo.
Intervention Training for Law Enforcement
Legislation from Rep. Rex Reynolds, R-Huntsville, and Sen. Andrew Jones, R-Centre, would require at least 16 hours of crisis intervention training for law enforcement officers. House Bill 326 and Senate Bill 82 both cleared committees last week.
“We have a mental health crisis in the state, so one component of that is training our law enforcement how to deal with the mentally ill,” Jones said. “We just want to raise awareness; we want to work with law enforcement to improve their training so they know how to address those situations.”
Mental Health Coordinators for Schools
Sen. Rodger Smitherman, D-Birmingham, has a bill that requires, subject to legislative appropriation, each school system within the state to have a mental health coordinator responsible for student mental health services for students throughout the system.
Earlier this year, State Superintendent Eric Mackey told Alabama Daily News that the mental health needs of Alabama students are increasing.
“There are simply more mental health issues than there were 10 years ago,” Mackey said.
Suicide was the second-leading cause of death among people age 10 to 24 in 2017, according to the Centers for Disease Prevention, accounting for 19% of deaths.
Resolution to ‘Step-Up’
Rep. Anthony Daniels, D-Huntsville, and Sen. Steve Livingston, R-Scottsboro, are sponsoring resolutions encouraging Alabama’s 67 counties to implement the national Stepping Up initiative, which aims to reduce the number of people with mental illnesses in jails by developing mental health referral and case-management systems.
According to the resolution: People in jails are three to six times more likely than the general population to have mental illness; inmates with mental illnesses tend to stay longer in jail and are at a higher risk of recidivism than people without mental health disorders; and jails spend two to three times more money on inmates with mental illnesses who require interventions compared to those without those treatment needs.
Daniels, the House Minority Leader, said the Stepping Up program is in more than 500 counties nationwide, including a few in Alabama.
“What sold me on the program is what they have in Morgan County,” Daniels said. “In the first six months of the program, they were able to have less than 7% of the people (return) to jail,” Daniels said. “And then it also reduced the number of people that were in emergency rooms.”
Speaker of the House Mac McCutcheon, R-Monrovia, said the bills will likely get floor votes when lawmakers return from their spring break later this month.
“They are priority bills,” he said.