Time to Get Serious About
Mental Health in Florida
FlaglerLive | December 21, 2012
By Paula Dockery
It seems to take a tragedy for lawmakers, the news media and the public to show an interest in addressing the growing national crisis in untreated mental illness. The recent calamity at Sandy Hook Elementary School in Newtown, Conn., caused millions of Americans to question, how does something like this happen? Weren’t there warning signs?
Of course there were warning signs. The sad truth is, in almost every tragedy like Sandy Hook, Aurora, and Virginia Tech, cries for help went unheeded or unfunded. Sometimes it’s the person with a serious mental illness (SMI) — schizophrenia, bipolar disorder, major depression — or a family member reaching out to help them. In either case, their pleas for help often fall on deaf ears or on a mental health system that is stressed with too much unmet need and too few resources.
Many experts on mental health lobby Congress and state legislatures to explain the need for treatment to deal with the large number of people suffering with an SMI and to warn of the potential consequences of ignoring that need. Due to the cost of providing treatment and shrinking government budgets, policy makers dismiss adequate mental healthcare funding as something less than a high priority.
They do this at great peril. Without treatment, the mentally ill can become a danger to themselves or others. Many end up in crowded and costly jails and prisons.
According to the Criminal Health Project, Miami-Dade County is home to the largest percentage of people with serious mental illnesses of any urban community in the nation. While 9.1 percent of the population has some form of SMI, fewer than 13 percent of individuals receive the proper care. As a result, law enforcement and correctional officers have increasingly become the responders to people in crisis.
With the annual cost of incarcerating an adult in the Florida prison system at roughly $20,000, untreated mental illness can be a very expensive burden on taxpayers. It’s also a safety issue or, in the worst-case scenario, a national tragedy.
While serving as chairman of the Senate Criminal Justice Committee, I became an ardent and vocal proponent of comprehensive strategies developed by a task force headed by Judge Steve Leifman of Florida’s 11th Judicial Circuit.
Judge Leifman served as special advisor on criminal justice and mental health for the Florida Supreme Court from 2007-2010. During that three-year period, Leifman’s committee produced a report entitled “Transforming Florida’s Mental Health System,” which received considerable state and national recognition. The report outlines recommendations to reduce the number of people with mental illness in prison and to develop alternative approaches that offer treatment and support for recovery.
The 165-page report chronicles the history of confinement, first in jails and then in psychiatric hospitals, of the mentally ill. The development of medications led to the community mental health movement. President John F. Kennedy signed a $3 billion authorization to support federal legislation to move from institutional to community-based treatment. However, funds were never appropriated. (See the full report below.)
Federal lawsuits led to the deinstitutionalization of public mental health care. Without funding, an adequate network was never established to absorb these newly displaced individuals, leaving enormous gaps in treatment and the potentially dangerous untreated in our communities.
Sadly, Florida ranks near dead last nationally in the level of expenditures for front-end community-based mental health services. Yet it ranks near the top of the list in the area of forensic mental health services at the tail end.
The justice system is ill-suited to serve as the safety net for the mentally ill. Our jails and prisons have been forced to house an increasing number of individuals who are unable to access needed and competent community care.
The report outlines several consequences of failure to design and implement an appropriate system of community-based care for people who experience the most severe forms of mental illness:
– Substantial and disproportionate cost shifts from considerably less expensive, front-end services in the public health system to much more expensive, back-end services in the juvenile justice, criminal justice and forensic mental health systems;
– Compromised public safety;
– Increased arrest, incarceration, and criminalization of people with mental illness;
– Increased police shootings of people with mental illness;
– Increased police injuries; and
– Increased rates of chronic homelessness.
It shouldn’t take another devastating loss of life to spur action on a growing problem in our society — the failure to provide a safety net to those who can be a danger in our communities if their mental illness is left untreated.
The Florida Legislature should quickly embrace the work of Judge Leifman and his expert task force – something that we failed to do in 2010 and each year after. Let’s not be penny wise and pound foolish when so many precious lives are at risk.
Paula Dockery was term-limited as a Republican state senator from Lakeland after 16 years in the Florida Legislature. She can be reached by email here.