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‘This is a crisis:’ dwindling mental health resources dominate budget talks

Concerns over the state of mental health care resources dominated a budget meeting Wednesday where representatives from four of Alabama’s health service agencies outlined their funding needs and requests for the upcoming fiscal year.

At the State House building, commissioners from four agencies – the departments of Human Resources, Senior Services, Mental Health, and the Medicaid Agency – presented their 2024 budget requests to a joint legislative committee.

Mental health resources in Alabama

Alabama routinely ranks as having among the worst mental health resources in the country. A 2022 study by Mental Health America, a nonprofit organization founded in 1909, found that Alabama was only second to Texas as having the worst access to mental health resources in the country. 

That same study ranked the state 49th out of 51 in having the highest number of uninsured adults with a mental illness – 154,000 – and 51st in its mental health workforce availability, with only one mental health care provider for every 920 residents.

‘Mental illness is overpowering this state’

In a presentation, Department of Mental Health Commissioner Kim Boswell laid out the department’s budget requests, which included a $41.4 million increase from the state’s General Fund. This year, the department received about $193.1 million from the General Fund this year.

The request includes $30.6 million to increase and improve the workforce, $5.1 million to reduce the developmental disabilities wait list, $3.5 million for crisis centers and teams, $1.1 million for prevention services, and $500,000 for autism adult services.

The remaining $2 million requested from the state’s Education Trust Fund included $1 million for telemental health services, and another $1 million for school-based mental health resources.

Rep. Pebblin Warren, D-Tuskegee, who sits on the joint budget committee, told Boswell that while she appreciated the work her and the department did, it was inadequate to address the growing mental health crisis in the state.

“You did a very good presentation today, but in my opinion, you’re putting a bandage on a running sore,” Warren said. 

“Mental illness is overpowering this state, and what I want to see is more aggressiveness on your part, I want you to fight this Legislature. I want them to understand that this is a crisis in this state that we can’t just push over.”

Rep. Pebblin Warren speaks during the joint budget committee meeting.

Following Boswell’s presentation, legislators in attendance were offered an opportunity to ask questions. One of them was Rep. Thomas Jackson, D-Thomasville.

“I live in Clarke County, I represent southwest Alabama, and what I am concerned about is that we’re sharing mental health cases with the Department of Corrections,” Jackson said.

“There’s a young man that is in my district that’s been in jail going on the third year now, (and) I’ve been trying to get him a place outside of the jail for service. This guy is mentally ill in a jailhouse, and nobody there cares about him, and I found that to be true throughout my district; only ten beds in the whole area, and all of them are filled.”

Jackson went on to to point out the inadequacies of the department’s 988 mental health crisis and suicide hotline given the extended wait times for those seeking care.

“Calling 988 is not going to help this young man, there’s nowhere for him to go because everyone tells me that there’s a waiting list,” Jackson continued. “Three years and still waiting… could you clarify this, (because) we need help.”

“Absolutely we need more beds,” Boswell responded. “I’m not going to argue that point at all.”

Rep. Thomas Jackson shares a story about a constituent of his struggling to find mental health resources.

Another legislator in attendance was Sen. Vivian Figures, D-Mobile, who argued that it wasn’t the department at fault for the current state of Alabama’s mental health resources, rather it was the state legislature’s inadequate funding of the department.

“You all do the best that you can, and you can only do with what the legislature gives you to work with, and so we can’t blame it on you,” Figures said. 

“You come here every year saying what you need; you try to stay within reason of what you’re asking for, and most of the time you don’t even get that. I’ve been here 26 years and I’ve seen these cans get kicked down the road year, after year, after year, but it amazes me that we can always find the money for things that we really want, such as money to build new prisons.”

Other agencies present their budget requests

Commissioner Nancy Buckner of the Department of Human Resources also presented her department’s budget requests during the meeting, requesting $192 million from the General Fund, and $99.6 million from the Education Trust Fund. For a total of $291.8 million, the budget request represents an increase of $133.5 million over the previous year.

The majority of the requested $133.5 million increase – $51.8 million’s worth – would be used toward family services, which includes things like foster care and child support. The second largest line item is for personnel, which would include staffing amid significant workforce shortages.

“I know we’re asking for a lot of money, and I don’t want to talk in a meeting like this to tell you specifics that certain children have (to deal with), but I’m telling you, it is absolutely horrendous,” Buckner said. “It is absolutely despicable what has happened to (some of the children we service).”

Commissioner Jean Brown of the Department of Senior Services presented her department’s budget as well, asking for $45.9 million, an increase over this year’s budget by almost $7 million.

Calling the requested increase “a big request for us” and “unusual,” Brown said the Elderly Nutrition Program – which served 5.6 million meals last fiscal year – accounted for the largest portion of the requested increase.

The Alabama Medicaid Agency’s budget request, presented by Commissioner Stephanie Azar, was for $849 million from the General Fund, an increase over this year by $55.4 million. Factors that accounted for the $55.4 requested funding increase, as explained by Azar, included inflationary cost increases at places like nursing homes and pharmacies, as well as federal funding decreases as the COVID-19 public health emergency declaration is set to expire this year in May.

Gov. Kay Ivey must submit her proposed budgets to the state Legislature by Mar. 9. The Legislature will have until May to adopt the 2024 budgets.

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