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Time to Get Serious About
Mental Health in Florida

| December 21, 2012

Magritte, ‘Le double secret’ (1927). Click on the image for larger view.

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.

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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.

Transforming Florida’s Mental Health System

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11 Responses for “Time to Get Serious About
Mental Health in Florida”

  1. Lonewolf says:

    We do need to get serious about mental health. I know people who have anger problems and yet still have a concealed weapon permit. Not very comforting

  2. Richard Moore says:

    Too bad most of the perpetrators of mass violence in this country are under psychiatric care. At least under our version of psychiatric care, which is a daily dose of psychotropic drugs that can lead to psychopathic behavior. The pharmecuetical industry needs to be more responsible with their medication, they need to research why these certain individuals have such an adverse reaction and develop a screening test.

    Of course that might cut into their billions in profits, so I won’t hold my breath.

  3. Linda says:

    Certainly this is an element of necessary measures that might contribute to less violence, and I advocate improving the care.
    However, as the article indicates, others knew of the plans or possibilities of the shooting events prior to them occurring, and did not act on their knowledge.
    Moreover, unless there is a defined threat against a victim/victims, privacy in medical treatment trumps. Can we expect all the mental health caregivers to know when to violate that privacy and when not to, and at the risk of civil suits? After all, they are dealing with the mentally ill who often say asocial and anti-social comments but would never act on them. And the mental health care would not show up on a background check for guns or ammo. It’s private without consent from the patient.
    Yes, we need improved mental health care for many reasons, mostly to improve the quality of the individual’s life and those around them. But under the current system, I don’t see that it would be a major deterrent in mass shootings.

    • Richard Moore says:

      We do expect mental health professionals to determine whether patients are going to harm others, the doctor-patient privilege ends when the caregiver suspects the patient will do harm to his or herself of others.

  4. Anonymous says:

    Flagler County’s Public Safety Committee received funding from a grant for this exact purpose. Where is the team providing these services and how does the public go about contacting them?

  5. Deep South says:

    One thing that concerns me is how many inmates are in prison with severe mental health issues that will possibly be released someday and never got any mental health treatment. Prisons became the alternative for mental health facilities, because those seeking treatment could not afford it.

  6. JoJo says:

    The problem I have with helping individuals that are mentally challenged is the wide net the government will go in pursuing individuals. Don’t laugh, it may be your child in school who has an outburst which will be interpreted as threatening or worse, a potential murderer in the making. I get goose bumbs when I read about a shift, with no oversight, to find and seek ways of potential mass murderers lurking in our community. Will the neighbor down the block call the police on another neighbor out of malice. Is the school principal or teacher held in such high esteem to report such people at will. I think not. Is your family doctor allowed to ask you if you have a gun and if you do, turn you into the psycho squad that will come and get you or worse, ransack your house for that rifle you used for target practice. History often has a way of repeating itself and I am concerned that some people may be innocently accused of this fear mongering which faintly reminds me of the witch hunt by Senator McCarthy (McCarthyism) in the 1950’s. The public was swayed and hoodwinked to get on the band wagon which even Hollywood wasn’t safe from.

    I read in the NY Times that Police Commissioner Raymond Kelly wants to create a unit, much like a Terrorism Unit (might as well be called a Muslim witch hunt), with a new unit for stalking the internet – get this! For buzzwords that may reflect a lonely troubled or potential mass murderer in our mists on the internet. Hello! Will he have priests, rabbi’s, Protestant ministers Muslim clerics and psychiatrists manning these internet connections. Even so, we should be outraged.

    I think we should have a Blue Ribbon panel of distinguished people, including psychiatrists, decide what is the best recourse for our immediate societal problem. The answer might just be to restore funding and to treat mental illness not only with dignity but to assist families that are crying out for help with an individual family member which has been ignored for years. Perhaps the Raymond Kelly’s of America can save tax payers needless money on such useless ideas and leave mental health issues to the experts.

    • Anonymous says:

      If your doctor asks if you have a gun, then you just say “no”. Doctor’s have complete freedom to pass out gun safety information to 100% of their patients without inquiring who has guns and who does not.

  7. L.D. Ablo says:

    Well, that explains Palm Coast city council.

  8. Samuel Smith says:

    I’m pretty sure that Rick Scott’s massive cuts to mental healthcare were done to deter people from using Stewart-Marchman on the people that voted for him.

  9. w.ryan says:

    When money became a dominant factor in treatment of the mentally ill they became susceptible to inhumane treatment. We can’t predict if and when we fall ill. Troy Gordon is an example of what can happen to anyone that can’t help themselves. He came back from Iraq as a Veteran that fell ill probably due to PTS and ended up shot dead by the police here in Flagler Co. If we can have all these prisons we certainly can find the resource for mental health facilities and treatment.

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