Alabama lawmakers and mental health officials did not push a bill in the 2024 legislative session that would have created a dedicated funding source for crisis care, at least in part because of the potential funding for it that would come from a proposed gambling expansion in the state.
The lottery and casino gaming bill, which died on the final day of the session, would have generated revenue for General Fund priorities, including mental health.The Alabama Department of Mental Health has received some budget increases in various other spending bills, but not enough to fully fund needed services, including a national 988 hotline for mental health emergencies. The agency is currently reorganizing for 2025.
“We’ll come back next year and do it again. Part of the game in the Montgomery Legislature is getting funding for projects,” Republican Sen. Garlan Gudger of Cullman said Wednesday.
Last year, Gudger and Rep. Rex Reynolds (R-Hazel Greene) introduced a bill that would have provided about $69 million a year through monthly phone charges. Opponents called it a tax on phone bills, and telecommunications industry groups opposed it. This year, Garlan said he hoped the lottery bill would be the solution. In addition, the state’s settlement with opioid drug manufacturers provided some new lump-sum funding. Lawmakers earmarked $3 million of that to expand the state’s 988 capacity. Gudger did not introduce a mental health bill this year, but said he would next year.
“This is one of those issues that concerns everyone across the state of Alabama and we desperately need it. Whether it’s drug prevention, substance abuse prevention, suicide prevention, you name it,” Gudger said. The easy-to-remember number, 988, saves lives, he said.
“I absolutely I promise you I will do everything in my power to ensure that there is adequate funding,” Gudger said.
Nationwide, people experiencing a mental health crisis have been able to call or text 988 since July 2022. The federal law that created the hotline also allows states to charge fees for the provision of 988 and crisis services.
Kimberly Boswell, director of the Alabama Emergency Medicine Center, told the Alabama Daily News that 80,000 Alabamians have called or texted 988 in less than two years. The goal is for trained staff at three centers across Alabama to respond to at least 90 percent of calls. In May, 75 percent of 2,340 calls were answered across the state. That’s up from 57 percent, or 1,361, a year ago, according to ADMH data.
Calls answered in the state get better, potentially life-saving information about local resources, Boswell said.
“Ideally, if someone calls in crisis and they need to go to a crisis center, or we need to send out a mobile crisis team or anything that’s part of a crisis care system, Really “Access to these crisis services depends on the call being answered within the state,” she said. “If you get through to a national line, you’ll get more general information.”
Last year’s 988 bill also helped fund four additional crisis centers in the state. These newer crisis centers provide stabilization and short-term care for people struggling with mental illness, followed by referrals for longer-term treatment. One goal is to keep emergency patients out of jails or hospital emergency rooms. There are now five centers, with a sixth scheduled to open in Dothan later this summer.
“We think we need somewhere between 10 and 11,” Boswell said.
“… What we’ll do next year will probably be to ask for a general fund appropriation for a crisis center, because we’ve tried a lot of other things.”
Reynolds, chairman of the House General Fund Appropriations Committee, said Thursday that the crisis management center is having a huge impact.
“When you look at these crisis care systems, I think we’ve really made a difference in the state of Alabama,” he said.
In the 2025 budget, ADMH is expected to have about $238 million, up $24 million from this fiscal year.
Most of the money will go to staffing the Taylor Hardin Secure Medical Facility in Tuscaloosa, Boswell said. All three of the state’s psychiatric hospitals have struggled with staffing shortages in recent years, with Taylor Hardin’s facility the most severe. Meanwhile, the hospital for criminally incarcerated people is expanding and needs more staff.
Taylor Hardin has been using contract staff, but officials are phasing out the more expensive option.
“Recruiting is improving, but there are a few more challenges at Taylor Hardin,” Boswell said.
Funding beyond 2025 will depend on general fund revenue sources, Reynolds said.
“We’re still optimistic. We’re still seeing some growth across all of the major contributors to the general fund, but we don’t know how long that will last,” Reynolds said. “We know that if interest rates go down, that’s going to have a big impact.”
ADN reported last week that general fund revenues for the current fiscal year increased by nearly 9%..
Reynolds has not ruled out the possibility of introducing 988-specific legislation in 2025.
“We see other states going down that path as a funding source and we may have to do the same,” he said. “We don’t want to put that burden on our citizens, but we know the impact mental health is having in our state.”
Gudger said the bill he introduces could be different from last year’s bill, with different funding streams, to avoid fights with telecommunications companies.
“I expect there will be negotiations with other groups,” Gudger said.
Meanwhile, Republican Sen. Gregg Albritton of Atmore plans to question ADMH and other general fund agencies about spending and services provided during budget hearings scheduled for this summer.
He noted that lawmakers recently significantly increased the general fund budget for mental health from about $143 million before the recession.
“What does the state get for that investment?” he said.
Meanwhile, the Department of Health announced last week that the state had been selected for the Federally Qualified Community Behavioral Health Clinic Medicaid Demonstration Program. The program provides sustainable funding to increase access to mental health and substance use treatment through certified behavioral health clinics.
“Our department has a bold vision,” Boswell said in a written statement, “that one day every resident in every county in Alabama will have access to 24/7 mental health and substance use treatment so they can live fulfilling lives in their communities.”
“Receiving this grant and the opportunity to expand our work on the CCBHC model is a major step toward that vision.”
The ADMH said in a press release that the accredited clinics provide comprehensive mental health and substance use disorder services and ensure access to treatment for all those seeking it, regardless of their ability to pay. The initiative builds on the department’s crisis care system.
