Better, faster care for mental illness, substance use, is goal of new Alabama federal initiative

Alabama aims to improve mental health care and substance use treatment under a federal program aimed at helping patients faster and making a wider range of services available in one place.

The US Department of Health and Human Services announced last week that it had selected Alabama and nine other states to develop Certified Community Behavioral Health Clinics.

Alabama Department of Mental Health Commissioner Kimberly Boswell said AltaPointe Health in Mobile and WellStone in Huntsville will be the state's first two regional mental health centers to convert to the CCBHC standard of care, which integrates mental health, substance abuse and physical health care.

To qualify as a CCBHC, centers must provide at least nine essential services and meet other staffing and service time requirements. CCBHCs receive enhanced federal funding — a 90-10 federal match — intended to make improved care sustainable, according to the Department of Mental Health.

Boswell said 18 of Alabama's 19 regional mental health centers conducted self-assessments to determine their readiness to become CCBHCs, and that AltaPointe and WellStone were the most prepared. The plan is to convert several more centers during the four-year course of the federal demonstration program.

The initiative is part of an ongoing effort to improve mental health care in Alabama and follows the development of six crisis care centers in cities across the state, including AltaPointe and WellStone, mobile crisis teams and the 988 Suicide & Crisis Lifeline , collectively known as the Alabama Crisis Care System.

Boswell said the creation of the Crisis Care System, which is not yet complete, was essential to helping Alabama compete for the new round of expansion of the federal CCHBC program.

"What we lacked in our state to be competitive for this national initiative was crisis services," Boswell said. "And so a big part of why we were trying to build crisis services in our state is so that our community mental health centers can be competitive for this national model of integrated care that really addresses a lot of the issues we have with the behavioral health system.

“It improves recruitment and retention. It integrates substance use and mental health care. In fact, it does all the things that we've worked so hard to solve over the last five years."

Congress authorized the creation of CCBHCs in 2014. There are more than 500 CCBHCs nationwide.

Shalandra Rogers, CCBHC's state project director for Alabama, said the initiative marks the beginning of significant change. For example, Alabama's mental health centers are now designed to serve people within their designated geographic areas. Nationwide, there are 19 regions governed by so-called 310 boards, named after the 310 Act, the state law that authorized them.

"With CCBHCs, there will be no restrictions regardless of residency," Rogers said. “If I have a mental health crisis or if I need services, if I'm traveling somewhere, I can access that CCBHC in that area. No questions asked. No proof of residence is required. I do not have the ability to pay if I am from the poor population. If I don't have insurance, I can get those services.”

To qualify as a CCBHC and receive expanded federal funding, mental health centers must offer at least nine core programs or forms of care services - crisis; outpatient mental health and substance use services; screening, diagnosis and risk assessment; person- and family-centered treatment planning; psychiatric rehabilitation services; Community-based mental health care for veterans; primary outpatient screening and monitoring; peer and family support counselor services; and targeted case management.

CCBHCs may assign other collaborating organizations to provide some of these services, but most provide at least five.

The Department of Mental Health said the increased funding would help recruit and retain staff. This means patients should be able to receive assessments and services more quickly.

"One of the most exciting things is to really try and get to one day of service for everyone," Boswell said. “Right now, if you went to one of our community mental health centers and needed outpatient therapy, you would likely be put on a waiting list. What we know from research is that the longer you wait, the less likely you are to show up for your appointment.”

Missed appointments mean patients don't get care and it means wasted time and resources for clinics.

"That counselor is sitting there at that time that is set aside for that individual," Boswell said.

Rogers said now it can sometimes take 30 days for a patient to get an evaluation. Rogers said the goal with CCBHCs is to reduce that to 10 days or less.

"That's what we're after, where people can get the services they need and not fall into crisis," Rogers said. "And they don't have to go to an ER or they don't have to be seen by law enforcement because they have some kind of mental health need."

Rogers said AltaPointe and WellStone are preparing to begin their CCBHC tier of care on July 1. Rogers said there is a chance two of the other three centers will convert to CCBHCs in 2025.

Rogers said it is reasonable to expect that problems and uncertainties will arise during the transition to CCBHC.

"But one thing I do know is that as we continue to work with this program, as we continue to get this program across the state, that we're going to start to see better health care, better mental health care for individuals in general . So, I just ask that everybody be patient as we try to process this and get it done and go."

Other states selected for the CCBHC Medicaid demonstration program were Illinois, Indiana, Iowa, Kansas, Maine, New Hampshire, New Mexico, Rhode Island, and Vermont.

In addition to WellStone in Huntsville and AltaPointe in Mobile, Alabama's other mental health crisis centers are in Birmingham, Montgomery and Tuscaloosa, and a sixth is expected to open this summer in Dothan.

Crisis centers provide stabilization and assessment for patients who might otherwise have gone to hospital emergency rooms or wound up in jail after encounters with law enforcement.

Boswell said the long-term goal is to have 11 crisis centers, including some that will be designated for rural areas. One of the rural centers is planned for Brantley in southern Alabama.