Alabama will shut down most of its hospitals for the mentally ill by May of 2013. While there has been a national movement to relocate those with mental illnesses from state-run hospitals to group homes and private hospitals, Alabama’s announcement has occurred at a time when the state is in dire financial straits. As the New York Times reports, Alabama has been reducing state funding for mental health services by 36 percent since 2009, the second highest rate in the nation; in 2013, financing will be reduced by an additional 25 percent, or $29 million.
According to the Birmingham News, it costs about $140,000 to care for an individual in a hospital, but $60,000 in a community-based setting. In addition, Medicaid will reimburse the Alabama Department of Mental Health for most of the costs of community care, but not for patients in state facilities.
Four hospitals for the mentally ill will be shut down next year and 948 employees laid off. Since the 1990s, Alabama had already closed ten other centers for those with mental health issues. Two mental health facilities, one for criminals and the other for geriatric patients, will remain open. By next spring, 524 mentally ill residents will be transferred to group homes and community centers which are, say state officials, “less expensive and give them more freedom.”
Mental health advocates with responded carefully, noting that state hospitals are too often places where those with mental health issues are kept separated, isolated and in effect warehoused. Conditions at the state facilities were indeed “so poor,” say advocates, that treating people in the community would be better. But the question remains — considering the drastic cuts to funding for mental health services in Alabama — will there be sufficient funds for people in the community centers? As the New York Times quotes Bob Carolla, a spokesman for the National Alliance on Mental Illness, “What’s unusual is how many hospitals in Alabama are being closed so fast.”
While saying that moving individuals into community settings is “more humane,” James Tucker, associate director of the Alabama Disabilities Advocacy Program at the University of Alabama, also expresses concerns about whether “there will be time to build up the infrastructure needed,” to support both patients being discharged from state facilities and new people entering the system.
It remains to be seen is how those 524 mentally ill individuals will be transitioned to the group homes and community centers and if these will be adequately staffed and by individuals with sufficient training and support for everything from crisis situations to giving people medication. There are addtional concerns if individuals are placed in private facilities — or are in group homes where their care is contracted out to private agencies — as, under such arrangements, they have less recourse than they would in a public facility to question treatment that is below the standard of care.
Is the state of Alabama, under the pretext of providing community-based care for individuals with mental health needs, actually shortchanging their care?
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