Florida’s Strained Mental Health System

By Kacey Heekin (2015)

Mental illness is a serious and prevalent condition in today’s society. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 18.5% of adults in the United States currently experience any mental illness and 4.2% experience serious mental illness (SAMHSA, 2014). Despite the consistent magnitude of this condition throughout the U.S., each state has different levels of mental health funding, types of services, and policies and legislation. As a result, some states have created substantially greater capacity to meet mental health needs than most of the states. Florida is not among the higher performing states in this regard.

Florida, in fact, has long struggled to provide adequate mental health care for its residents and to develop a stronger mental health system.

Legislature opens door to for-profit mental-health services

“The data on Florida’s mental health problem tells the story: People whose mental illness goes untreated are more likely to be addicted to drugs, have children in the state’s child welfare system, draw unemployment checks, and land in prison.

The total cost to taxpayers is unknown but, according to the Kaiser Family Foundation, Florida ranks 49th in terms of per capita spending on mental health.

After another year of tragic headlines, Florida legislators have proposed at least 22 bills that make the most dramatic changes to the state’s mental health delivery system in decades. The proposals would change everything from the way the mentally ill are treated by law enforcement, doctors, child welfare workers and courts to the way the state matches federal mental health money.”

– Miami Herald

A Brief History of Florida’s Mental Health System

The Florida Department of Children and Families (DCF), the single state authority for mental health services, was created in 1996 (Florida Supreme Court, 2007). Since 2003, the Florida Legislature has enacted different policies to elevate the priority level of mental health programs within the DCF, to modify the organizational structure of the public mental health system, and to improve the effectiveness and efficiency of the DCF mental health programs.

A consistent trend throughout Florida’s history with mental health services is the rise in unmet need. Florida has long maintained one of the lowest per capita mental health expenditures in the nation. According to the most recent available data from the Kaiser Family Foundation, Florida has a state mental health agency per capita mental health services expenditure of $37.28, giving it a rank of 49th for mental health funding in the U.S. Many individuals with mental health needs in Florida have not received the necessary care. The rate of the utilization of mental services has remained lower in Florida than in the nation at large.

More recently, Florida’s mental health policy has focused on the restructuring that is required by a shift toward a community-based approach to mental health services. There are numerous districts in Florida that each administer the mental health system. Funding, however, has been disproportionate across these districts, causing inconsistent and uneven systems of care. Increased funding and access to mental health care are continuous concerns, as is evidenced by two of the most recent National Alliance on Mental Illness (NAMI) supported advocacy and legislative priorities for Florida: Medicaid expansion; and increased state funding for public mental health and substance abuse services.

Problems Surrounding Mental Health Care in Florida

One of the biggest obstacles to Florida’s current mental health system is that it contains one of the largest uninsured and underserved populations.

Florida also has a critical lack of funding for community-based mental health and substance abuse services. Mental health services are not readily available, especially for individuals residing in rural areas.

Furthermore, there is currently a huge and growing number of incarcerated individuals in need of mental health services. This creates a vicious and economically draining cycle, especially on the state’s limited mental health services budget. Many of Florida’s scarce inpatient psychiatric beds are used for individuals with criminal charges to help restore competency before they stand trial. Many of these individuals enter the criminal justice system first when they experience a crisis and do not have access to adequate mental health services. Once these individuals are driven through the criminal justice system, they are often placed back in the community without access to further mental health services, creating a very costly and ineffective pattern of unmet need and criminal justice system involvement.

Hope for the Future

The DCF is working to improve Florida’s mental health system by supporting several priorities, including: implementing care coordination to reduce the use of emergency behavioral health services; pursing the expansion of community-based interventions (e.g., Community Action Teams); reintegrating individuals into community settings from institutional placements (e.g., state mental health treatment facilities and prisons); and increasing the diversion of individuals with mental health issues who become involved with criminal justice system by expanding Crisis Intervention Teams and mental health courts.

Gov. Rick Scott expands executive order to review, coordinate Florida mental health services

“Calling Florida’s funding of mental healthcare “too fragmented,” Gov. Rick Scott on Wednesday expanded an executive order aimed at developing a statewide model of integrated behavioral health services, beginning with pilot programs in three counties, including Broward.

“We have to get better at serving those struggling with mental illness,” Scott said in a written statement accompanying the addendum to the order, which was initially signed in July.

Wednesday’s action expands the pilot program in Broward to Pinellas and Alachua counties, and adds more state agencies, including the Department of Health and the Agency for HealthCare Administration, to the mix of public entities charged with reviewing Florida’s taxpayer-funded mental health system.”

–Miami Herald

Recommendations for Improvement

Florida’s mental health service system has many inadequacies, especially the significant lack of funding for mental health services, insufficient investment in community-based mental health services, and a crisis of mental health care in the state’s correctional system.

Urgent policy and budget changes needed in Florida involve: improving the forensic system to divert individuals with mental illness from jails and prisons into structured community placements or services; increasing crisis intervention services, psychiatric beds, and caregivers to decrease the number of individuals with mental illness in emergency medical departments and forensic facilities; better coordination of care; and expanded funding for state mental health services across the board. This expansion of funding for mental health services in general is also needed at the national level. However, since the U.S. and Florida’s mental health systems have chronically remained significantly underfunded, it is important to increase the focus on mental health research and policy analysis initiatives designed to identify more cost-effective methods of providing mental health services. Coordination of care and resources is also critically important.

Recommendations for the movement toward a more effective mental health system include continuous investigation of the comparative cost-effectiveness of available mental health services, implementation of frameworks designed to improve the ability to measure the quality of mental health care, and expansion of evidence-based services and more integrated forms of behavioral health services.