Alabama will close the majority of its mental health hospitals by spring 2013 in face of significant budget cuts. The decision is consistent with a national trend to cut spending on mental health, forcing hundreds of patients back into communities, and possibly into prisons.
Nearly 1,000 employees will be laid off as a result of Alabama’s decision to close four mental health hospitals this year. One hospital will remain open in Alabama for geriatric and criminal suspects with mental illnesses.
Since 2009, Alabama has reduced spending on mental health services by 36% – the second-highest rate in the country. Next year, Alabama is expected to cut an additional 25% of mental health spending, equalling $29 million dollars.
From 2009-2011, states cut a combined total of $1.6 billion dollars from non-Medicaid mental health spending. Cuts are expected to rise over the next few years including at least $338 million in cuts to Medicaid in Washington state alone, according to the National Alliance on Mental Illness (NAMI).
Nationwide, nearly 4,000 state psychiatric hospital beds have been eliminated over the past two years. As a result of the hospital closures in Alabama, over 500 mentally ill patients will be transferred to group homes and community programs, which some believe give more sufficient, long-term support than hospitals.
James Tucker, Associate Director of the Alabama Disabilities Advocacy Program, thinks, “the move to close a couple hundred hospital beds is the right move when the alternative is terminating services to 20,000 persons in the community.”
However, hospitals are not the only mental health facilities facing budget cuts. Not all Americans are convinced there are enough community mental health services available to prevent a rise in crime and imprisonment among mental health patients.
NAMI reports that Ohio, once a national leader in mental health systems, has abandoned many outpatient mental health programs as a result of significant budget cuts. Today in Ohio, thousands of adults are unable to access community mental health and outpatient services, resulting in higher levels of homelessness, hospitalization, and even imprisonment.
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Budget Cuts Could Increase Mental Health Issues in Prisons
The U.S. Department of Justice reports that roughly half of all prison and jail inmates suffer from a mental health problem. Some critics believe that cutting mental health care spending will result in a even higher number of mentally ill patients in prison.
The Colombia Missourian reported, “Frank Butler, a professor of criminal justice at La Salle University in Philadelphia, said…with the closing of state hospitals due to deinstitutionalization, jails by default became inpatient mental-health centers.”
During major cuts to mental health services, “We saw a 25 percent increase in people with mental illness in our homeless count between 2009 and 2010,” said Troy Christensen, manager of mental health and homelessness in Pierce County, Washington. There was also a 12 percent increase in requests for mental health assessments during that same period at the Pierce County Jail.
The vast majority of patients with mental illness are not believed to by violent according to mental health advocates. However, without proper care, mentally ill adults are more likely to repetitively end up in prison due to inadequate adjustment services.
Bill Gilstrap, a 53-year-old welder with bipolor disorder has been utilizing mental health services since 1997. “I”m a taxpayer, and I have a real sense of belonging in the community,” said Gilstrap. “The stark reality of my situation is that if I wasn’t getting quality outpatient services, I’d be in a psychiatric hospital or I’d be in jail.”
According to Dr. Butler, “Mentally ill inmates are often ‘frequent flyers,’ ending up in jail time and again, commonly for minor offenses…Treatment resources for the mentally ill tend to be grossly inadequate in jail, in part because need far outstrips the resources allocated.”
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Mental Health Care May Worsen with Prison Privatization
The bleak situation for mentally ill patients serving prison time may get worse as trends shift towards increasing privatization of prisons.
Just this year, the Corrections Corporation of America (CCA) announced a plan to purchase 48 state prisons for $250 million each. The CCA experienced a fivefold increase in profits since the mid-1990s and sees the economic recession as an opportunity to further expand business.
Unlike state facilities, private prisons are not mandated to provide mental health services to inmates. Often times, private prisons refuse to accept inmates with mental illness altogether due to the high costs of mental health services, placing all responsibility on poorly-funded state prisons.
The American Friends Service Committee quality assessment of Arizona’s private prisons found that when prisoners become ill, they are transferred to a state prison, and the Department of Corrections absorbs the cost.
Despite concerns over the efficiency and morality of private prisons, states are running out of alternatives to managing prisons during massive budget cuts. Mental health services will continue facing cuts over the next few years, and there is no guarantee that mental health services will be included in future state prison sales.