Perdue: Mental health near crisis

Published 12:15 am Wednesday, January 13, 2016

Perdue has proposed adding  a quarter to insurance premiums to fund autism early intervention

Perdue has proposed adding a quarter to insurance premiums to fund autism early intervention

Alabama Mental Health Commissioner Jim Perdue told Andalusia Rotarians Tuesday, “I have a very important speech to give.”

And then he added, “Tomorrow.”

His speech might have been a rehearsal of sorts for what he intends to tell the budget committees of the Alabama legislature today.

“What I want them to understand, is the Department of Mental Health, and the statewide delivery system of mental health, is near crisis,” he said.

The department, which has seen its funding slashed 50 percent in the last five years, once operated six in-patient facilities. Now it has three: Taylor Hardin Secure Medical Facility, Bryce Hospital, and Mary Starke Harper Geriatric Psychiatry Center.

“Taylor Hardin is a very secure mental health facility,” he said. “Residents there have committed an act, but have been judged not guilty by reason of insanity. Death row is not much different.”

The facility has 115 beds, and the most vacancies he’s ever seen is two beds.

“Within 24 hours, they were full,” he said. “Sometimes, we have as many as 50 people who have been found not guilty by reason of insanity, in jail, waiting to get to Taylor Hardin. But we don’t have a bed.”

Legally, those people should not be housed in a county jail. But the state has nowhere else to send them.

As a result, when the Department of Mental Health treats someone who has been judged not guilty by reason of insanity, once those clients have been judged less hostile, they are moved to Bryce Hospital, which has 268 beds.

Perdue said when a probate judge commits someone who is mentally ill, the person usually hasn’t committed the violent act residents of Taylor Hardin have.

“But they’re sure thought about it, or heard voices that told them to,” Perdue said. “But someone has intervened, brought then to a judge, and they’ve been treated. Some of them are so bad, they need to go to state hospital. But there is never a bed available. It is almost that bad.”

Some of those people are held in jail; others are hold in emergency room situations for days on end. Others are sent home.

“Because they did not wake up mentally ill one day,” he said. “They’ve been mentally ill for a while by the time we see them.”

Mental health has reached this impasse in part, he said, because of politics.

“Conservatives in America want less government. They want less institutional care. They want to pay less,” he said. “The other side wants less institutional care, and doesn’t think we should warehouse people.”

Because there aren’t enough community beds, judges have nowhere to send the patients.

“Formerly, we kept them there 30 to 60 days,” he said. “Now they are there for like 10. You can’t treat someone in 10 days for issues that 60 days used to cover.”

When Taylor Hardin residents are moved out to Bryce, in increases the crisis for beds.

At present, the Department of Mental Health leases the space that is Bryce Hospital from the University of Alabama. UA has agreed to build additional capacity, but Perdue needs legislative support – and funding – to lease the additional space. And he also wants to look at moving more DMH employees to Tuscaloosa. While there are approximately 900 employees of the mental health facilities there, the management is all housed in Montgomery, also in leased space, he said.

The department also serves Alabamians with intellectual and development disabilities. At present, he said, the department serves 6,000 and has an additional 3,500 waiting for services.

“We’ve got to reduce that waiting list,” Perdue said. “That’s my challenge in talking to the legislature. We can’t have people waiting for services that have nowhere to go.”

Perdue envisions programs that help those people find work. And he wants to work toward early intervention with children on the autism spectrum.

Studies show that early intervention with autistic children, between ages 2 and 6, would mean half could be mainstreamed into public education.

He’s proposed an amendment to a bill on insurance premiums. If every policy holder in the state paid an additional premium, he said, that early intervention could be funded.

“The additional premium would be 25 cents,” he said. “The insurance industry is against it, because if you do autism today, what gets added tomorrow?”

The DMH also deals with substance abuse, which Perdue called “ a shadow under all the other things I just mentioned.”

Forty percent of the people in prison are there because of mental health or substance abuse issues, he said.

“It seems to me if we treated those with mental illness or substance abuse, we might solve our prison problems, he said.

And at present, the Department of Corrections contracts with a private company in Virginia for mental health services. Perdue also wants to look at long-term solutions in which the two state agencies could work together.