ADMH board hears plans to study jail-based competency restoration and to address ICF-level gaps for complex cases

Commissioner Kimberly G. Boswell told the Alabama Department of Mental Health Board of Trustees on Aug. 15 that agency staff will investigate additional jail-based competency and restoration options and convene a focused team to work with developmental-disability providers on complex, dually diagnosed cases.

Boswell opened the discussion as part of her commissioner’s report, framing it as both an orientation item for new trustees and an operational priority. "We do not have the ICF level of care for complex needs," she said, noting that most current providers cannot address medically fragile people who also have behavioral health needs.

The division of developmental disabilities detailed the pressure that drives the need for new capacity. Associate Commissioner Kathy Sawyer told the board that a large portion of the division’s waiting list consists of people with dual diagnoses and complex medical requirements. She said the Community Waiver Program aims to keep individuals in their homes, and that an 1115 Waiver limits costs so services cannot exceed institutional care expenses.

Board members and staff discussed concrete responses: forming a staff/provider team to identify service gaps and possible small-site intermediate care facility (ICF) options, pursuing earlier interventions such as mobile crisis teams for youth, and strengthening foster-family engagement and school-based trauma-responsive practices to reduce escalation into institutional care.

The board did not take a formal vote on new facility authorization or funding during the meeting. Staff were directed to follow up by researching restoration options for people in jails and by meeting with developmental-disability providers to evaluate feasible short-term and long-term solutions. The next formal update was not scheduled at the meeting.