Mental health care officials and lawmakers are discussing this summer the future of funding for crisis services after a bill that would have provided about $69 million per year through fees on phone lines died this past legislative session.
“We’ll have to make some policy decisions about how we fund mental health services in our state,” Kim Boswell, Alabama Department of Mental Health Commissioner, told Alabama Daily News recently.
House Bill 389 would have put a fee of $.98 a month on land and cell phone lines. The money would have expanded centers in Alabama to respond to 988 calls, a new national hotline for mental health emergencies. The money also would have helped expand mental health mobile crisis teams statewide and add crisis centers in cities of 50,000 or more. The state currently has four crisis centers, with two more opening this year.
Whether ADMH will try again next year with the fee bill or seek the funding in the General Fund or elsewhere is to be determined, Boswell said.
“This summer, we’ll be having conversations, particularly with members of the Legislature, to sit down and say, from a policy perspective, what is the best way to continue to expand these crisis services statewide,” Boswell said.
In a legislative session that saw record tax cuts, lawmakers weren’t keen to tack a 98-cent per month surcharge on peoples’ phones, Sen. Greg Albritton, R-Range, told Alabama Daily News.
“It was a raising of fees, it was viewed as a tax increase and the Legislature would have absolutely none of that,” Albritton, chairman of the Senate General Fund budget committee, said.
Boswell said the fee increase was seen as a more consistent revenue source. While the General Fund revenues are more stable than a decade ago, an indefinite nearly $70 million a year increase is a big ask, Boswell said.
In the 2024 General Fund budget approved by lawmakers and Ivey late last month, $211.4 million was allocated to ADMH, including $500,000 for the 988 call centers and $36 million for the state’s relatively new crisis centers that offer stabilization and short-term care, and then referrals to long-term treatment, to those in crisis. One goal is to keep those with acute needs out of prisons and hospital emergency rooms.
Boswell said there is some federal money for the call centers in 2024, but money for 2025 is the larger concern.
ADMH’s state funding is now above pre-recession levels of nearly $143 million, before General Fund allocations in 2010 were nearly halved and took more than a decade to recover.
At the same time budgets were cut, the state closed three mental health hospitals in part to save money and also because of federal mandates that said mental health care is better delivered in smaller settings in patients communities, not large institutions. Networks of community-based care providers now do much of the work large hospitals used to for those who have gone through a civil commitment proceeding. The crisis network ADMH is building, including the centers, responds to those with immediate emergencies.
“We’re still trying to recover from a lack of funding for a number of years,” Boswell said. “Not just recover and do the same old thing, we’re really transforming it into a business model that works in the current health care environment.”
Albritton said lawmakers want to know more about the model.
“We want a better plan, a more complete plan,” Albritton said about the goals for mental health services in the state.
Meanwhile, personnel shortages are a concern Boswell has repeatedly brought to lawmakers’ attention.
“We don’t have a pipeline … we don’t have anyone being trained to come into this industry,” Albritton said. “ And I don’t just mean social workers. I mean psychiatrists, psychologists who can triage and diagnose.”
In addition to mental health, ADMH provides services to Alabamians with developmental disabilities and substance addiction disorders. In the current fiscal year, its total funding, including federal sources, is $1.29 billion. Boswell has previously said much of the federal funding is earmarked for specific programs and can’t be used on capital projects, like crisis centers.
House General Fund budget chairman Rep. Rex Reynolds, R-Huntsville, sponsored the fee bill this session. Reynolds said more funding is “absolutely needed” for the continued expansion of crisis services. The question is where that money should come from. He agreed that conversations will continue this summer.
“I’m not closing my eyes to looking at other forms of revenue,” Reynolds said.
988
Nationwide, people in mental health crisis have been able to call or text 988 since July 2022. The federal act that created the hotline also authorizes states to assess a fee for providing 988 and crisis services.
From July through March, more than 34,000 people in Alabama have called or texted 988. In March, 55% of calls were answered by trained staff — a bachelor’s degree is required for call specialists — at one of three call centers in Alabama. The rest rolled over to out-of-state centers.
Had the funding bill passed this year, it would have allowed for more 988 staffing in Alabama. The goal is for 90% of calls to be answered in Alabama
“Then, the people answering the calls can tell you how to access mental health services in Alabama,” Boswell said.
Those services could include mobile crisis units and the soon-to-be-six crisis centers around the state. Though the centers didn’t begin until 2021, through 2022 they’d gotten care to more than 2,000 people, including more than 400 who were suicidal, more than 600 experiencing psychosis and nearly 700 with a substance use disorder.
“It’s not overstating it to say these services are saving lives,” Boswell said.
The failed legislation would have added four more crisis centers around the state for a total of 10.
Though it didn’t pass, Boswell said she’s happy the bill was filed in the 2023 session.
“I’m glad we did because I feel like the amount of education and engagement and conversation that we created around it is going to really, really help us out in the next budget cycle,” she said.