Contrary to rumors over the past few years, the Alabama Department of Mental Health (ADMH) says it has no plans to utilize the former campus of Searcy Hospital, the state-owned psychiatric facility in Mount Vernon abandoned six years ago.
Searcy and two other state hospitals shut down in 2012 as part of a larger shift in Alabama’s approach to serving the mentally ill. Just before the doors closed for good, there were 291 employees and 193 patients at Searcy, but since then the state hasn’t found a viable use for the 118-year-old facility.
In 2016, former ADMH Commissioner Jim Perdue cited “reopening Searcy” among his top priorities, but he was removed from his post by Gov. Kay Ivey as part of a larger administrative shakeup in the last year. Another thing Purdue had focused on was helping improve mental health care services in Alabama prisons.
In 2017, a federal judge ruled the Alabama Department of Corrections’ (ADOC) mental health system to be “horrendously inadequate” as part of a lawsuit that also identified problems with overcrowding in state prisons. As a result, the state has been forced to evaluate solutions that could ultimately cost millions.
Earlier this year, ADOC began the process of “developing a master plan for long-term capital investments” to address the “myriad of issues surrounding the conditions of ADOC facilities.” While no firm estimate has come out of those efforts, a remedy proposed by former Gov. Robert Bentley sought $800 million for new prisons.
However, for more than a year now, Mobile County Health Officer Bernard Eichold has tried to sell current ADMH Commissioner Lynn Beshear and Ivey on his idea to utilize the old Searcy campus as a correctional facility for state inmates in need of mental health services.
Eichold believes the move could kill two birds with one stone.
“We already own Searcy, and there’s probably room for a couple hundred beds there,” Eichold told Lagniappe. “If a large percentage of the population in Alabama prisons have mental health, alcohol or substance abuse problems, then let’s actually treat those underlying medical problems.”
While there would no doubt be steep costs associated with bringing Searcy back to operational status, Eichold believes they would ultimately be less than the cost of building new facilities or upgrading multiple existing state prisons.
ADMH spokeswoman Malissa Valdes-Hubert said there have been discussions over the past year about finding some kind of use for “some of the newer buildings ‘outside the walls’ of the historic area of Searcy Hospital,” but reopening the entire facility isn’t something state officials are currently considering.
“While the Alabama Department of Mental Health is supportive of the effort to bring business back to Mt. Vernon, the biggest challenge is the lack of infrastructure,” Valdes-Hubert said. “To make the buildings [at Searcy] operational, millions of dollars would be needed to address infrastructure issues.”
Currently, the Searcy property is inaccessible to the public, and ADMH Land Manager Bryan Penn declined Lagniappe’s recent request to visit the site due to the “unsafe condition of the campus,” though Penn did say ADMH has recently been working to improve those conditions.
Not everyone agrees that reopening Searcy is the cure-all for the state’s mental health system, though. AltaPointe CEO Tuerk Schlesinger told Lagniappe last month he believes Alabama could get more bang for its buck by investing in its community mental health system directly or by funding the expansion of Medicaid eligibility.
“There is some need there, but Searcy was put up there for committed patients, and we don’t have a backload of committed patients in the South Alabama region with nowhere to go,” Schlesinger said. “What we need are enough acute care beds for voluntary psychiatric stabilization.”
Acute care beds are needed when stabilizing patients having temporary mental episodes, and it’s a service fewer and fewer providers have offered over time. Just last year, Mobile Infirmary announced the end of its inpatient psychiatric treatment for adults under age 65 — the age threshold to qualify for Medicare.
Schlesinger said expanding Medicaid eligibility would make providing that type of acute mental health service to Alabamians more sustainable for hospitals because it would allow them to be reimbursed through the program.
But Alabama is one of 14 states that haven’t expanded Medicaid pursuant to passage of the Affordable Care Act.
This year, the Alabama Hospital Association is making a strong effort to change that, in part to help support rural hospitals serving predominantly low-income populations without adequate health insurance. Schlesinger said those same problems make it difficult for most hospitals to offer inpatient psychiatric services, too.
“People with serious mental health problems are often disabled or unable to sustain employment with good insurance. They fall back on the public system, and our state has chosen to serve the regular Medicaid population, which is very limited,” he said. “[Hospitals] have the responsibility to take all comers, so it’s very difficult to serve acute mental health patients when a disproportionate amount have no insurance at all.”
Expanding Medicaid has been a contentious political topic in recent years, though.
An expansion would mean more assistance from the federal government, but Alabama would have to pay more for its share of the annual Medicaid costs — something the state Legislature has struggled to find funding for in recent years. Bentley once estimated the increased cost for Alabama would be $170 million over a six-year period.
Ivey, whose campaign did not respond to requests for comment on the subject, hasn’t taken a strong stance on whether she would support expanding Medicaid. Instead, she’s formed a committee to meet with members of the medical community across the state to determine the best course of action for Alabama.
Across the aisle, though, Democratic gubernatorial candidate Walt Maddox has made Medicaid expansion a cornerstone of his platform and has said it’s an issue he’d tackle on his first day in office. This week, campaign communications director Chip Hill said an expansion could improve mental health services as well.
“Medicaid is the number one payer for mental health services in the U.S., and almost a third of Medicaid recipients have a mental health or substance abuse disorder, or both,” Hill wrote via email. “Medicaid expansion will allow more mental health patients to receive treatment, including less expensive outpatient treatment.”