Montgomery---The Alabama mental health system has in many ways served as a pacesetter for other mental health systems across the country. This is particularly true with respect to the movement of individuals from state institutions to quality community-based care. Thirty years ago Alabama mental health system facilities were serving large populations in institutional care on numerous campuses across the state. With over 95% of our clients now being served in the community, there is no longer the need for numerous and expensive institutional campuses. For example, in the early 70’s Bryce Hospital in Tuscaloosa had over 5,000 patients. Today there are fewer than 350 patients at Bryce. Also, in the early 70’s there were over 2,000 individuals with mental retardation at Partlow Developmental Center in Tuscaloosa. Today there are less than 200 people served at Partlow. With improvements in medications, treatment and care, persons with mental disabilities have been living peaceful and productive lives in Alabama communities for many years. In fact, the Alabama Department of Mental Health and Mental Retardation serves over 100,000 Alabamians with mental illness or mental retardation a year through its community contract providers and approximately 5,000 consumers a year through state-operated facilities, with over half of the DMH/MR budget devoted to the maintenance and operation of these facilities.

Commissioner Kathy Sawyer has, therefore, recommended to Governor Bob Riley a plan which includes the consolidation and closure of seven of the state’s fourteen facilities. The key elements of her plan were highlighted in a letter sent Friday, April 18, 2003 to families of consumers, employees, Legislators, and other stakeholders. In her letter, the Commissioner emphasized that no services will be eliminated for consumers. She also stated that employees will have opportunities for assistance and transfers. Alternative uses of facilities will be developed in collaboration with the Governor, Legislators and community leaders to enhance local economies.

The key points of the proposed plan are:

1. There are three state-operated nursing homes in Alabama that provide services to elderly citizens with mental illness. These state facilities were established many years ago to fill a void in services. At that time, few private nursing homes were equipped to serve elderly people who also have a mental illness. Today that is not the case. More and more private nursing homes are able to serve persons whose needs are associated with age and mental illness. Because of this fact the census in state nursing homes has fallen from 496 in 1999 to 282 today. Once again, we have large facilities with fewer patient populations to serve. The plan calls for consolidating services from three facilities to one centrally-located facility. The plan recommends that consumers from the S. D. Allen facility in Northport be relocated to a designated unit at the Harper Geriatric Center on the Bryce campus. The plan also recommends closing the Claudette Box Nursing Home in Mt. Vernon and relocating patients to community nursing homes or to the Alice Kidd Nursing Home on the Bryce campus Tuscaloosa.

2. Accompanying the plan is a proposed increase in acute care (short-term) beds to accommodate admissions from the probate courts. Although long-term beds have steadily been reduced at state facilities there has been an increasing demand on short-term bed capacities through a rise in commitments from the probate courts. The plan will raise the number of acute (short-term) care beds by adding 20 new acute beds at Bryce Hospital (Tuscaloosa) and 10 new acute beds at Searcy Hospital (Mt. Vernon).

3. Extended care (long-term) beds are used to provide services to consumers who are not ready to return to the community. The census of long-term beds in state facilities has dropped from 669 in 1999 to 367 today. Due to the lessening demand for long-term bed services, the plan recommends closing the Thomasville Mental Health Rehabilitation Center and relocating the 72 long-term beds at Thomasville to the space now occupied by the Box Nursing Home on the campus of Searcy Hospital in Mt. Vernon. The cost of per patient care per year at Thomasville has risen from $58,000 per year in 1995 to over $100,000 per patient per year in 2003. The proposed move saves taxpayers money without reducing services to these consumers.

4. The main goal in providing services for persons with mental retardation is to help them achieve optimal independence and reach their maximum potential as an individual. Consequently, persons with mental retardation experience a sense of achievement and individuality by living in community-based care rather than in an institutional setting. There are four state operated developmental centers, L. B. Wallace (Decatur), W. D. Partlow (Tuscaloosa), A. P. Brewer-Bayside (Daphne), and J. S. Tarwater (Wetumpka), serving people with mental retardation. The plan includes recommendations for the consolidation of services for residents of the Wallace, Brewer, and Tarwater Centers to the campus of Partlow. Families of consumers may choose to place their loved one in community-based care closer to home, or to bring them home and receive round-the-clock in-home services or to transfer their relative to Partlow. The department will arrange transportation assistance for consumers and families to visit each other.

As people have moved from state facilities to community-based care the cost of care per person in state facilities has skyrocketed. In 1995 the L. B. Wallace Developmental Center in Decatur had a budget of 18,069,106 and had a census of 244 individuals. In 2003 the Wallace Center’s budget is $17,077,737 with a census of 68 individuals. The A. P. Brewer Center in Daphne had a budget of $14,289,150 in 1995, serving a census of 188 individuals. In 2003 Brewer-Bayside had a budget of $11,808,518, serving a census of 60 individuals. The J. S. Tarwater Center in Wetumpka had a budget of $11,281,245 in 1995, serving 130 individuals. In 2003 Tarwater’s budget is $11,802,509 with a census of 68 individuals.

SUMMARY:

If implemented, the Commissioner’s plan is expected to save taxpayers over 40 million dollars per year without cutting services to mental health consumers. The Commissioner will hold a series of meetings in May with families of consumers, employees, and Legislators. She will listen to their concerns and give them the highest consideration before any implementation of the plan. The nursing home consolidation phase of the plan is expected to occur in FY 2003. Subsequent closings and consolidations are scheduled for implementation in FY 2004.