Alabama is once more downsizing and consolidating mental health care services, moving away from institutionalization and toward community-based care.

This is the second time in a decade that the Alabama Department of Mental Health has faced closure of facilities for the mentally ill and developmentally disabled. In 2003, a similar shift in state and federal funding resulted in the closure of the Lurleen B. Wallace Developmental Center in Decatur.

This round of closures threatens North Alabama Regional Hospital in Decatur and the laying off of 948 employees.

The state of Alabama has a grim history in its treatment of the mentally ill and continues to lag behind much of the nation in services.

A January 8 USA Today story stated Alabama cut 36-percent of its total general fund mental health budget from 2009 to 2012 — from $100.9 million in 2009 to $64.2 million in 2012. Quoting from a 2009 report, updated with 2011 data, the story states: “Alabama also has fewer psychiatrists, relative to its population size, than almost any state in the nation. Hospitals are filled beyond capacity and shortages in acute-care hospital and crisis beds have reached critical levels.”

While the introduction of psychotropic drugs in the late 1950s and early 1960s helped decrease the number of inpatient psychiatric cases throughout the nation, the warehousing conditions inside of Alabama’s mental health facilities continued.

The 1960s signaled a turn in mental health treatment nationwide with the passage of the Comprehensive Mental Health Bill in 1964 and the Medicare and Medicaid Acts in 1966. In Alabama, the late Gov. Lurleen B. Wallace was elected in 1965. Early in her 16-month tenure as governor, she visited Bryce Hospital and was reported to have been “visibly shaken” and wept openly.

The governor proposed and the Legislature approved a $43 million bond issue — nearly $300 million in 2013 dollars — to upgrade the state’s mental health care system and state parks.

When contacted by phone last week, George Wallace Jr., who was just a teen when his mother served, said the securing of that bond issue was the greatest contribution of her tenure and raised the consciousness of the people of Alabama on mental health treatment.

“Reporters from that time say that they believed the Legislature was moved by her heartfelt appeal,” he said. “Moved in a way — and I don’t mean to sound sexist — that no man could have moved them.”

But the greatest shift in mental health care standards resulted from the nearly 30-year-long Wyatt vs. Stickney suit in which the 15-year-old Ricky Wyatt became a plaintiff in a federal lawsuit against the Alabama Department of Mental Health over conditions at Bryce Hospital.

Wyatt had been “dropped off” at Bryce by a custodial aunt because he was having trouble in school. He was not mentally ill. The state Department of Mental Health was placed under federal court control for 33 years. The case was settled in 2003.

Former state mental health commissioner Kathy Sawyer said of the settlement:

“The significance of Wyatt was the impact on mental health care treatment around the country. It was a blueprint for people with disabilities to some degree and a blueprint for regulations that were later adopted by Medicare and Medicaid.”

The closure of mental health care facilities also has had an impact on jail populations. In a 2009 report commissioned by the Treatment Advocacy Center and the National Sheriff’s Association, Alabama is cited as having 40,561 state inmates with 6,490 of that population being “seriously mentally ill,” compared to 1,609 mental health cases in the private sector hospitalized in state and private mental psychiatric hospitals and units. The state ranks 35th in state funding for mental health care expenditures.

Former mental health commissioner John Houston is quoted in the report as saying that in 2007 the percentage of state inmates thought to be mentally ill had risen from 5 percent in 1971 to 20 percent in 2007. “We are more or less criminalizing mental illness,” he said. “Jail becomes a default mental-health facility because there are no resources to provide care,” said Houston.

Six years later a solution seems no closer. Gov. Robert Bentley halted construction in March of a $73 million hospital to replace Bryce Hospital in Tuscaloosa because of budget constraints.