Sharp ‘Disconnect’ Between Providers and Needs In Flagler’s Mental Health and Addiction Landscape

There was no “yay” from an audience of some 90 people. The disconnect was too obvious, the head-scratching again and again verbalized by some of the 90 people in the audience, several of them elected and health department officials, several of them veterans of Flagler County’s grinding and so far largely fruitless attempts to broaden meaningful, accessible mental health and addiction services to what amounts to a mental health desert.

“Have you done an analysis for Flagler County,” Bob Snyder, who heads the Flagler County Health Department, asked the panelists, “about comparing the number of clients that you are serving and who the projected need or, by way of number of folks that you’ve maybe turned away, or actually a need analysis so we can get a sense for how large the gap is?”

The circuitous answer from Christine Cauffield, the CEO of LSF Health System, a chief service provider in the region, was no: waiting on numbers.

“There seems to be a disconnect between the services that we’re hearing are available for community members and what community members are feeling that they have actual access to,” Colleen Conklin, the school board member who’s led various suicide-prevention efforts and is involved in Flagler Cares, the organization behind Monday’s forum, asked the panelists. “What do you attribute to the disconnect?”

Conklin, like Snyder, got told “great question,” the throat-clearing, head-patting preface to what is often the lack of an answer. And there was no answer from Cauffield, who further diagnosed existing problems (who Medicaid does and does not cover, the 15 percent of the population that can be covered by her company’s services) before reverting to what even she recognized as a “trite” cliche: “It does take a village.” But the village was here–it was around every table, looking for solutions. It just wasn’t hearing much of even the beginning of any, though it was hearing more of what it’s heard before.

“Even if they don’t put more money into the system, keeping it the way it is is mandating a reduction in capacity every year,” said panelist Rhonda Harvey, the chief operating officer at SMA Healthcare, the state-supported–and rare local–provider of mental health and addiction treatment services. “Because if they don’t increase the money that they’re putting into the system, inflation alone, and the fact that people are moving into our counties and cities every day is causing a reduction in capacity.”

Then came LSF COO Shelley Katz: “You have a really strong base of advocacy in this county,” she told the room, “in this community, and you have legislators who are interested in these issues, so I really think mobilizing all of that passion to start asking for some special projects to serve Flagler County is one way, and maybe the county can do some matching funds.”

“I can’t believe that you just said that,” interrupted Sue Urban, who had been live-Facebooking the event but was about to stop. She is the mother of an 18 year old who took his own life in 2018, not long after graduating from Matanzas High School. “We have requested that multiple times over the last several years and we have been told no, over and over and over again.” Cauffield then gave a lesson on chasing after legislators for funds. Urban walked out, calling it “a waste of my time.”

“I’m very frustrated with this whole process, one, because we were told that this meeting was going to be a community meeting, where we would be able to voice the community’s concerns [following] the intergovernmental roundtable that we weren’t allowed to speak at,” Urban said later, in the venue’s parking lot. “The second reason I’m so frustrated with it is, every time we try and ask the questions of where are the services, why can’t people access the service, we are immediately shut down.” Urban was standing by a just-donated van she and her partners are calling the Mobile Mental Health Unit, which they hope to equip with a psychiatrist, a counselor and a case manager and take to various locations in the county at set times. The van was donated by Family Matters, the non-profit. They’d parked it with its array of suicide-prevention and hope-inspired messages in the parking lot of the Flagler County Association of Realtors building, where Monday’s forum took place.

“We ran out of time,” Carrie Baird, Flagler Care’s director, who hosted the forum, said. “We were hoping to identify the barriers that individuals seeking services or helpers are finding so that we can try to address some of the barriers, since the capacity issue is insurmountable right now. Like some of the research that we’ve been doing–to find out that all those providers are wrong on the list.” Baird is attempting to produce a comprehensive list of local and regional service providers, but even those providers listed on websites by Medicaid (for example) are wrong, creating an additional challenge to sort through the maze of rare, non-existent or mis-identified providers.

Baird had started off the forum with a summary look at the latest figures and trends, including the results of a community health survey in which some 1,000 people participated. Mental health and addiction problems topped the list of community concerns, followed by homelessness, unemployment, child abuse and neglect, vehicle crashes, cancer and domestic violence, in that order. Mirroring those results, 43 percent of respondents said mental health services and counseling are the hardest health care services to obtain in Flagler, followed by “alternative therapies” and substance abuse services.

Baird also provided the preliminary figure for the total number of suicides in 2019: 24, down from 29 last year and 31 the year before, when Flagler’s suicide rate was the highest in the state.

But in 2017-18, the last year for which numbers are available, Flagler broke another grim record: it had 716 Baker Acts–the involuntary seizure and confinement of an individual to a psychiatric facility for up to 72 hours, when the individual is threatening harm to self or others–by far breaking the previous year’s total of 561, which had been near the 2010-11 record of 563. Of those, 185 were children and adolescents younger than 18, also a record, and 87 were 65 or older, also a record.

Flagler County Sheriff Rick Staly, who was in the audience at the forum, asked the panelists what was being done in follow-ups, after deputies–who are chiefly responsible for executing Baker Acts at the point of initial contact with an individual–relinquish the individual to providers’ care. Staly is concerned that often individuals will get better, or seem as if they’re getting better, only to get off their medicines, relapse and spiral back into the sort of behavior that requires another Baker Act. With more rigorous follow-ups that would monitor the individuals’ adherence to meds, perhaps the spiral could be reduced or avoided, Staly suggested. But when he asked what sort of follow-ups are in place at the provider’s end, he received the sort of answers the previous members of the audience who’d raised questions did: not much.

“I don’t think there’s sufficient cooperation” with potential providers such as community health workers, Harvey said. “Clearly we can do a better job.”

Clunky and dubious as the mobile van parked outside the forum appeared, it nevertheless was the most concrete attempt at trying to bridge the divide between needs and services in the county, at least when contrasted with the optimistic and polished but hollow messages from service providers at Monday’s forum.

The Flagler Cares Presentation: