At budget hearing, Alabama Department of Mental Health cites need for more crisis beds

ADMH Commissioner Kimberly Boswell discusses the state's mental health initiatives at its February board meeting. (Photo/Alander Rocha)

Two Alabama state agencies told lawmakers during an informal budget hearing  Wednesday that they have urgent funding needs, emphasizing challenges and impacts on public services.

The Alabama Law Enforcement Agency (ALEA) and the Department of Mental Health (ADMH) highlighted pressing requirements for equipment, personnel, and resources to state legislators.

ADMH Commissioner Kimberly Boswell, presenting an overview of the agency’s efforts, said the agency’s five crisis centers have served over 12,000 individuals since the first one opened in 2021, “providing critical care and avoiding unnecessary jail and emergency department visits,” she said.

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Boswell emphasized the critical shortage of crisis beds, particularly for individuals with severe mental health issues and co-occurring disorders. The agency detailed the current gaps in civil commitment beds and extended care beds. That has led patients to undergo prolonged hospital stays — where mental health services are limited — instead of getting specialized services that can be delivered when a person is committed to a crisis bed.

In July, Boswell said, the University of Alabama in Birmingham (UAB) had 27 patients committed to its crisis beds. These patients were in the hospital for a total of 2,462 days but only needed specialized services for about 190 of those days. If those patients had been in the hospital for only that amount of time, Boswell said, an additional 325 patients who needed hospital care could have been served during that period.

“When our individuals get stuck in hospitals, there are lots of people in that community who are not getting what they need, and those individuals are not getting what they need because they need other specialized work,” she said.

One major challenge is the shift in rural hospital models, Boswell said, driven by federal regulations that limit the number of inpatient beds available. This change has resulted in the loss of critical mental health beds in some areas, exacerbating the crisis.

In 2023, the U.S. federal government authorized rural emergency hospitals (REHs) as a way to respond to rural hospital closures and to give rural communities more access to health care, according to the Centers for Medicare and Medicaid Services (CMS). They are allowed to provide emergency services, observation care and outpatient medical and health services that do not exceed an annual per patient average length of stay of 24 hours in exchange for enhanced Medicare reimbursements and a monthly fee paid to the facility. Rural hospitals that have converted to REHs in the state have shut down inpatient services, such as psychiatric services.

“Now they’re all switching their business model, and we’re no longer able to buy beds from them. We just recently lost 30 beds in Bullock County,” Boswell said.

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She said the Department of Mental Health is exploring alternative solutions, such as utilizing vacant beds in existing facilities and developing new treatment programs, but finding willing providers and securing funding continues to be a challenge.

The presentation also provided a historical context of budget cuts to the agency, resulting in significant loss of mental health services. Despite recent funding increases, Boswell said continued investment is needed to meet growing demands, with significant gaps to fill.

Boswell also said the impact of social media on youth mental health is a key factor affecting mental health in young people, citing a June 2024 advisory from the U.S. Surgeon General that said adolescents who spend more than three hours a day on social media face double the risk of anxiety and depression symptoms and that adolescent social media use may cause a decrease in life satisfaction for certain developmental stages, includes 11–13-year-old girls and 14–15-year-old boys.

Boswell said the department works with the Department of Education to address these issues and promote healthier lifestyles for Alabama’s youth by providing licensed therapists to students in some schools but also suggested policies that can help curb screentime, such as making schools phone-free zones.

Hal Taylor, Secretary of Law Enforcement in ALEA, said there have been some recruitment challenges. Despite a yearly salary of $55,615 for a trooper trainee and competitive benefits offered to attract new recruits, the rigorous selection process combined with an increasing rate of expected retirements continues to be challenging. He was asked if they would need more funding to address those issues, but Taylor said they are managing.

He did say the price of ammunition is going up and they may need help with that in the future.

“Ammo is going up, like the cost of everything. Right now we’re okay with that, but as we hire more, and go to the range more, and train more, we will use more ammo,” he said.

Taylor did not say how much the agency spends on ammunition.

Senate Taxation and Finance General Fund Committee Chair Greg Albritton, R-Atmore, said at the beginning of the hearing that it was meant to allow agency representatives to outline their current status and future plans.

“We know there are problems [in the state] … The concern that we’ve got is, of course, in the future with where we may be. We have been on a growth pattern, which allowed us to [increase services]. The concern is when we will have a reversal of that,” Albritton said during the hearing.

Albritton said hearings on other state agencies will take place in August.

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