Alabama intends to improve mental health care and substance abuse treatment under a federal program that aims to help patients more quickly and put a wider range of services within reach at a single location.

The U.S. Department of Health and Human Services announced last week that it had picked 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 would 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 CCBHCs, centers must offer at least nine core services and meet other requirements on staffing and timeliness of service. CCBHCs receive enhanced federal funding – a 90-10 federal-state match – that is intended to make the 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 for becoming CCBHCs and that AltaPointe and WellStone were the most prepared. The plan is for some other centers to convert over 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 System of Care.

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

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

“It improves recruitment and retention. It integrates substance use and mental health care. Really, it does all the things that we’ve been working so hard to resolve over the last five years.”

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

Shalandra Rogers, CCBHC state project director for Alabama, said the initiative means the beginning of important changes. For example, Alabama’s mental health centers are now set up to serve people within their designated geographic areas. Statewide, there are 19 regions governed by what are called 310 boards, so named after Act 310, the state law that authorized them.

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

To qualify as CCBHCs and receive enhanced federal funding, mental health centers must offer at least nine core programs or forms of care – crisis services; 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; outpatient primary screening and monitoring; peer and family support counselor services; and targeted case management.

CCBHCs can designate other collaborating organizations to provide some of those services but most provide at least five themselves.

The Department of Mental Health said the enhanced funding will help recruit and retain staff. That means patients should be able to receive evaluations and services more quickly.

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

Missed appointments mean patients do not receive care and mean wasted time and resources for the clinics.

“That counselor is sitting there in that time that has been so set aside for that individual,” Boswell said.

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

“That’s what we are shooting for, where people can have the services they need, and not fall into crisis,” Rogers said. “And not have to go to an ER or not have to be seen by law enforcement because they’re having some type of mental health need.”

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

Rogers said it is reasonable to expect that problems and uncertainties will crop up during the transition to CCBHCs.

“But one thing I do know is that as we continue to work this program, as we continue to get this program recognized throughout the state, that we will start to see better health care, better mental health care for individuals overall. So, I just ask that everyone be patient as we try to roll this out and get it up and going.”

Other states chosen 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 the sixth is expected to open this summer in Dothan.

The crisis centers offer 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-range 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 south Alabama.