Alabama's crisis response needs some improvements to expand its coverage and effectiveness, according to a new report.

The mental health policy group Inseparable looked at 988 crisis lifeline responses by state and suggested ways to enhance them.

In Alabama, it said the 988 call centers have received more than 54,000 calls, just since March but the state's call capacity is only at 75%, below the target of 90%.

Kim Boswell, commissioner of the Alabama Department of Mental Health, said efforts are underway to boost the resource.

"The good news is that the Opioid Commission appropriated $3 million to help us with the call center capacity," Boswell pointed out. "I feel like with the $3 million, we will get to our 90% goal of calls being answered in-state."

She noted the crisis system has improved access to care since its launch. It has diverted more than 1,600 people to mental health resources rather than sending them to jail and diverted 6,700 from emergency departments. It's also helped over 9400 people receive mental health evaluations at crisis centers.

The report also called attention to the state's need to increase the number of mobile crisis response teams and crisis center beds. Boswell acknowledged the legislature has supported the expansion of mobile teams. There are 14 teams to address both adult and child crises, with plans for further expansion.

"We would love to have a mobile crisis team in every county, or at least coverage for every county, especially some of our more rural counties," Boswell emphasized. "Because as you know, a big barrier to care is transportation."

She added more funding has also been allocated to increase residential substance use treatment beds, which had not been expanded since the 1970s. And efforts are ongoing to ensure access to care for both Medicaid-eligible people and those without insurance.

Angela Kimball, chief advocacy officer for Inseparable, said to enhance services and extend its reach across the state, the report asks state legislatures to focus on sustainable funding sources and accountability measures for the crisis response system.

"By having these accountability pieces, this allows legislators to oversee the system over the long haul," Kimball stressed. "And to set up the structures for continuous learning, continuous system improvement."

She explained data collection, annual reporting and coordination between the 988 and 911 systems are ways states can make them more accountable.

A U.S. Department of Justice investigation has found Kentucky is failing to provide access to community-based mental health services for people who need them, and instead relies too heavily on psychiatric hospitals.

The report says the state is potentially in violation of the Americans with Disabilities Act, or ADA.

Licensed Psychologist Sheila Shuster, who is part of the Advocacy Action Network, said years of budget cuts have reduced or eliminated the city's crisis centers - such as the Living Room, which opened its doors in 2018 and was shut down within a year due to lack of funding.

"Three to four hundred people a month coming in and using the services, and getting referrals," said Shuster. "And then boom, it's gone. So, that was May of 2019, and we don't have anything like it back in place."

The University of Louisville Hospital provides emergency psychiatric treatment to more than 2,200 adults with serious mental illness each year.

In a separate investigation last year, the Justice Department concluded the city and the Louisville Metro Police Department violated the ADA by subjecting people with mental illness to an unnecessary police response.

While the new report raises awareness about the needs of people living with mental illness, Shuster said it doesn't capture the full picture.

She cited recent changes the city has made, such its 911 call diversion program for mental health-related incidents, as well as families' view of the role of hospitalization.

"By and large, what I hear from the family members is not that their loved ones are being kept too long in the hospital, but that they're not being kept long enough," said Shuster, "which I think is what is leading to the revolving door."

Marcie Timmerman, executive director at Mental Health America of Kentucky, said the focus should be on early intervention and treatment, so folks don't end up being involved with the police.

"We would love to have more providers available," said Timmerman. "I'm not sure that pinpointing our psychiatric hospitals is really helpful."

She added that a mobile crisis response system, and Medicaid-funded housing and support programs, could help reduce the number of people who continue to cycle through hospitalization and the criminal legal system.





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Mental health experts have released a checklist for parents of students headed back to school in Montana.

Research shows kids who need services are often go without and substance abuse and mental health experts say half of students who are clinically depressed are not getting the mental health care they need.

Caitlin Hochul, vice president of public policy for the mental health advocacy organization Inseparable, said it is important services are available to students as they return to school.

"They help improve access to care and are really one of the most effective tools we have to help
improve children's mental health well-being," Hochul explained. "We are reaching kids where they spend most of their time, and that is in schools. "

The U.S. Department of Education said young people who get school-based services are six times more likely to complete treatment than those who get their services in community settings. A program at Montana State University has shown success in reducing the teen suicide rate by increasing mental health literacy among young students.

Hochul pointed out research showed increasing mental health literacy decreases symptoms of depression, and noted there are several steps to achieving the goal.

"One is making sure that kids understand what brain health is, what mental health is, similar to physical health education," Hochul outlined. "Then there's also training up staff and teachers, too, so they're understanding warning signs and can help with suicide prevention and substance use disorder prevention."

Hochul added regular mental health check-ins with kids, even if they are just informal, can help identify students who may need support.

Between 2016 and 2023, more than 14,000 Missourians died from drug overdoses, making it the leading cause of death for adults aged 18-44 in the state.

Many drug-abuse prevention organizations across Missouri concur syringe service programs reduce the devastating effect abuse has on the community by providing clean, sterile needles to people who inject drugs, in exchange for used ones.

Marietta Hagan, substance abuse initiative project coordinator for CoxHealth, has worked in substance abuse prevention for eight years, primarily in Stone and Taney counties. She is a strong advocate for the syringe programs in Missouri and talked about the roadblock organizations such as hers face.

"Syringe access programs are not allowed and that is because Missouri drug-paraphernalia laws include sterile syringes as drug paraphernalia," Hagan explained. "Organizations are not allowed to hand them out to people and people who use drugs are not allowed to have them on them."

Studies showed the programs can decrease the incidence of hepatitis C and HIV infections by up to 50% among those who participate.

Research also found syringe service programs are economically beneficial, saving more than $75 million in lifetime HIV treatment costs with an annual investment of just $10 million. Hagan pointed out beyond providing sterile syringes, the programs offer vital resources, including safe drug use information and connections to treatment services for people who need help.

"What they found in global research studies is that people who utilize the syringe access programs, they are five times more likely to enter treatment and three times more likely to stop using drugs altogether," Hagan reported.

A legislative task force meets monthly at the Missouri state Capitol to discuss ways to reduce substance abuse in the state.


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