After gambling bill failure, state leaders to look again at long-term mental health funding

Alabama lawmakers and mental health officials didn’t push in the 2024 legislative session a bill creating a dedicated funding stream for crisis care at least in part because proposed gambling expansions in the state could have been a source.

The lottery and casino gambling bill that died in the final days of the session would have generated revenue for more General Fund priorities, including mental health. The Alabama Department of Mental Health did get some funding increases in other various spending bills. But not enough to fully fund needed services, including a national 988 hotline for mental health emergencies. Officials are now regrouping for 2025.

“We’ll come back next year and we’ll start over and that’s part of the game in Montgomery, in the State House, is trying to find funding for projects,” Sen. Garlan Gudger, R-Cullman, said Wednesday. 

Last year, Gudger and Rep. Rex Reynolds, R-Hazel Green, sponsored a bill that would have provided about $69 million per year through a monthly fee on phone lines. Opponents called it a tax on phone bills and telecoms groups lobbied against it. This year, Garlan said he was hopeful the lottery legislation would have been the answer. Additionally, some new one-time money was available through the state’s settlement with opioid drug manufacturers. Lawmakers appropriated $3 million of that to build 988 capacity in the state. Gudger didn’t bring a mental health bill this year but said he will next year.

“This is one of the things that affects everybody throughout the whole state of Alabama though, and we desperately need that. Whether it’s drug prevention or substance abuse or suicide prevention,” Gudger said. The easy-to-remember 988 number saves lives, he said.

“I’m definitely committed to doing everything I can to make sure it gets fully funded,” Gudger said.

Nationwide, people in mental health crisis have been able to call or text 988 since July 2022. The federal act that created the hotline also authorizes states to assess a fee for providing 988 and crisis services.

In less than two years, 80,000 Alabamians have dialed or texted 988, ADMH Commissioner Kimberly Boswell told Alabama Daily News. The goal is to have at least 90% of those contacts answered by trained staff at three centers in Alabama. In May, 75% of calls, 2,340, were answered in state. That’s up from 57%, 1,361 calls, a year prior, according to ADMH data.

Calls answered in the state get better, potentially life-saving information about local resources, Boswell said.

“Ideally, if someone is calling in a crisis, and they need to get to a crisis center, or they need a mobile crisis team deployed, or any of the things that are part of that crisis system of care, the only way to really get access to those crisis services is if that call is answered in state,” she said. “If it goes to the national line, they’re gonna get more generic information.”

Last year’s 988 bill would have also helped fund four additional crisis centers around the state. Still new in recent years, the crisis centers offer stabilization and short-term care, and then referrals to long-term treatment, to those in a mental health crisis. One goal is to keep those with acute needs out of prisons and hospital emergency rooms. Currently, there are five and a sixth will open in Dothan later this summer.

“We feel like somewhere between 10 and 11 is what we need,” Boswell said. 

“…What we will likely do next year is ask for a General Fund appropriation for crisis centers, just because we’ve tried a lot of other things.”

Reynolds is the chairman of the House’s General Fund budget committee. He said Thursday the crisis centers are having a tremendous impact. 

“If you look at those crisis systems of care, I think we’ve truly made a difference in Alabama,” he said.

In the fiscal 2025 budget, ADMH has a $24 million increase over the current year to nearly $238 million. 

A large portion of that is for staffing at the Taylor Hardin Secure Medical Facility in Tuscaloosa, Boswell said. All three of the state’s mental health hospitals have had staffing shortages in recent years, but Taylor Hardin’s has been the worst. Meanwhile, that hospital for the criminally committed is expanding and needs even more personnel.

Taylor Hardin has been using contracted staff, but officials are trying to phase that more expensive option out.

“Recruitment is improving, but it’s just a little bit more of a challenge at Taylor Hardin,” Boswell said.

As for funding beyond 2025, Reynolds said that will depend on revenue streams in the General Fund.

“We’re still positive, the General Fund is still seeing some growth in all of our major contributors to the General Fund, but we don’t know how much longer that will last,” Reynolds said. “We know there will be a significant impact when interest rates go down.”

General Fund revenues are up nearly 9% this fiscal year, ADN reported last week.

Reynolds is not ruling out a 988-specific bill in 2025.

“You’re seeing other states go that route as a funding source and we may have to do the same thing,” he said. “We don’t want to put that burden on citizens, but you see the impact mental health is having on our state.”

Gudger said a bill he brings may be different than last year’s with a different funding stream to avoid the fight with telecommunication companies. 

“I think there’s going to be some negotiations with some other entities,” Gudger said.

Meanwhile, Sen. Greg Albritton, R-Atmore, plans to question ADMH and other General Fund agencies this summer in planned budget hearings about their spending and services provided.

He recently pointed out that lawmakers have significantly increased mental health’s General Fund appropriations from pre-recession levels of nearly $143 million.

“What is the state getting for that investment?” he said.

Meanwhile, the department last week announced the state’s selection for the federal Certified 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 set a bold vision,” Boswell said in a written statement. “One day, every Alabamian in all counties will have access to 24/7 mental health and substance use treatment and live a full life in the community.

“Receiving this grant and the opportunity to expand our work on the CCBHC Model is a major step toward this vision.”

The certified clinics offer a comprehensive range of mental health and substance use disorder services, ensuring accessibility for all individuals seeking care, regardless of their ability to pay, ADMH said in the press release. This initiative builds on the department’s crisis care system.