America is in the grips of a mental health disaster. As suicide rates continue to rise, states are failing to keep up with the demand for mental health services.

More than 43 million adults in the United States have a mental health condition, with nearly half having also struggling with substance abuse and 9.6 million experiencing suicidal thoughts, according to the 2018 State of Mental Health Report by Mental Health America.

More than half of adults with a mental illness, 56 percent, did not receive treatment. More than 76 percent of youth with severe depression – 1.7 million kids – did not get the treatment they need. Of people screened ages 11-17, 50 percent said they often think about suicide or self-harm throughout the week.

More so than other states, Alabama is feeling the effects of the mental health care shortage with only one mental health professional per 1,260 people. The report ranks Alabama 48^th in the U.S. when it comes to access to mental health care.

Most of the state’s long-term psychiatric hospitals are now closed. The only hospital for adults is Bryce Hospital in Tuscaloosa and it has 268 beds.

In Shelby County, 40 acute care beds, serving individuals who display significant signs of mental illness and require immediate hospitalization for stabilization, are available at Shelby Baptist Medical Center – 20 for adults and 20 for geriatric patients.

According to Allison Boyd, Shelby County probate judge and former probate court mental health programs coordinator, it’s a struggle to find an acute care bed for someone in need as they are almost always full.

Nowhere to go

Tracy Billingsley, administrative assistant to the Shelby County probate judge, said there wasn’t a sudden increase in the number of mental health cases the court was handling after the closure of state hospitals – it was gradual. Over time, the wait time to find a bed for someone began to increase. Now, a two- to three-day wait is normal for the average person. Two- to three-week waits are becoming the norm for someone incarcerated.

“Sometimes a person’s symptoms aren’t visible prior to going to jail,” she said. “Often times when they go to jail and get off any drugs they might have been using to self-medicate, then symptoms start to surface.”

Sometimes those who need to be hospitalized end up in jail because there’s nowhere else to put them.

If a bed is unavailable at Shelby Baptist, Boyd searches for one at St. Vincent’s East, Grandview Medical Center or Brookwood Baptist Medical Center. Most of the time those beds are full as well.

“In some cases, they are being disorderly and won’t stop tearing up things,” said Lt. Cody Sumners, a 20-year Shelby County Sheriff’s Office employee and current assistant division commander for the county jail. “They need to go to the hospital, but there are no beds available so they end up going to jail for a petty charge like disorderly conduct.”

Two mental health counselors from Chilton/Shelby Mental Health Center now report to the Shelby County Jail five days a week and they are on-call on the weekends. They provide assessment and counseling services and help find hospital placements among other things.

“It’s basically unheard of in this state to have that type of help and access,” Sumners said.

In dire situations, SCSO deputies will drive three hours roundtrip to take someone to a hospital in Walker County. In addition to taking them to the hospital, deputies have to transport the person to and from court hearings and any other legal matters they need to be present for. Boyd and Billingsley have even called Montgomery to see if a bed was available, but luckily deputies have never had to drive someone there.

“It’s a huge responsibility and use of resources that can be a burden, but they do it because they want to help people and do the right thing,” Boyd said.

Sometimes Boyd said residents come to her office looking for help for family members, but if the person doesn’t meet the criteria to be involuntarily committed there’s not much she can do.

“We’ve had to send people back home and pray nothing happens until a bed opens, and then it falls back on our police officers because who are you going to call if something happens?” she said. “That’s why training is so important for law enforcement.”

Sumners said it would be helpful if law enforcement had a way to refer people to help or have an officer designated to follow up on issues involving someone who they suspect of having a mental illness.

“In a 12-hour shift, we may have to go to a guy’s house multiple times because he thinks someone is trying to break into his house,” Sumners said. “It would be best to catch these issues on the front end before it becomes a dangerous situation.”

In order for an involuntarily commitment order to be issued, which expires after 150 days, a person has to be a danger to themselves or others, have a serious mental illness such as bipolar disorder, major depression or schizophrenia, be 19 years or older and live in Shelby County. Once someone had been committed, they have to comply with their doctor’s treatment plan and the Probate Court makes sure they’re following the rules.

Boyd said there tends to be a revolving door of commitments. Once the order expires, they might stop taking their medication because they feel better and believe they no longer need it or they don’t like the side effects of the medicine, such as weight gain.

“They start to spiral again and end up back in the same situation,” Boyd said.

Involuntary commitments are funneled through Chilton/Shelby. The facility completes an assessment and makes a recommendation to the judge about a treatment plan. If someone is committed, Chilton/Shelby works with the courts to determine the best treatment plan, which often includes substance abuse treatment.

Educating law enforcement

The SCSO’s first mental health training session for law enforcement officers took place in 2016 in collaboration with the National Alliance on Mental Illness and Auburn University in Montgomery. The effort was spearheaded by Sumners.

Sumners said the biggest impact he can make is by educating law enforcement officers, who are often the ones responding to incidents involving someone with a mental illness.

“The first class was great, but we needed it to be more Shelby County specific,” Sumners said.

Sumners worked with Boyd to develop Crisis Response Team Training, which educates law enforcement officers about mental illnesses for free. The first weeklong CRT Training program was held in July 2017. Participants received info about how to connect those in need with mental health services in the county, learned about the different types of mental illnesses, how to be an active listener and how to identify someone who might have a mental illness. The 2018 CRT Training took it a step further by facilitating a roundtable discussion with residents in Chilton/Shelby’s group home and law enforcement officers.

SCSO deputies and corrections officers, Alabaster Police Department, Pelham and Hoover police department negotiators and the North Shelby Fire Department have all participated in an eight-hour training course.

“I hope this training helps them learn empathy,” Sumners said. “Mental illness is real, it’s a sickness of the brain. Sometimes people might think they’re faking or it’s not real, but this population deserves to be treated with the same care as someone having a heart attack.”

Richard Fallin, executive director of the Chilton/Shelby Mental Health Center, said the negative stigmas surrounding mental health play a role in why people don’t seek help.

“Adults may see themselves as a failure and kids don’t want to be seen as different or get bullied,” he said. “We’re looking at programs right now aimed at educating the public and decreasing stigma. Education is the key.”

In the community, mental health fairs are gaining popularity. The goal isn’t only to provide those in need with resources, but to break down barriers and educate the public. Right now, Chilton/Shelby offers four classes each in both counties at different times throughout the year aimed at education.

The city of Helena hosted a Community Mental Health Fair in March, the Shelby County chapter of the National Alliance on Mental Illness (NAMI) hosts an annual mental health fair in May and resources were available at a health fair held at Alabaster City Hall in August. At a meeting on Sept. 24, the Shelby County Commission proclaimed Oct. 7-13 as Mental Illness Awareness Week in the county.

Although there are no immediate solutions to problems, Boyd said the county is in the best position it’s ever been in because key entities are working together to address issues and they all have good working relationships.

A generation at risk

“Schools are a reflection of society, so of course we’re dealing with it too,” said Pelham City Schools Superintendent Dr. Scott Coefield.

The district has a contract with Chilton/Shelby that provides two mental health workers for the system, which is up from the one worker the district had last school year. Coefield said the district has a balance of social workers and those who can provide therapy sessions to students. The district is also spending more time training staff on school safety, suicide prevention and situational awareness.

“School safety includes the mental health of our students and everyone – teachers, administrators, school counselors, school nurses and school resource officers – play a role,” Coefield said.

In a five-year period, rates of severe youth depression have increased from 5.9 percent to 8.2 percent. And according to statistics from NAMI, 20 percent of youth ages 13-18 live with a mental health condition.

“We all have to ask the question, ‘Why is this happening?’” Coefield said. “Is it what we’re eating? Is it linked to social media? It’s an issue that we have to come together to address as a community. It’s something that in my 30 years of experience, there’s more of in today’s schools than there were years ago.”

 In Alabaster City Schools during the 2017-18 school year, almost 1,700 PRIDE Surveys were administered to students in sixth through ninth grades to measure their perception social, emotional and bullying concerns with their school. The results showed that the majority of students feel safe at school and are not experiencing a lot of bullying. The system is also implementing a new suicide prevention program this school year.

According to Fallin, several factors play a role. Increasing amounts of time spent in front of screens rather than with other people results in lack of connections or a sense of community; an increase in terrorism post 9/11, school shootings and economic turmoil have contributed to stressors for many; video games and electronics have become increasingly addicting and have contributed to increased social isolation, poor school performance and impaired sleep patterns; increased drug use among youth; and hyper connectivity with social media has transcended the home environment, which was previously a safe zone.

State funding for mental health dwindles

According to a 2011 report by NAMI, Alabama’s total general fund mental health budget was cut 36 percent from fiscal year 2009 to fiscal year 2012, the second-largest reduction by any state.

Since then, the Department of Mental Health has received level funding, which does not account for inflation in medical costs. Fallin said state funding for Chilton/Shelby has been flat for several years.

“Costs are rising so we’re trying to find grants that align with our mission and services, and we’re trying to think of possible fundraisers, cost-saving measures and increasing efficiency,” Fallin said.

Considering funding, Fallin said the facility will not be adding much-needed beds to its group home program. The organization operates nine group homes in Chilton and Shelby counties. Patients live in these homes until their illness is under control. When a patient is ready to leave the group home, Chilton/Shelby helps them secure permanent housing and still provides in-home services.

Most of the state’s long-term psychiatric hospitals are now closed. The state has closed three psychiatric hospitals – Greil Memorial Psychiatric Hospital in Montgomery, Searcy Hospital near Mobile and North Alabama Regional Hospital in Decatur.

Fallin said he does believe in the deinstitutionalization of the mentally ill because it’s not a good environment for them to be in. However, there does need to be adequate funding to successfully manage seriously mentally ill individuals through acute care beds and groups homes.

Three state-run hospitals remain open. In addition to Bryce Hospital, the Mary Starke Harper Geriatric Psychiatry Center in Tuscaloosa provides inpatient psychiatric services for citizens aged 65 and older and has 96 beds. The Taylor Hardin Secure Medical Facility, also in Tuscaloosa, is not open to the public. It serves the criminally mentally ill and has 140 beds.