"The definition of insanity is doing the same thing over and over again and expecting different results."
It is ironic that the above maxim comes from the 12-step community in mental health practice ... the problem with irony is not everybody gets it. So it is that not everybody that needs mental health treatments gets it in Alabama.
We routinely find our beloved state ranked among the worst in the nation by external studies. Yet even our own Alabama Commission on the Evaluation of Services (ACES) releases well-researched reports showing problems in Alabama’s Department of Mental Health (ADMH).
The latest example came in September when ACES released “An Evaluation of Mental Health’s Crisis Centers” in Alabama. It opens with an ominous note that “the Department of Mental Health has deficient strategic control, which leads to a lack of accountability.” The report goes on to note more specific concerns, including:
- Logistical barriers including transportation and EMS reimbursement.
- Lack of clarity regarding uniform data standards.
- “A lack of quality control and accountability in reporting.”
- “[A]n imbalance between current funding and actual needs of each center.
These findings should alarm the state’s taxpayers. As the report notes, Alabama has dedicated $175 million in state funding to open and operate Crisis Centers since 2021. Yet this likely does not even account for the many additional millions shoveled to ADMH in recent years via the opioid settlement agreements.
This is not the first time that ACES took a hard look at Alabama’s mental health system. In September 2020, ACES released its comprehensive study of suicide prevention, with findings including:
- "Alabama lacks critical state infrastructure to effectively collaborate and coordinate its suicide prevention activities.”
- “Lead states” have invested in suicide prevention efforts while Alabama has relied on federal grants.
- "Evidence shows that suicide risk assessment, treatment, and management training programs are needed to increase the level of healthcare provider confidence to assess at-risk individuals [veterans with PTSD and addictions] and decrease provider hesitations in addressing suicide ideations with patients."
This report praised the Alabama Department of Veterans Affairs’ (ADVA) efforts under then-Commissioner Admiral Kent Davis to address suicides among military veterans. Of course, Davis was then fired for filing an extensive and fact-based ethics complaint about the state’s repeated mental health failures related to the state’s veterans.
This latest ACES 2025 report seems to demonstrate that its employees are ready to risk facing the same apparent retaliation as Davis did. The report didn’t exactly meet with a positive response, as ADMH Commissioner Kim Boswell issued a defensive letter largely whining about its “negative tone.”
Meanwhile, the governor’s office reportedly sought to downplay and even subdue the findings, while simultaneously attempting a selective media campaign to attack what it characterized as the unnecessarily “negative tone” of the report. They were partially successful, as there was very little coverage of the September 2025 ACES report, save for an apparently pre-staged article in Alabama Daily News. Even the author of that article could not completely sugar-coat the ACES findings, despite her best efforts to characterize the report as unduly “negative.”
Even more disturbing, the governor’s office reportedly pressured ACES to retitle its report as “preliminary” in nature due to “incomplete data.” It is clear that using mental health as a front company of sorts to absorb and conceal different federal and state funds is the primary modus operandi for this administration.
What will be the response to these latest findings about Alabama’s woeful mental health system? Here is my prediction:
- The governor’s office will continue to cover for ADMH and Boswell, while simultaneously attacking anyone who dares to criticize their cronies. I would welcome a public forum to discuss this with both of them.
- No one in ADMH will be held accountable for its repeated failures. Business as usual will continue unimpeded with large sums of monies in a secluded and secured stovepipe, while failed programs and initiatives for the good citizens of Alabama who need mental health services will sadly continue.
- Various state legislators will continue to make excuses for the ADMH’s repeated failures. They will also continue to funnel millions of taxpayer dollars to ineffective programs, attempt to reinvent the wheel with redundant and wasteful projects, fail to emulate successful models from other states, and ultimately fail to address core problems in the state.
- Most critically, Alabamians in dire need of effective and efficient mental health services will be neglected, particularly niche populations in crisis, such as the state’s often-ignored military veterans.
- Alabama will continue to rank at or near the bottom in quality-of-life statistics.
- Alabama will continue to vote for the poor leaders who are responsible for all the above, while simultaneously driving away the leaders who could improve our state. Take heart, Alabama, hopefully our next governor will address much, if not all, of this in the near future.
Troy Carico is a former infantry enlisted soldier (11B) and infantry officer with branch qualifications including counterintelligence (35E) and military intelligence (35D). He served with distinction in the U.S. Army for more than 22 years and is highly decorated and service-connected disabled. He also has prior service as a civilian intelligence officer for the Defense Intelligence Agency Great Skills Program and has served in numerous clandestine assignments throughout the world.
The views and opinions expressed here are those of the author and do not necessarily reflect the policy or position of 1819 News. To comment, please send an email with your name and contact information to [email protected].
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