There is not enough action, but a lot of thought: Mental health proposals go unheeded

Access to mental health services in Florida is difficult for thousands of people. Complex and disjointed treatment systems exist. Residents are often referred to different doctors and given different medications. Clinicians may not be aware of this. Many who are in need of care have made prisons and jails their homes.

These and other problems were highlighted in a damning report by the Commission on Mental Health and Substance Abuse released earlier this year. 19-person panel Florida legislators created this law in 2021 to promote reforms of the state’s behavioral health services for low-income families and uninsured individuals.

What is the most concerning about the findings of this group? These findings are not new.

The commission was established by the Florida Legislature more than 20 years ago. With the same name To examine the same issues and make recommendations about how to improve mental healthcare in the public-funded system.

It is evident that the echoes of these two groups, which have been separated for over 20 years, are inextricable. Florida is not the only state that struggles with this problem. Criminalization of mental illness?, Lack of coordination Between providers Insufficient access to treatment.

According to the national advocacy group Mental Health America, Florida was 46th out of 50 states and the District of Columbia in terms of access to this care. According to the nonprofit, Arizona, Kansas and Georgia were the worst off states. It ranked them on their access to insurance, special education, cost, quality, and number of mental health professionals.

Nationally, conversations about mental health are at forefront of the public’s attention. Mass shootings are on the rise, pandemic-related stress, Rising suicide ratesThe shifting perspectives on the Police play an important role In handling 911 calls.

“It all comes down to how much money legislators are willing and able to invest in building a system that works,” Caren Howard, director for policy advocacy at Mental Health AmericaThe nonprofit organization, located just outside Washington, D.C.

The 1999 Commission on Mental Health and Substance Use was established in Florida by Jeb Bush, who was then governor. A 2001 Report of 74 pagesThe group described the state’s treatment system as “complex, fragmented and uncoordinated” and called it often ineffective.

According to the commission, Florida’s prisons and jails had the highest number of mental hospitals. “deinstitutionalization” The 20thThA century-old movement to close state psychiatric facilities, and instead treat people through community services.

The Report also criticizes Florida agencies For not sharing patient information with each other and being unable track whether people with severe mental illnesses, such as schizophrenia, were really getting the help they needed.

“A lot the things we’re finding now they found back then,” stated Bill Prummell of Charlotte County, who was the chairperson of the commission for 18 months.

These similarities raise concerns for the group that its work may also end up on a shelf collecting dust as Florida legislators continue to struggle with the same problems.

Prummell asked, “Are they really going take us seriously?”

A man reaching for something in a bookcase stuffed with reports and old books.
David Shern’s office has a shelf that holds a copy of the 2001 report, which was released by Florida’s 1999 Commission on Mental Health and Substance Use.(Ivy Ceballo / Tampa Bay Times)

Dropping the ball

The 1999 commission hosted public meetings in Florida and urged reforms. Mental health courts.

The group recommended that a “coordinating committee” be established in the governor’s office to oversee the system and create a care strategy.

This never happened.

David Shern, former dean of South Florida’s Louis de la Parte Florida Mental Health Institute and chairperson of 1999 group, stated that he believes Bush’s office has lost the ball.

The Republican governor He is well-known for his cutting of spendingShern said that he didn’t want to hire staff for his office so the coordinating committee was never established.

He said that this is “where the plan really failed”.

Instead, lawmakers Established in work group The Department of Children and Families will review Florida’s behavioral health system and prepare a report for Bush and other leaders.

In 2003, the work group was disbanded. In 2003, the legislature was created. Not-for-profit organization It was established to supervise the system but it was dismantled in 2011. According to state business records. The spokesperson for the Department of Children and Families Laura Walthall told the Tampa Bay Times that the report was not available when they asked for it. Bush did not respond to emails.

Sandra Murman, a former state representative, stated that what happened was just a result of bureaucracy.

Murman, a Tampa Republican and member of the 1999 group, stated that “it’s the same for all commissions.” “The average life span of any major report is about five years.”

Tallahassee’s term limits force lawmakers to leave. Agency heads step down. New officials get elected. Priorities change.

She said that Florida’s legislative leaders “come in with their agendas, and you won’t ever see social services at the top.”

Close-up of the 2001 Florida Mental Health Commission Report.
David Shern has a copy the 2001 report that his mental health commission published. A new report from the state commission came up with similar conclusions.(Ivy Ceballo / Tampa Bay Times)

Some state legislators focused their attention on mental illness after the shooting in 2018. That left 17 students, and staff. Members dead Marjory Stoneman Douglas High school in Parkland. In light of mounting public demand for more severe gun control measures such as an Ban on assault weapons, the Republican-controlled legislature instead approved more limited restrictions, like Florida’s Red flag lawAlong with other steps not related to gun control, the allocation of approximately $400 million for Initiatives for school safety and mental health.

Before the massacre Nikolas Cruz, Parkland shooter According to a, the gunman received mental health services from several private and public providers. This split his medical history. 2019 Report From the Marjory Stoneman Doug High School Public Safety Committee.

The report stated that “No single health professional had the complete story” about Cruz’s mental and family health. This was partly due to a lack communication between providers and disclosure by Cruz family members.

A large majority of people suffering from a mental illness are not aware that they have one. They are not violentAccording to the nonprofit, it is. National Council for Mental Wellbeing They are located in Washington, D.C. more likely To be victims of violent crime rather than perpetrators.

2020 A grand jury Investigating school safety concerns related to the shooting called Florida’s mental health system “a mess”.

“Deficiencies of leadership, funding and services” The grand jury pronounced“Tend to appear everywhere like bad pennies.”

The panel stated that it did not have the time to review the entire system thoroughly and asked state legislators to create a commission.

According to the latest report, the system is still fragmented and has “enormous gaps” in treatment. There’s also no central database that tracks patients.

Just like its predecessor, the group suggested that Florida establish more jail diversion programs, and that all state agencies share patient information. The commission also has new ideas such as a pilot program where one agency handles all public behavioral health funding within a specific geographic area. This will allow providers to focus on their care and less on complex billing processes.

Prummell stated, “This isn’t going away. And if we don’t address it it, it’s going to get worse.” Last month, told a House subcommittee.

According to Holly Bullard, chief strategy officer and development officer at The Florida Foundation, solutions to Florida’s problems don’t grab headlines. This makes it difficult to get political support. Florida Policy InstituteAn Orlando nonprofit.

She said that “Building good governance can be technical” and it’s sometimes difficult to convey its importance.

What Will Change?

Photo of a man placing a copy of a report on his bookshelf.
David Shern holding a copy the 2001 report of his mental health commission.(Ivy Ceballo / Tampa Bay Times)

Jay Reeve, who is the CEO and the chairperson of the new commission, stated that there has been progress in Florida’s mental healthcare system since 2001. Apalachee CentreTallahassee’s behavioral health provider,

Because of seven state contracts, the system is better able to respond to regional issues. “managing entities” He said that there are many nonprofits that provide safety-net services to the uninsured.

Initiatives like Mobile ResponseThese services are available to people who have mental health emergencies. Training in crisis intervention Reeve stated that police officers receive training in de-escalation techniques as well as psychiatric diagnosis so that they can determine when residents should be taken to treatment, rather than arresting them.

According to the 1999 commission, the Department of Children and Families spent approximately $500 million per year on community-based behavioral healthcare services, such as case management and crisis stabilization units. It now has a budget of $1.1 billion for such care.

There are pockets of innovation at the local level too. For example, in Palm Beach County where an initiative called BeWellPBC Shern, senior associate at the department of mental healthcare at the University of Minnesota, stated that the project aims to increase the area’s mental care workforce. Johns Hopkins Bloomberg School of Public Health.

But challenges remain.

Nearly 3,000,000 Florida residents have a mental disorder.According to Mental Health America, it is approximately 17%. This is approximately 17% of the state’s 18-year-old population. The nonprofit reported that 225,000 youths had experienced at least one major depression episode during the past year.

According to the Parkland grand jury, Florida was last in 2020 for funding per capita mental healthcare. The Miami-Dade County Jail System will close in 2021 The state’s largest psychiatric hospitalAccording to the 11th Judicial Circuit,

Ann Berner, member of the 2021 Commission and CEO of the company, stated that accountability is much easier to avoid if you keep things separate. Southeast Florida Behavioral Health NetworkA managing entity.

Shern stated that major reforms require political will. Murman, who works for the CIA, stated that follow-up is also important to the work of the commission. Shumaker Advisors FloridaA lobbying firm.

She said, “In this instance, it probably needs to be revived every 5 years to make an impact.”

Rep. Christine HunschofskyParkland Democrat, on the 2021 commission said that there is bipartisan support for improving the system.

The Tampa Bay Times could not find a single House bill or a matching Senate bill during the current legislative session. This was despite the 35-page interim report of the commission. It contained a proposal to examine Medicaid expansion for young adults 26 years and younger. Florida’s Republican leaders have rejected expanding Medicaid. federal-state health care program The Affordable Care Act was passed in 2010.

Hunschofsky stated that she believes the legislature will take greater action after the final report of the commission is released. This is due by September 1.

Republican Governor Ron DeSantis’ Office referred questions the Department of Children and Families. Officials didn’t respond.

Senator Kathleen Passidomo did not respond to voicemails or interview requests through a spokesperson. Paul Renner, House Speaker, was also unavailable for comment.

Shern is now frustrated after more than 20 years.

He said, “It’s now that we can move on these problems.” “We have spent literally decades talking about these issues, thinking about them.”

Photo of a man taking a portrait in his office.
David Shern at his home office.(Ivy Ceballo / Tampa Bay Times)

This article was created in partnership with Tampa Bay Times.

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