As state departments begin trimming their budgets due to prorated revenue projections, the Alabama Department of Mental Health expects significant cuts. That could result in less funding for county facilities such as the Calhoun-Cleburne Mental Health Center in Anniston. With less funding comes the possibility of less treatment for many patients — which means local hospitals and law enforcement may have to pick up the slack.
“This is the worst I’ve ever seen it and I’ve been with the center for 22 years,” Mickey Turner, executive director of the Calhoun-Cleburne Mental Health Center, said of the financial crunch.
Gov. Robert Bentley on March 16 ordered a nearly 11 percent, or $170 million, cut to the General Fund, which supplies money to the Alabama Department of Mental Health and, in turn, supplies funding to local centers like Calhoun-Cleburne Mental Health. Tony Thompson, executive assistant to the commissioner of the Alabama Department of Mental Health, said his agency expects a loss of $12.3 million due to the General Fund proration, the name given to mid-year budget cuts.
Thompson said it was still too early to say exactly how the cuts would be absorbed, but noted no option was off the table, including reducing funding to centers like Calhoun-Cleburne Mental Health.
“Most of the services we provide are through contracts with community providers,” Thompson said. “Cuts to those providers is certainly one of the things that could be considered.”
Turner said it was still unknown how the proration would affect facilities like his.
“We may have to close programs because of the proration,” Turner said. “But it’s hard to say right now which programs would be cut because every program we have is very vital to the community.”
Calhoun-Cleburne Mental Health, which serves 6,000 patients, has three divisions that treat the mentally ill, substance abusers and the developmentally disabled. Various programs are handled under those three divisions.
The proration cut comes a month after the Alabama Department of Public Health announced a plan to close four state hospitals due to budget constraints and transfer the patients from those facilities to county centers. Those state-run facilities include Searcy Hospital in Mount Vernon, North Alabama Regional Hospital in Decatur, Greil Memorial Psychiatric Hospital in Montgomery and the Taylor Hardin Hospital in Tuscaloosa. Thompson said the department plans to transfer all the patients in those institutions to community providers.
“The reason we came up with the idea to close the state hospitals is so we don’t have to completely cut funding to community providers,” Thompson said. “And we believe those state patients can be better served in community-based centers.”
Thompson noted that the cost to treat the state patients would be covered by the department and would not fall on the shoulders of community providers. Still, local centers like Calhoun-Cleburne Mental Health will still need to divert manpower and space for extra patients.
“We would have to open up a 16-bed intermediate care facility to handle the extra patients,” Turner said.
In addition to direct cuts to mental health in the state, the proration will cut about $68.4 million from the Alabama Medicaid Agency, which could have an indirect effect on local mental health facilities.
“Right now, we’re looking at optional programs to make cuts,” said Robin Rawls, director of communications at the Alabama Medicaid Agency. “The federal government has a number of mandatory programs we can’t touch.”
According to a list of mandatory and optional programs under the Medicaid system, provided by Rawls, inpatient and outpatient hospital services except those in mental institutions are considered mandatory.
Also, prescription drugs are not considered mandatory for coverage under the current Medicaid system.
“That was just the way it was done on the outset of the program in the 1960s,” Rawls said. “Back in the ’60s, they didn’t have all the medications like we have today.”
Turner said cuts to Medicaid for prescription drugs would be a real problem for his center and its patients.
“If they cut medication benefits that would be huge for us, because we have so many clients who have numerous medications,” Turner said.
According to a January report from the American Hospital Association, one in four people in the United States experiences a mental illness or substance abuse disorder each year. The report states that in 2007, people diagnosed with mental illness had annual earnings averaging $16,000 less than the general population. In 2005, Medicaid and state and local governments accounted for 61 percent of behavioral health care expenditures, compared with 46 percent for all other health services.
The report also states that people with mental illnesses are more likely to live in poverty and to be less educated, increasing the chances they will end up homeless or incarcerated.
Calhoun County Sheriff Larry Amerson said he has been in contact with other sheriffs across the state and they are all concerned about the cuts to mental health services.
“There is a reason for concern on several levels and one is the tendency for people who are mentally ill to wind up in jail anyway,” Amerson said. “With the state closing mental health facilities, that is only going to get worse.”
Amerson said he had heard of the Calhoun-Cleburne Mental Health’s plan to create a 16-bed facility to accommodate the extra patients from the state.
“What if 19 people need crisis treatment and there are only 16 beds … what we have today is the potential that those people will get turned back out,” Amerson said.
That increases the possibility of more people ending up in the county jail, which is already under-funded and overcrowded, he said.
“The working relationship between the law, the probate office and mental health has been more than good, but there is only so much we can do with local funding,” he said. “This is one more situation where state cutbacks put more of a burden on local communities.”
Rosemary Blackmon, president of the Alabama Hospital Association, said hospitals across the state would be indirectly affected by the cuts to mental health services.
“Certainly any time you have cuts … that will eventually impact hospitals with patients coming in from other areas like mental health,” Blackmon said.
David McCormack, CEO of Regional Medical Center in Anniston, agreed that cuts to mental health centers could mean increased costs and work for hospitals.
“They’re going to show up in emergency rooms,” McCormack said of mentally ill patients. “We get a lot now. It’s sort of a concern.”
McCormack said the concern is the extra mental health patients could eat up resources normally allocated to patients with physical injuries or illnesses.
“And we have to have a sitter to watch the more seriously mentally ill,” McCormack said. “It’s tough for everybody and the poor patients are the ones who suffer the most.”
Staff writer Patrick McCreless: 256-235-3561. On Twitter @PMcCreless_Star.