Alabama mental health officials have announced plans to fire 948 employees and close all but two of the state’s psychiatric hospitals by next spring. One of the two surviving hospitals will be limited to forensic patients, the other to geriatric patients.

In other words, everyone too mentally ill to seek treatment is out of luck unless they commit a crime or are elderly  – and so are their families and communities. 

The Alabama Department of Mental Health says the move will enable the state to expand community care (“948 Alabama mental health workers to lose jobs," Birmingham News, Feb. 16). Advocates of the move say it's more important to preserve care for patients living in the community than to treat people too ill to live there.

It is mind-boggling that public officials could be this oblivious to the well-established consequences of deinstitutionalization, which has reduced the nation’s hospital bed population by 90% over the last half-century in the name of less-restrictive treatment and community services.

Already, law enforcement resources are under severe strain from service calls related to untreated mental illness, hospital ERs are overflowing with people in psychiatric crisis for whom there are no beds, and rare but shattering events such as rampage killings involving untreated mental illness are on the rise. Meanwhile, people with chronic mental illness who once lived in state hospitals live instead on the streets and in jails and prisons, die of suicide or victimization and suffer.

Mentally ill individuals who are stable are able to access and benefit from community services. Those who suffer from anosognosia and don’t know they are ill, those in acute psychiatric crisis and unable to distinguish reality from unreality, and those with treatment-resistant mental illnesses that render them chronically unstable cannot.

Even Alabama proponents of the move “wonder whether there will be time to build up the infrastructure needed to handle patients being discharged from the hospitals and new ones coming into the system.”

We don’t wonder.

States began shuttering hospitals and discharging patients in the name of community services more than 50 years ago. The infrastructure still isn’t there to handle them. In their absence cops, jails, prisons and desperate families do their best, and all but a fraction of the most severrely ill fail to receive the treatment they need to live better lives.

Even “a fraction” seems to be too many for Alabama.  Check out the state's current involuntary treatment standards for civil commitment to a state hospital. Where will all these people go? And what price will Alabama pay for not treating them?

The state’s mental health officialdom should be ashamed.

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