Alabama's Mental Health Shift

Like many states, budget cuts have forced Alabama officials to take a good hard look at how the state cares for people with mental illness. Since 2008, the Department of Mental Health has lost $40 million in state funds. So they've opted for a less expensive form of treatment -- community-based mental health centers and apartment communities.

Martha Ledlow is a part of that shift. She lives in a small two-bedroom apartment in Oneonta, a town northeast of Birmingham. She's been living in a simple, no frills, state-sponsored apartment for two years. Several years ago, Ledlow suffered from severe depression. She attempted suicide by setting her family’s house on fire. She was sent to Bryce Hospital – a state psychiatric facility in Tuscaloosa. After being released she now lives in the community near friends and family.

"The family support has really helped a lot," Ledlow said. "If it wasn't for my family, my friends with their support, I would probably still be the shy little person still in a corner, like I can't do this or can't do that. But, now being through the hospital, and here, has all shown me that I don't have to be shy anymore.

Like Ledlow many of those dealing with mental illness are now fighting their battle outside of mental institutions.

At one time, there were approximately 6,000 patients in Alabama state hospitals, most of them at Bryce. Over the last several decades, some were evaluated and released to live independent lives. Some were transferred to community mental health centers. Very few remained institutionalized. Today only 290 are at Bryce.

Richard Craig is the executive director of the JBS Mental Health Authority. That agency is charged with transitioning patients from Bryce to community care. He emphasizes he and his staff take great care in deciding who can relocate to the community and who remains at Bryce.

"A person has to be sufficiently in a state of recovery from their illness in order to live and get along in the community. An individual who is experiencing severe persistent constant hallucinatory experiences and cannot care for themselves, at least minimally on a daily basis, that's an individual that we cannot bring back to the community," Craig said.

Timothy Stone, Medical Director for the Alabama State Department of Mental Health, believes society still struggles with how to accommodate those with mental illness.

"And bringing them into the community and accepting them as full members of that community. And, if folks are ever going to be successful in staying out of the hospital, if we’re ever going to be successful in closing these institutions, then society will have to change the way that it sees people with mental illness," said Stone.

Alabama hasn't always treated those suffering from mental illness very well. The state faced a lawsuit in the 1970s for not providing mental health patients adequate care. Opponents accused the state of merely warehousing them. Alabama lost and was required to create certain minimal levels of care for individuals.

The current focus is a comprehensive community-based treatment program such as the one Sheila Hurley offers. She's executive director of CED Mental Health Center in Attala. Hurley explains her office offers clients wrap-around services, which is a team approach.

"With a psychiatrist taking care of their medication, a nurse if it's needed to look at their medications and how they're managing their care, a therapist that watches over their treatment plan and the things they want to achieve and their goals," Hurley said.

Beyond medical personnel, peer specialists are an important element in these extensive services. They are people who have recovered enough to share experiences with those still suffering from mental illness. Cindy Smith's son suffers from schizophrenia. He was a patient at Bryce Hospital for 12 years. Smith feels peer specialists have measurably helped her son.

"They're approaching the clients who have never done anything in the past few years and saying, hey look at me. I can do this. I've got a job. I'm driving. I'm seeing people. I'm helping people and you can do that too." Smith said. "That's very, very motivating and empowering for a person who is sitting around his apartment all day and smoking cigarettes and drinking coffee."

But how effective are community-based mental health programs? Experts say it's instrumental to get clients into the community and that's happening. However, some feel Alabama is not doing enough. Ira Burnim is the legal director for the Bazelon Center for Mental Health Law, based in Washington, D.C. He gives Alabama high marks for de-institutionalizing the system, but less so for getting patients out in the community.

"Alabama got a little stuck, and so it's a system looks a lot like the system that was about to be state of the art in the eighties and nineties. But, the rest of the country has really moved on in important ways," Burnim said.

Burnim says other states have created more independent housing for mental health clients plus a better emphasis helping people find and keep jobs.

Alabama officials say offering mental health clients the most effective treatment is a constantly evolving process. But they add community-based health programs save the state a lot of money. It costs half of what it once took to treat people in state institutions. That's savings for the state and a better environment for patients, but still room for improvement.

~ Les Lovoy, July 23, 2013