Under the plan, there will be one main state mental hospital left by May 2013: the under-construction replacement for Bryce Hospital in Tuscaloosa, which will hold only patients found not guilty because of insanity or mental defect or deemed incompetent to stand trial. When that new, unnamed hospital is ready, the Taylor Hardin Secure Medical Facility in Tuscaloosa will close and its patients will move there.
Greil Memorial Psychiatric Hospital in Montgmery, North Alabama Regional Hospital in Decatur and Searcy Hospital in Mount Vernon would close by Sept. 30.
Mary Starke Harper Geriatric Psychiatry Center in Tuscaloosa, which nearly covers its costs through Medicare, will stay open.
The department has long worked to shift from treating patients in state hospitals to caring for them in group homes, private hospitals and other community settings as part o f a nationwide movement. But the current budget situation sped up the plan, said David Jackson, chief operating officer of the Alabama Department of Mental Health.
The governor's 2013 budget calls for cutting ADMH's general fund budget 10 percent, from $ 116 million a year to about $104.4 million. And worst- case scenarios show the state Legislature slashing the mental health budget by 25 percent, dropping its operating money to $87 million, Jackson said.
" This is already an extremely short timeline," Jackson said. "We can't wait around to find out."
By closing the state hospitals, the department can move a good part of the $106 million it spends a year operating the hospitals into setting up new options for community care, including contracting with private providers to build more group homes or expand treatment centers.
Even if the cuts don't come, Jackson said, ADMH Commissioner Zelia Baugh is committed to the plan, which she announced Wednesday in a two- page letter to mental health caregivers and advocates. In it, she said the agency was forced to choose between keeping its aging hospitals running or slashing funding for community programs, which treat more people for less money and also get more federal money.
" This would be a tragic step backwards and would lead to an unavoidable cycle in which ever- increasing amounts of funding would need to be shifted from community treatment programs to fund the ever-increasing requirements for state institutions," Baugh wrote.
Some estimates show that cuts on the community side could leave about 20,000 patients on their own, said James Tucker, associate director of the Alabama Disabilities Advocacy Program at the University of Alabama.
"I think they have made a strategic choice that has been kind of forced on them, and I think that in a set of bad choices they've made the best possible choice," Tucker said.
Advocates like Tucker have long fought to move people from institutions to community-based care, saying it's more humane.
It's also cheaper. ADMH estimates that it costs about $140,000 to care for the average patient in the hospital, compared to about $60,000 for community resources to take over. Plus, Medicaid reimburses ADMH for most of the cost of community care but pays nothing for institutionalized patients.
That said, Tucker and others wonder whether there will be time to build up the infrastructure needed to handle patients being discharged from the hospitals and new ones coming into the system.
For example, probate judges who decide whether people should be committed involuntarily currently can choose between sending them to Bryce or another state institution or a community option.
"It's almost essential for me to have a state hospital for people who really can't cope, even if it's for a short period of time," said Jefferson County Probate Judge Sherri Friday. " I'm really anxious to see how this stuff is going to affect the day-today."
Psychiatric patients usually enter the state hospital system through such commitments. Most stay a short time -- perhaps a month or two -- and are then either released to their family or to a group home or other facility near home. Some, however, stay for years, and some patients have lived at the hospitals for decades.
ADMH was already working to move many long-term and acute care patients out of Bryce, which was slated to be replaced next spring by a new 268-bed hospital that's under construction in Tuscaloosa on the grounds of the former W.D. Partlow Developmental Center.
Now, that new hospital will instead be a secure facility for 230 forensic patients. Of those, 115 will come from Taylor Hardin and the remainder are in step-down care at the other hospitals but cannot be released without the approval of the circuit judge who sentenced them. The existing Bryce will temporarily treat all forensic patients -- about 40 are already there -- until the new hospital opens in May 2013.
Alabama Plans to Close Most Hospitals for Mentally Ill
By ROBBIE BROWN
Published: February 17, 2012
ATLANTA — Alabama will shut down most of its mental health hospitals by the spring of 2013 in a sweeping plan to cut costs and change how the state’s psychiatric patients receive treatment, state officials announced on Wednesday.
The decision to close four hospitals and lay off 948 employees is a bleak reminder of Alabama’s shrinking budget. But it is also the latest example in a longstanding national effort among states to relocate mentally ill patients from government hospitals to small group homes and private hospitals.
Mental health advocates believe patients often get better care in smaller, less isolating facilities. Since the 1990s, Alabama has closed 10 other mental health treatment centers.
“What’s unusual is how many hospitals in Alabama are being closed so fast,” said Bob Carolla, a spokesman for the National Alliance on Mental Illness. “The trend has been to downsize much more gradually.”
By May 2013, the state plans to have two remaining state mental health hospitals, one for criminal suspects and another for geriatric patients. Nearly all of the 524 other mentally ill patients will get treatment at group homes and community centers, which are less expensive and give them more freedom, state officials say.
The announcement, by the Alabama Department of Mental Health, was made against a dire financial backdrop. Since 2009, the state has reduced financing for mental health services by 36 percent, the second-highest rate in the country. And next year, the Legislature says, the budget for those services could be cut an additional 25 percent, or $29 million.
“Given that we are facing potentially a $29 million decrease in our budget, we have to be able to come up with that money,” said David Jackson, the department’s chief operating officer.
Mental health advocates were torn. While many have criticized state-run hospitals as isolating patients and stigmatizing mental illness, they worry about the state’s having group homes to accommodate the closings.
“In general, we think it’s a good thing, considering the budget,” said Robert Hermes, the executive director of Wings Across Alabama, an advocacy group. “The hospital tends to be an alienating environment. You often get warehoused and institutionalized. But we need to make sure there are enough community centers for these patients.”
