Alabama is Ranked 50th in Mental Health

By Marti Webb Slay

It’s no secret that Alabama is facing a shortage of resources and beds for mental health patients. The repercussions of that shortage are being felt in a variety of ways.

“The lack of state beds for committed patients is putting a lot of pressure on mental health facilities,” said Amy Gillott, BSN, Service Line Director at Decatur Morgan West Behavioral Medical Center. “On top of that, most psychiatrists are unwilling to do inpatient care, causing us to resort to telehealth which may not be as effective. This lack of providers is causing a lot of outpatient facilities opt out of the volume. It’s a multi-faceted issue, but when the state decreased its beds in 2015, it has had a ripple effect.

“We seek placement for patients using tele-screening in seven locations in the Huntsville system. We look for placement as far as Dothan, southeast Alabama, and Tennessee. We have a list we go down, and it’s amazing how many places are on diversion because their beds are full. Work on bed placement is ongoing.”

There’s also a shortage of providers to provide post-hospitalization care. “We try to make sure patients have follow-up care once they leave the hospital,” said Cayley Edmonds, MS, LPC-S, Clinical Services Manager at Decatur Morgan West Behavioral Medical Center. “The first 30 days after discharge are a precarious time, especially for someone experiencing suicidal issues. We work hard to ensure they have follow-up care, but one of the issues is that there aren’t enough outpatient providers to get people in to see someone in a reasonable amount of time. Psychiatrists are typically scheduling out a month or two, sometimes more. Most of our patients are on medication when they leave here, so they need someone to follow up with that. Finding psychiatrists and counselors who are accepting new patients is difficult, and this is especially important for patients coming out of the hospital because there’s more acuity there.

“We have to get very creative, but most of the time we are able to find something. They may have to go to their family doctor until they can get in with a psychiatrist. If a therapist doesn’t have an opening, we get them on a waiting list. But there’s only so much we can do. Once they leave the hospital, they may decide for a variety of reasons not to follow up, and they end up back here.”

Medicaid patients have even fewer resources to draw on. “They don’t get appropriate outpatient care, which makes the recidivism rate high,” Gillott said.

“There are almost no psychiatrists in private practice that accept Medicaid, so those patients have to go to a community mental health center,” Edmonds said. “It’s been difficult to get appointments with some of those centers. With staffing issues, it’s hard to get them to even answer the phone.

“Most children have insurance, even if it’s Medicaid. But a lot of adults come through here without any insurance, and that’s even tougher. They need to see somebody, and that is very expensive. Most of the uninsured patients don’t have an income.”

COVID has also been a factor. “Mental health has really gone by the wayside during COVID. We call the mental health crisis the fourth wave of the pandemic,” Gillott said. “So many people went without medicine and treatment for so long.”

“There’s such a great need right now, post-pandemic,” Edmonds said. “I see children in my private practice, and most of the issues I’ve seen have been triggered by the anxiety of the pandemic. Testing is an additional problems for children as a result of the provider shortage. Psychologists who do testing for ADHD, learning disabilities, or other kinds of mental disorders, have a six to 12 month wait.”

There are no easy solutions. “Alabama is so far behind, to catch us up to where we need to be is going to take a lot of work and plenty of advocates,” Gillott said. “We aren’t seeing much of that. There’s such a stigma to advocating for mental health. We need someone who understands it and speaks to it in such a way to get this issue the attention it needs. We just aren’t there yet.”