Stepping Up Alabama

54% of individuals with SMI are re-incarcerated and 68% of those with co-occurring mental illness and substance abuse are re-arrested (International Journal of Law and Psychiatry). Stepping Up Alabama is making a MAJOR impact in the lives of the people they touch.

What makes this program so impactful is the fact that it not only provides services on the individual level but works on the policy and systems levels to create a continuum of care for individuals with SMI and co-occurring mental illness in these counties. This program works to break down silos and foster relationships that result in providing individuals with the necessary resources and treatment to place them on a positive trajectory.

Since the first Stepping Up programs began providing services in January 2019, over 46,393 people have been screened for serious mental illness (SMI) and substance abuse (SA) and over 9,609 people screened positive for SMI and/or SA. That means that AT LEAST 20% of individuals in the participating Alabama jails are living with mental illness and/or substance use issues.

History of Stepping Up Expansion:

Stepping Up received a state appropriation in Fiscal Year 2021, and ADMH awarded an annual grant of $50,000 to centers through an RFP process. This award supported intensive case management services to screen, assess, develop a case plan for and link clients to appropriate, necessary mental health (i.e., group/individual mental health counseling, crisis intervention, and court advocacy) and social services (i.e., housing, transportation, food); recruitment for and facilitation of a local planning committee to create supportive local policies, and community outreach to mobilize community support.

In June 2018, ADMH released a Request for Proposals (RFP) for community mental health centers to apply for a ONE-TIME award of up to $50,000. In June 2019, the same RFP was released to replicate these services in new counties.  In 2020, an RFP was released to the previously funded eleven counties to provide support for the continuation of the project and re-establishment support to some mental health centers whose programs were impacted by COVID-19 and other circumstances within their community. Additional counties received funding to continue their Stepping Up programs in October 2022.

ADMH also opened the application process for interested counties to receive funds to initiate their own Stepping Up program. New sites were onboarded quarterly in cohorts. Lawrence, Talladega, and Tallapoosa counties began their program in January 2021; Washington and Russell counties began their program in April 2021; and Baldwin, Clay, and Jefferson counties began their program in July 2021.   As of September 2023, all 17 counties continue to receive annual funding to run their Stepping Up programs.

With the exception of Mobile County, each site only has one case manager. In addition, case management capacity at each site has suffered greatly since the COVID-19 pandemic, In spite of these challenges, Stepping Up Alabama has provided intensive case management services to over 1,393 clients and 98% of these clients received mental health treatment at the community mental health centers. Overall, the recidivism rate among Stepping Up clients is 29% which is less than half of Alabama’s recidivism rate of 38.3%.

In addition, according to the study published in the International Journal of Law and Psychiatry, 54% of individuals with SMI are re-incarcerated and 68% of those with co-occurring mental illness and substance abuse are re-arrested.² This means that Stepping Up Alabama is making a MAJOR impact in the lives of the people they touch.

What makes this program so impactful is the fact that it not only provides services on the individual level but works on the policy and systems levels to create a continuum of care for individuals with SMI and co-occurring mental illness in these counties. This program works to break down silos and foster relationships that result in providing individuals with the necessary resources and treatment to place them on a positive trajectory.

Alabama has two counties that have earned national Innovator Project designations: Mobile County and Shelby County. This reflects sites that meet the national standards of achieving 3 criteria:  1) establish a shared definition of severe mental illness (SMI) that is used throughout the local criminal justice and behavioral health systems; 2) use a validated mental health screening tool on every person booked into the jail and refer people who screen positive for symptoms of SMI to a follow-up clinical assessment by a licensed mental health professional; and 3) record clinical assessment results and regularly report on this population.

If continued progress is made and investment by all partners is sustained, communities can benefit from:

• Increased treatment for individuals living with mental illness
• More efficient use of public funds
• Less strain on jails, courts, and law enforcement
• Increased peace of mind for families and the community
• Healthier community members
• Greater prosperity for the entire community

Report on Year 1 of Stepping Up Alabama
Report on Year 2 of Stepping Up Alabama
Report on Year 3 of Stepping Up Alabama
Report on Year 4 of Stepping Up Alabama

The National Stepping Up initiative is sponsored by the National Association of Counties, the American Psychiatric Foundation, and The Council of State Governments Justice Center, in partnership with the U.S. Department of Justice’s Bureau of Justice Assistance. Since its inception in May 2015, more than 566 counties in 43 states have passed resolutions or proclamations to join the Stepping Up Initiative.