Nestled on the eastern shore of Mobile Bay, cheek-by-jowl against the Florida panhandle, Baldwin County is the largest county in Alabama with a population of close to 220,000. And, Baldwin County faces the same challenges of treating the mentally ill as New York County, New York, which is the second smallest county in the U.S. but the most densely populated, with more than 28 million people occupying roughly 23 square miles.

But Baldwin County is experimenting with a federally-supported “Assisted Outpatient Treatment Program” to provide a wide-range of services for mentally ill residents who are involuntarily committed to outpatient treatment. The primary goals of the program are to reduce hospitalizations, emergency department visits, interactions with the criminal justice system, and homelessness, all while keeping costs at a minimum.

Praveen Narahari, MD, of the University of South Alabama College of Medicine, and colleagues reported on the first year of operation of the program in a poster at Psych Congress 2019.

Among the findings:

  • In the year before the program, 65 individuals were hospitalized 96 times for a total of 1,610 days.
  • In the first year of the program, 10 individuals accounted for 16 hospitalizations for a total of 315 days.
  • Hospitalizations were reduced by 83.3% and days in the hospital were reduced by 80.4%.
  • 16 participants made 27 emergency department visits before the program; 9 participants made 12 visits after enrolling in the program.
  • Emergency department visits were reduced by 44.4%.
  • In the 12 months prior to the program, there were 80 encounters with law enforcement for the 65 participants in the sample versus 29 encounters in the program’s first year.
  • In the year before, four participants were homeless for a total of 477 days. In the year after, three were homeless for a total of 56 days.

But what about costs?

Using cost estimates provided by local law enforcement, municipalities, and hospitals, the authors estimated that over the course of a year the program saved Baldwin County taxpayers more than $1 million.