Collaborative Mental Health Policy is Best for Alabama

By Amy Hinton

For many years, mental health advocates have complained that mental health policy is made in a vacuum. The tendency is to treat mental health as if it were an island, separate and distinct from any of the other legitimate functions of government. It is not.

Several state agencies, including the Department of Mental Health and Mental Retardation, the Department of Corrections and the Department of Youth Services (DYS), recently participated in the first phase of a multi-year collaborative strategic planning grant from the U.S. Department of Justice. It gave Alabama the opportunity to explore ways to reduce the number of adults and juveniles with mental health and/or substance abuse disorders that come into contact with law enforcement and the state criminal and juvenile justice systems. The goal is to not only reduce the numbers, but also to improve early identification efforts that would appropriately route persons with mental illness into the correct social service delivery system.

Many state agencies are being forced to deal with mental health issues in much the same way as an entertainer tries to keep multiple plates spinning on sticks during a vaudeville show. This is neither an effective nor efficient use of Alabama’s limited policy and planning resources. The concept of collaborative policymaking regarding mental health issues is relatively new and unfamiliar to most state agency leaders who may feel the issue has little relevance to their particular service area. Nothing could be further from reality. Mental health is an important policy issue that touches every major service area in state government.

Every day, in jails and prisons across Alabama, law enforcement officers find themselves responsible for individuals with serious mental illnesses and/or substance abuse and addiction. Lacking qualified medical staff and access to appropriate medications for inmates, correctional facilities are ill-equipped to serve as de facto mental health treatment centers. We should look to Alabama’s existing mental health and drug courts, which have evidenced promising results in diverting offenders with mental illness and/or substance abuse disorders into appropriate services.

Gov. Bob Riley recently invited the Annie E. Casey Foundation to conduct a comprehensive assessment of the state juvenile justice system. It was discovered that more juvenile offenders in Alabama are committed to DYS for property crimes than for violent offenses. Numerous juvenile judges acknowledged that

these commitments are usually inappropriate, but community-based adolescent substance abuse treatment resources are lacking statewide. Many juvenile offenders are removed from their families and committed to DYS to access substance abuse treatment resources unavailable in their communities.

The lack of training and professional development for public school personnel regarding early identification of mental health and substance abuse disorders ties the hands of the individuals who could be the most effective in early identification of juveniles with mental health needs. County and municipal governing bodies and State Department of Education officials need to be brought to the table to discuss how to integrate mental health into their policymaking activities.

Three problems exist that, if rectified now, could generate significant cost savings for Alabama.

First, serious deficiencies exist in data collection that would help state agencies identify individuals with mental health needs entering or being released from state correctional facilities and community corrections programs.

Second, too many individuals are incarcerated because the mental health and/or substance abuse service delivery systems in their communities are inadequate or nonexistent. It costs more to institutionalize someone than to provide community based services.

Third, the money that was previously spent on institutional mental health services did not follow patients into the community during the wave of psychiatric hospital closings that occurred nationwide beginning in the 1970s and 1980s. This has resulted in inadequate budgets for community-based services that are being accessed by increasing numbers of people each year.

The importance of adequately funding community-based mental health and substance abuse treatment services cannot be understated. Alabama should encourage these efforts between state agencies who deal with mental health issues every day.
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Hinton is an advocate and public policy consultant specializing in mental health policy and former mental health services provider, who most recently served as project coordinator for Phase One of the Justice and Mental Health Collaboration Project at the Alabama Department of Mental Health and Mental Retardation.
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Copyright (C) 2008 by the Alabama Forum. 4/08